复杂性肝包虫病手术治疗分析

ANALYSIS ON THE SURGICAL TREATMENT OF COMPLICATED HEPATIC ECHINOCOCCOSIS

目的 探讨复杂肝包虫病的较好手术方法。 方法 采用回顾性调查方法总结分析 84例复杂肝包虫病的手术方法。肝切除术 2 5例 ;内囊摘除后外囊内翻缝合 10例 ;外囊部分切除、大网膜填塞 15例 ;残腔内置T管引流 3 4例。结果 行肝切除者 8d拆线 ,痊愈出院 ,随访 2～ 7年 ,无复发 ;行内囊摘除后外囊内翻缝合者并发囊内感染 2例 ,膈下感染 1例 ,3年后复发 1例 ;大网膜填塞者并发囊内感染 2例 ,2年后复发 1例 ;残腔内T管引流者 ,拔管时间最短 18d ,最长 190d ,平均 5 6d ,随访 1～ 7年 ,无复发。 结论 肝切除术是治疗复杂肝包虫病的最佳选择 ,清除内囊后残腔T管引流亦是较好的手术方法 ,但引流时间往往较长。

Objective To explore the better surgical treatment method of complicated hepatic echinococcosis. Methods The retrospective investigation was carried out to analyze the data from 84 operated cases with complicated hepatic echinococcosis. Among them, hepatic resection was carried out on 25 cases; after removed the inner cyst, the out cyst was turned into the inner and sutured on 10 cases; the out cyst of 15 cases was resected partially and stuffed with the greater omentum; the T tube was put into the residual cavity for drainage on 34 cases. Results The cases with hepatic resection were removed stitches and cured after operation 8 days, followed-up survey 2 to 7 years, no one relapsed. In the cases of removing the inner cyst and the out cyst was turned into the inner and sutured, there were 2 cases with reinfection in cyst and 1 case with the reinfection under the diaphragm, as well as 1 case relapsed after operation 3 years. In the cases of stuffing the greater omentum, there were 2 cases with reinfection in cyst and 1 case relapsed after operation 1 year. In the cases of putting the T tube in the residual cavity, the shortest time of decannulation was 18 days, the longest was 190 days, and the average time was 56 days, followed-up survey 1 to 7 years, no one relapsed. Conclusion The hepatic resection was the best choice for treatment of the complicated hepatic echinococcosis. Cleaning out the inner cyst and putting the T tube in the residual cavity for drainage was also the better surgical operation method, but the drainage time was longer.