肝包虫病外科治疗的单中心经验

A Single-Center Experience on Surgical Treatment of Hepatic Echinococcosis

目的探讨肝包虫病手术治疗的方式。方法四川大学华西医院2009-2014年期间共收治肝包虫病患者402例,其中271例行外科治疗。在271例行外科治疗的患者中包括肝囊型包虫病195例,肝泡型包虫病76例。肝囊型包虫病患者中行内囊摘除术或附加外囊次全切除术80例,行外囊完整剥除术或肝脏切除术109例,行姑息性治疗6例。肝泡型包虫病患者中行姑息性切除术7例,行肝脏切除术54例,行同种异体肝移植术12例,行自体肝移植术3例。结果 1肝囊型包虫病患者中,行内囊摘除术或附加外囊次全切除术的血浆引流管时间、术后并发症发生率及术后复发率分别为（18.6±2.7）d、21.2%（17/80）及15.0%（12/80）,均明显高于行外囊完整剥除术或肝脏切除术者〔（5.4±0.6）d、7.3%（8/109）及0.9%（1/109）,均P〈0.05〕。2肝泡型包虫病患者中,行肝脏切除术的血浆引流管时间及术后复发率分别为（5.9±0.7）d及1.8%（1/54）,均明显低于姑息性切除术者〔（9.7±1.4）d及57.1%（4/7）,均P〈0.01〕。肝移植术后12例完全康复、3例早期死亡。结论对于肝囊型包虫病患者,外囊完整剥除术或肝脏切除术可以达到根治的目的,应该作为首选;姑息性治疗的开展能够改善不能实行手术患者的症状。对于肝泡型包虫病患者,肝脏切除术应该作为手术治疗的首选术式;姑息性切除术只能用于缓解症状及体征,延缓疾病进展;肝移植术能够作为晚期泡型肝包虫病治疗的选择。

Objective To evaluate and discuss the various surgical methods for hepatic echinococcosis. Methods Four hundred and two patients with hepatic echinococcosis were treated in West China Hospital of Sichuan University from 2009 to 2014 and 271 of them were undergone surgical treatment. The cystic echinococcosis was in 195 patients, including 80 cases performed classic endocystectomy or subtotal cystectomy, 109 performed total cystectomy or hepatectomy, 6 cases performed palliative surgery. The alveolar echinococcosis was in 76 patients, including 7 cases performed palliative surgery, 54 cases performed hepatectomy, 12 cases performed liver allotransplantation, and 3 cases performed liver autotransplantation. Results ① The draining time, the rate of postoperative complications, and the recurrence was（18.6±2.7） d, 21.2%（17/80）, and 15.0%（12/80） respectively in the cases of cystic echinococcosis underwent classic endocystectomy or subtotal cystectomy, which were significantly higher than those cases of cystic echinococcosis underwent total cystectomy or hepatectomy 〔（5.4±0.6） d, 7.3%（8/109）, and 0.9%（1/109）, respectively, P0.05〕. ③ The draining time and the recurrence was（5.9±0.7） d and 1.8%（1/54） respectively in the cases of alveolar echinococcosis underwent hepatectomy, which were significantly lower than those in the cases of alveolar echinococcosis took palliative surgery 〔（9.7±1.4） d and 57.1%（4/7）, respectively, P0.01〕. The 12 patients underwent liver transplantation were complete rehabilitation, while the rest 3 were death. Conclusions ① Total cystectomy or hepatectomy should be the first choice for cystic echinococcosis; Palliative treatment could improve the symptoms of unresectable patients with cystic echinococcosis. ② Hepatectomy should be the first choice for alveolar echinococcosis, palliative surgery could only be used to alleviate symptoms and physical signs, delay the progression of this disease. ③ Liver transplantation might be an alternative for advanced hepatic echinococcosis.