分期切除治疗多发泡型肝包虫病的初步经验

The preliminary experience of two-stage hepatectomy for multiple hepatic alveolar echinococcosis

目的探讨分期切除治疗多发巨大泡型肝包虫病的临床应用。方法对四川大学华西医院和甘孜藏族自治州医院2013年8月至2016年6月期间采用分期切除法治疗的7例多发泡型肝包虫病病例的临床资料进行回顾性分析,根据CT和(或)MRI、血清学及疫区生活史,术前诊断较为明确,对CT测量切除病灶后剩余肝体积小于30%的多发病灶患者行分期手术治疗,第1次术后每月查1次上腹增强CT、肝功能及血常规,3个月后行第2次手术,术后1、6及12个月复查上腹部彩超、增强CT或MRI、肝功能、血常规、包虫抗体,以后每年复查1次。结果第1次术后7天肝功能均恢复正常,术后无并发症。第2次术后7 d肝功能均恢复正常,1例出现胆瘘,随访期内无复发及死亡。结论分期切除术用于治疗多发巨大泡型肝包虫病,可降低手术风险及费用,缩短住院时间,提高患者生活质量。

Objective To discuss the clinical application of two-stage hepatectomy for multiple and huge hepatic alveolar echinococcosis. Methods The clinical data of 7 patients with multiple hepatic alveolar echinococcosis treated with two-staged hepatectomy in West China Hospital of Sichuan University and The people＇s Hospital of Ganzi Tibetan Autonomous Prefecture of Sichuan Province from August, 2013 to June, 2016 were analyzed retrospectively. The preoperative diagnose was definite according to CT and （or） MRI, serological and life in the epidemic area. The patients, which the future liver remnant was less than 30% according to CT, received two-staged hepatectomy. Epigastric enhancement CT, liver function and blood routine examination were reviewed monthly after the first surgery, the second surgery was operated after 3 monthes, epigastric ultrasound, enhancement CT or MRI, liver function, blood routine examination and serological were adopted in 1, 6, and 12 months and each year after the second operation. Results The liver function was normal in 7 days after two operations and no complications after the first suegery, one patient developd with biliary fistula after the second surgery, no recurrence or death occurred during the followed-up period. Conclusion The two-stage hepatectomy can be operated in multiple and huge alveolar echinococcosis to reduce surgery risk and cost, shorten hospital stays and improve quality of life.