“掏核式肝切除法”治疗晚期巨大肝泡型包虫病9例临床分析

“Cutting hepatectomy ”for treatment of advanced giant hepatic alveolar echinococcosis: a report of 9 cases

目的探讨＂掏核式肝切除法＂治疗晚期巨大肝泡型包虫病的临床应用价值。方法 2010年8月至2013年7月9例难以常规根治性切除的巨大肝泡型包虫病行＂掏核式肝切除法＂手术,术中保留肝脏重要管道,并尽可能切除病灶组织,术后给予口服阿苯达唑（ABZ）抗包虫治疗。结果 9例患者手术顺利,手术历时140-370 min[（261.11±76.56）min];术中出血量100-700 ml[（373.33±173.71）ml];住院时间11-38 d[（22.44±9.23）d]。随访3年,3例患者出现残腔胆瘘,1例术后出现深静脉血栓。患者梗阻性黄疸、下肢水肿均消失,未发生病灶肝内转移或死亡。结论 ＂掏核式肝切除法＂为难以根治性治疗的晚期巨大肝泡型包虫病患者提供了可行性技术路径,值得临床研究推广。

Objective To investigate the clinical therapeutic effect of＂cutting hepatectomy＂on advanced huge hepatic alveolar echinococcosis（ HAE）. Methods The clinical data of nine patients with advanced giant HAE and with difficulty to achieve radical resection who underwent＂cutting hepatectomy＂from August 2010 to July 2013 were analyzed. For all patients,preserve liver important pipeline and resection of the lesion tissue were performed during operation,and anti-echinococcosis therapy was initiated postoperatively with oral administration of albendazole（ ABZ）. Results Operations were successfully performed in all the patients. The operative time was 140 - 370 min with average of（ 261. 11 ± 76. 56） min. The intraoperative blood loss was 100 - 700 ml with average of（ 373. 33 ±173. 71） ml. The hospital stay time was 11 - 38 d with average of（ 22. 44 ± 9. 23） d. During the 3 years of follow-up,3 patients had a residual cavity biliary fistula and 1 patient had a deep vein thrombosis after operation. Patients with obstructive jaundice and edema of lower extremity were disappeared without the occurrence of lesions in patients with intrahepatic metastasis or death. Conclusion The ＂Cutting hepatectomy＂ provides a feasible technical approach for the treatment of advanced giant HAE when it is difficult to implement radical treatment. It is worth the clinical promotion.