肝泡球蚴病的分型与外科治疗

Alveolar echinococcosis of the liver:classification and surgical therapy

目的 探讨肝泡性包虫病 (泡肝 )的分型及治疗方法。方法 将本组“泡肝”98例 ,通过CT、MRI、彩色超声及手术探查等方法分型为巨块型 6 4例 (6 5 % ) ,结节型 17例 (17% ) ,混合型 17例(17% ) ,手术方式依不同类型而定。结果 对巨块型“泡肝”首选根治性肝切除、其次为姑息性肝切除、病灶清除术及单纯肿块切除术 ,巨块型“泡肝”根治性肝切除率为 2 8% (18/ 6 4) ;结节型“泡肝”行化学治疗 ;混合型“泡肝”行病灶清除、化学药物治疗。本组对根治性切除 18例随访 10～ 2 4年 ,均存活。结论 泡性肝包虫病可分为巨块型、结节型和混合型 3种 ,对巨块型“泡肝”首选根治性肝切除 ,其它无法切除的各种类型的“泡肝”预后不良。

Objective [WT5”BZ] To investigate the surgical approach and operative procedure based on the classification of alveolar echinococcosis of the liver (AEL).[WT5”HZ] Methods [WT5”BZ] Using computed tomography (CT), magnetic resonance imaging (MRI), color ultrosonography and operative exploration, the 98 patients with AEL were classified into massive type, nodular type and mixed type.[WT5”HZ] Results [WT5”BZ] There were 64 patients (65%) of massive type, 17 (17%) of nodular type and 17 (17%) of mixed type. The surgical procedure was based on the classification of AEL. Radical resection was the therapy of choice for patients of massive type,focal cleaning or palliative hepatic resection were for those judged as unsuitable candidates for radical resection.The radical resection rate was 28% (18/64) in this series. Long term chemotherapy was used for patients of nodular type.Focal cleaning plus chemotherapy for mixed type. Patients with radical resection were followed up for 10～24 years, and the result was good.[WT5”HZ] Conclusion [WT5”BZ] The radical hepatic resection should always be attempted in suitable patients for long term survival.Patients undergoing palliative therapy have a rather poor prognosis.