新疆地区肾棘球蚴病的多中心诊治经验

Surgical management of renal hydatid cyst： a three-center review in diagnosis and management of renal hydatid cyst in Xinjiang

目的提高肾棘球蚴病的诊断及外科治疗效果。方法回顾性分析1985年2月至2010年4月新疆医科大学第一附属医院、自治区人民医院和伊犁州友谊医院泌尿外科86例肾棘球蚴病患者资料。男59例，女27例。年龄3～59岁，平均38岁。病变位于右肾48例，左肾38例。单纯肾棘球蚴病60例，并发肝、肺等其他脏器棘球蚴病者26例。病程1个月～5年，平均2．5年。结果B超、CT和包虫试验检查诊断符合率分别为88％（76例）、81％（70例）、85％（73例）。B超显示圆形或类圆形液性暗区，单发病灶，部分内含多个大小不等的圆形暗区及光环，形成囊中子囊征象，较大的类圆形病灶中出现“双壁征”，部分出现外囊壁钙化强回声光带。CT表现为圆形或类圆形囊性单发包块，其内有大小不一的子囊影，囊内CT值15～25HU，注入造影剂后囊内容物不增强。经手术治疗85例，其中包虫内囊摘除39例，穿刺抽液后内囊摘除者14例，肾部分切除术15例，外囊完整摘除术5例，肾切除者12例。随访53例，随访时间2—15年，平均7年，复发7例。结论B超、CT、免疫学检查是诊断肾棘球蚴病的主要方法，手术治疗仍是棘球蚴病的主要治疗方法，根据残余肾功能、包虫囊大小、数目、位置确定手术方案，肾包虫完整外囊摘除术是最理想的手术方式。

Objective To evaluate the diagnosis methods and surgical treatment of renal hydatid cyst. Methods Eighty-six cases of renal Echinococcosis were diagnosed and treated in the Urological Department of the First Affiliated Hospital, Xinjiang Medical University, the People＇s Hospital Of Xinjiang Uygur Autonomous Region and the Friendship Hospital of Yili from Feb. 1985 to Apr. 2010 were reviewed and analyzed. Results Abdominal ultrasonography, CT scan and laboratory immunological tests of renal Echinococcosis showed positive diagnosis rates of 58%, 51% and 85%, respectively. Eighty-five cases were accepted for surgical intervention including; 39 endocystectomies, 14 endocystectomies after needle aspiration, 15 partial nephrectomies, five intact ectocystectomies and 12 nephrectomies. Fifty-three cases were followed-up from two to 15 years and recurrence was found in seven cases. Conclusions Abdominal ultrasonography, CT scan and immunological tests are the main methods in the diagnosis of renal Echinococcosis. Surgical management is still the most effective approach in the treatment of renal Echinococcosis. The surgical strategy depends on residual renal function, cyst size, numbers and position of the hydatid cyst. The in- tact ectoeystectomy is the ideal treatment for renal hydatid cyst.