肝泡状棘球蚴病89例的治疗探讨

Treatment of liver alveolar hydatid disease: a report of 89 cases

目的 探讨肝泡状棘球蚴病 ,特别是晚期患者的治疗。方法 回顾性总结肝泡状棘球蚴病患者 89例的手术、手术前后药物治疗 ,或单纯药物治疗的结果。结果 手术治疗 73例 ,手术病死率 3 % (2 / 73)。出院的 71例均获得随访 ,随访 1～ 15年以上。早期患者行根治性肝叶切除术 9例 ,均健在。其中 7年后复发 1例。而行单纯液化腔引流术 4例 ,均死亡。行病变部分切除 5 8例 ,其中同时行胆管置管扩张成形及引流术 18例 ,随访期间死亡 18例。单纯活体组织检查和未手术者 16例 ,其中存活 4例 ,死亡 12例。药物治疗采用甲苯咪唑、丙硫咪唑、吡喹酮等 ,其中以吡喹酮效果较为明显和肯定。结论 根治性肝叶切除术对肝泡状棘棘蚴病是最为理想的治疗方法。部分病变切除 ,解除胆管和血管压迫 ,结合手术前后有效的药物治疗对晚期泡状棘球蚴病是有效、可行的治疗措施 ,有希望在多数肝泡状棘球蚴病患者取得较好的治疗效果。

Objective To summarize the experience for the treatment of liver alveolar hydatid disease,especially of the patients in an davanced stage.Method 89 patients with liver hydatid disease were treated by combined operations and medicine or only by medicine.Result 73 cases underwent operations. The operative mortality rate was 3%(2/73), 16 received only biopsy or did not undergo exploration.87 were followed up for 1～15 years.Recurrence developed 7 years later in 1 out of 9 undergoing radical resection.All 4 cases with external drainage of the necrotic cavaties died.18 out of 58 undergoing partial resection including biliary dilation and stent drainage in 18 cases died during the follow up period.12 out of 16 undergoing laparotomy or treated conservatively died.Medendazole\, albendazole\, praziquantel were used to treat the disease and praziqualtel had proved to be more efficacious.Conculsion\ Radical resection should be attempted if possible, while partial resection of the lesion combined by effective medicine could prolong the survival in late staged patients.