心脏包虫病的外科治疗

Surgical Treatment in Patients With Myocardial/Pericardial Echinococcosis

目的:总结心脏包虫病的临床特点及外科手术治疗的经验。方法:回顾性分析我院在1978-02至2009-10手术治疗的21例心脏包虫病患者的临床资料。其中男13例,女8例;年龄8～46(30.0±9.5)岁。有症状者16例,无症状5例。体检阳性者11例,阴性10例。包虫免疫试验阳性17例,阴性4例。21例患者均行X线胸片、心电图、超声心动图检查,4例行计算机断层摄影术(CT)检查。全麻非体外循环下行心脏包虫病手术19例,体外循环下手术2例。术后对生存者进行随访,随访时间5～168个月,平均(86±14)个月。结果:所有患者术后恢复顺利,围手术期无死亡。随访期间死亡1例,总死亡率为4.8%;复发3例,复发间隔8～15个月,总复发率为14.3%。结论:多普勒超声心动图对心脏包虫病有重要的诊断意义,外科手术是心脏包虫病的首选治疗措施,内囊摘除术可取得较好的效果。

Objective： To study the clinical features and the surgical treatment in patients with myocardial/pericardial echinococcosis. Methods： We retrospectively summarized 21 patients with myocardial/pericardial echinococcosis who were diagnosed and surgically treated in our hospital from 1978 to 2009. The patients included 13 male and 8 female with the mean age of （30. 0 ±9. 5 ） years. 16 patients were symptomatic and 5 asymptomatic. All patients were examined by chest X-ray, ECG and echocardio- graphy. 4 patients had CT scanning. 8 pericardial cysts were surgically removed, 9 myocardial cysts, 1 muhi-pericardial cysts, 2 complicated myocardial/pericardial cysts were resected with puncture-aspiration endocystectomy. 19 patients received regular anesthesia and 2 had extracorporeal circulation for the surgery. The patients were followed-up for the average of （86 ±14） months. Results： All patients successfully went through the surgery and no peri-operational death occurred. 1 patient died 10 months after the operation because of heart failure,the total mortality was 4. 8%. 3 patients suffered from re-occurred echinococcosis 8 ±15 months after the operation,the overall recurrence rate was 14. 3%. Conclusion： Echocardiography was an important diagnostic method for cardiac echinococcosis, surgery was the preferred treatment with good result in patients with myocardial/pericardial echinococcosis.