肝包虫病手术治疗的疗效评价

The long - term follow - up and evaluation of surgical procedures for hepatic hyda- tid disease

目的评价肝包虫外膜内外囊完整摘除术与其他不同术式的疗效。方法对我院1999年11月至2007年11月间收治的244例肝包虫病手术患者的疗效进行分析，188例获得随访，随访中位时间为36个月（3～96个月）。术式分为传统术式（保留外囊组）和根治性术式组（切除外囊组），根治性术式组又分肝包虫外膜内外囊完整摘除术组和以肝切除技术为基础的外囊完整切除术组。观察指标为术后并发症、死亡率、原位复发率、生存率、生活质量。并对各组数据行统计学分析。结果外囊切除术的术后残腔并发症及原位复发率均低于保留外囊术式组（P〈0．01）。而闭合性肝包虫外膜内外囊完整摘除术并发症低于其他根治性术式。外囊完整切除术生存率高、生活质量高于传统术式。结论肝包虫外膜内外囊完整摘除术可降低残腔并发症发生率与原位复发率，而闭合性肝包虫外膜内外囊完整摘除术安全、有效、预后住，应首选。

Objective To investigate the efficacy of surgical procedures in hepatic hydatid disease by long - term follow - up, and to evaluate the efficacy of ＂subadventitial total exocystectomy＂. Methods A prospective （follow - up） analysis was made on 188 cases of 244 patients with hepatic hydatid disease between Oct. 1999 and Dec. 2007 in our department. Six kinds of surgical procedures were performed （radical or conservative） and the clinical data （morbidity, mortality, relapse rate, survival rate, quality of life ） were analyzed relatively. The median follow - up period was 39 months （ range ： 3 - 96 months）. Results Percystcctomy was much better than cystectomy in the postoperative complications of liver residual cavity and local recurrence （ P 〈 0.01 , P 〈 0.01 ）. The complications of ＂close subadventitial total exocystectomy＂ were less than other radical managements. The survival rate and quality of life in ＂close subadventitial total exocystectomy＂ were higher than in percystectomy based on the techniques of liver resection （ P 〈 0.01 ）. Conclusion Subadventitial total exocystectomy can decrease the complications of liver residual cavity, and ＂close subadventitial total exocystectomy＂ is the first choice because of the most satisfactory effectiveness.