肝包虫囊肿外囊切除的价值及术式选择

Percystectomy in treatment of hepatic hydatid disease:choice of surgical procedu re and applied value

目的 探讨肝包虫囊肿外囊切除的价值及手术方式的选择。方法 对 1990～ 2 0 0 2年 60 1例肝包虫病病人手术情况进行回顾性分析 ,7种术式分为外囊切除术组与保留外囊术组 ;外囊切除术组又分“外膜内外囊切除术”组与以肝切除技术为基础的外囊切除术组。临床观察指标为手术耗时、术后平均住院日、出血量、术后并发症、手术死亡率、原位复发率等。并对各组临床数据进行统计学分析。结果 外囊切除术的术后残腔并发症发生率及原位复发率均低于保留外囊术组 (P <0 0 1,P <0 0 5)。外膜内外囊切除术组的出血量低于以肝切除技术为基础的外囊切除术组 (P <0 0 5)。结论 肝包虫囊肿外囊切除可降低残腔并发症发生率与原位复发率 ,但增加了手术难度及风险性。外囊切除手术方式中“外膜内外囊切除术”安全性高 。

Objective To evaluate percystectomy in hepatic hydatid disease and the choice of surgical procedures. Methods A n retrosp ective analysis was made on 601 patients with hepatic hydatid disease in a perio d of 11 years(from 1990 to 2002). Seven kinds of surgical procedures were perfor med and the clinica l data were analyzed relatively. ResultsPercystectomy was much bet ter than cyst ectomy in the postoperative complications of liver residual cavity and local rec urrence (P<0 01,P<0 05). The blood loss in total suba dventitial cystectomy were lower than that in percystectomy based on the techniques of liver resection ( P< 0 05).ConclusionThe results indicate that percystectomy can dec rease the co mplications of liver residual cavity and “total subadventitial cystectomy” sho uld be selected firstly.