根治性手术治疗不同Child-Pugh分级的肝泡型包虫病患者疗效研究

Radical surgery for treatment of patients with hepatic alveolus echinococcosis

目的观察采取根治性手术治疗不同Child-Pugh分级的肝泡型包虫病患者的疗效。方法2014年7月~2019年7月我院诊治的肝泡型包虫病患者60例,入院时Child-Pugh A级36例,B级24例。所有患者均接受根治性手术治疗,术后随访3年。结果在术后1 w,Child-Pugh A级患者血清总胆红素和碱性磷酸酶水平分别为(17.8±6.6)μmol/L和(80.0±21.5)U/L,显著低于Child-Pugh B级组【分别为(21.8±7.4)μmol/L和(97.8±17.9)U/L,P<0.05】;术后,Child-Pugh A级组切口感染、胸腔积液、深静脉血栓、肝性脑病、难治性腹水、胆汁漏和肾功能不全发生率为30.6%,显著低于Child-Pugh B级组的79.2%(P<0.05);36例Child-Pugh A级患者失访3例,Child-Pugh B级失访2例;Child-Pugh A级组1 a生存率为97.0%(32/33),3 a生存率为93.9%(31/33),而Child-Pugh B级组分别为90.9%(20/22)和86.4%(19/22),经Kaplan-Meier生存分析显示两组生存率无显著性差异(Log-Rank=8.99,P=0.343);随访期间,Child-Pugh A级组肝包虫病复发率为12.1%(4/33),Child-Pugh B级组复发率为27.3%(6/22,x^(2)=1.146,P=0.284)。结论采取根治性手术治疗肝泡型包虫病患者存在一定的术后疾病复发率,而术前肝功能纠正很重要,可以减少术后并发症的发生。

Objective The aim of this study was to observe the long-term efficacy of radical surgery for treatment of patients with hepatic alveolus echinococcosis.Methods A total of 60 patients with hepatic alveolus echinococcosis(Child-Pugh class A in 36 cases,and class B in 24 cases)were encountered in our hospital between July 2014 and July 2019,and all underwent radical resection of the diseased foci.The patients were followed-up for 3 years.Results One week after operation,total serum bilirubin and alkalinephosphatase levels in patients with Child-Pugh class A were(17.8±6.6)μmol/L and(80.0±21.5)U/L,both significantly lower than[(21.8±7.4)μmol/L and(97.8±17.9)U/L,respectively,P<0.05]in patients with Child-Pugh class B;the incidences of post-operational complications such as Incisional infection,pleural effusion,deep venous thrombosis,hepatic encephalopathy,refractory ascites,bile leak and renal deficiency in patients with Child-Pugh class A was 30.6%,significantly lower than 79.2%(P<0.05)in patients with Child-Pugh class B;during three year follow-up period,three and two patients missed in patients with Child-Pugh class A and class B,respectively;the one-year and three-year survival in patients with Child-Pugh class A were 97.0%(32/33)and 93.9%(31/33),not significantly different compared to 90.9%(20/22)and 86.4%(19/22)in patients with Child-Pugh class B(Log-Rank=8.99,P=0.343);the hepatic foci relapse rate in patients with Child-Pugh class A was 12.1%(4/33),also not significantly different compared to 27.3%(6/22,x^(2)=1.146,P=0.284)in patients with Child-Pugh class B.Conclusion Radical surgery is efficacious in treatment of patients with hepatic alveolus echinococcosis,even though with a relative high relapse post-operationally.The improvement of liver functions before operation is of very importance in order to decrease the post-operational complications.