肝包虫破入胆道的新术式123例临床研究

Clinical Research of 123 Hepatic Hydatic Cases with Rupture into Biliary Tract

目的探讨肝包虫破入胆道的手术方式,并分析其临床疗效.方法根据患者情况、术前各项检查以及术中情况进行分组,传统的肝包虫内囊摘除胆总管探查"T"型管引流组(68例)为甲组,肝包虫外囊次全切除胆总管探查术后胆总管Ⅰ期缝合+胆囊管引流组(55例)为乙组.对两组的术后残腔并发症(胆瘘、残腔积液、残腔感染)、胆道并发症(胆道梗阻、狭窄、感染、胆漏、出血)、电解质紊乱、平均住院日进行比较分析.结果与甲组相比,乙组患者的术后残腔并发症、胆道并发症、电解质紊乱及平均住院日都有所改善,且具有统计学意义(P<0.05).结论在正确掌握适应证的前提下,肝包虫外囊次全切除胆总管探查术后胆总管Ⅰ期缝合+胆囊管引流术可避免传统的置"T"管所引起的并发证,缩短了住院时间,提高了患者术后的生活质量.

Objective Investigate the effects of various surgical methods for treating hepaic hydatid cases with rupture into the biliary tract.Method The patients were divided into two groups according to their conditions,such as various preoperative examinations and the situation during the operation process.The patients who underwent internal cyst extirpation＋common bile duct exploration with T tube drainage（68 cases）were taken as group A and those who underwent the subtotal pericystectomy＋common bile duct exploration with primary suture＋biliary drainage（55 cases）were taken as group B.Differences between the two groups in postoperative residual cavity complications（biliary fistula,residual cavity effusion and residual cavity infection）,biliary tract complications（biliary obstruction,stenosis,infection,fistula and hemorrhage）,electrolyte imbalance and average day in hospital were compared and analyzed.Results Compared with patients in group A,postoperative residual cavity complications,biliary tract complications,electrolyte imbalance and average day in hospital were improved significantly and had statistial significance（P0.05）.Conclusion On the basis of correctly understanding the surgical indications,subtotal pericystectomy ＋ common bile duct exploration with primary suture＋biliary drainage can decrease postoperative complications induced by inserting ＂T＂ tube,shorten the hospital stay and improve the life quality of the patients after the operation.