心脏及心包包虫病的临床表现和外科治疗

Clinical characteristics and surgical treatment of cardiac and pericardial echinococcosis

目的 比较不同部位的心脏及心包包虫囊肿的临床表现 ,评价手术效果。方法 1978年2月至 1999年 7月治疗男 9例 ,女 4例包虫病人 ;年龄 8～ 36岁 ,平均 (2 3 0± 8 5 )岁。有症状者 10例 ,无症状 3例。体检阳性者 10例 ,阴性 3例。合并肝、肺包虫 4例。包虫免疫试验阳性 11例 ,阴性 2例。均行X线胸片、心电图、心脏B超检查。体外循环下摘除 1例 ,完整摘除 4例 ,内囊穿刺摘除 8例。结果 所有病人术后恢复顺利。随访 8～ 72个月 ,平均 (4 2± 18)个月 ,随访率 10 0 %。 1例 10个月后死于心衰。3例复发。结论 心脏及心包包虫病临床表现无特异性 ,心脏B超有重要的诊断意义。

Objective: To review clinical characteristics of cardiac and pericardial hydatid cysts and assess the results of surgical treatment. Methods: From February 1978 to July 1999, 13 patients were diagnosed as heart and/or pericardium echinococcosis. There were nine male and four female. Their age ranged from 8 to 36 years [mean (23 0±8 5) years]. 10 patients were symptomatic and 3 were asymptomatic. 3 patients had involvement of liver or lung. Pathologic cardiac murmur or cardiac enlargements were found in 10 patients. All patients were examined with chest roentgenograms, electrocardiogram and echocardiography. The serologic test was positive in 11 cases and negative in 3 cases. One right atrial cyst was removed under extracorporal circulation. 4 single pericardial cyst and multi pericardial cyst were resected, 6 myocardial cysts and one complicated myocardial and pericardial cysts were resected through puncture aspiration endocystectomy. Results: All patients were followed up from six months to six years [mean (3 5±1 5) years]. One late death occurred ten month after operation, and the cause of death was heart failure. 3 patients had recurrence and were reoperated. Conclusion: The clinical characters may vary according to the number, size and location of cysts. Echocardiography is important for surgical planning. The results of endocystectomy of cardiac and pericardial echinococcosis were excellent.