中国实用外科杂志

中国实用外科杂志

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应用不同手术方式治疗肝囊型包虫病疗效评价

王    琦，段    键，林    杰，黄汉飞，徐王刚，夏志超，张伟鑫，曾    仲   

  1. 昆明医科大学第一附属医院器官移植中心，云南昆明650032
  • 出版日期:2016-06-01 发布日期:2016-05-31

  • Online:2016-06-01 Published:2016-05-31

摘要：

目的    评估不同手术方式对肝囊型包虫病的临床疗效。方法     回顾性分析2010 年2 月至2015年2 月昆明医科大学第一附属医院器官移植中心收治的肝包虫病人77 例临床资料。分为3 组，A 组31例（行内囊摘除+外囊缝闭引流术），B 组27 例（行完整外囊剥除术），C 组19 例（行肝部分切除术）；对3 组病人术中情况、术后恢复及短期复发情况进行对比分析，计量资料采用  ±s表示，组间均数用t 检验，组间率采用χ2检验。结果    3 组病人基本情况相似，组间差异无统计学意义（P 值均＞0.05），3 组手术时间分别为（82.4±22.4）min、（102.9±18.6）min 和（200.5±21.2）min， P=0.007；术中出血量分别为（57.3±17.2）mL、（213.5±60.6）mL 和（287.9±95.7）mL，P=0.006；腹腔引流时间分别为（12.6±3.3）d、（7.7±1.6）d 和（6.5±1.8）d，P=0.021；残腔并发症发生率分别为11.1%、0 和0，原位复发率分别为7.4%、0和0，肛门排气时间分别为（2.3±1.2）d、（2.6±1.5）d 和（2.7±1.6）d，P=0.008；进食时间分别为（2.5±1.2）d、（2.9±1.4）d 和（3.0±1.4）d，P=0.048；住院时间分别为（7.3±1.1）d、（9.3±1.6）d 和（9.9±1.4）d，P=0.005。术后每隔3个月通过电话随访，时间最久者6年，最短者1年半，A组出现2例复发，B、C组无复发情况。结论    肝包虫的治疗方式多种多样，应根据病人的具体病情选择合理的个体化手术方案，以取得较好的手术疗效。

关键词: 肝包虫病, 内囊摘除术, 完整外囊剥除术, 肝部分切除术

Abstract:

Evaluation of different surgical methods for treatment of hepatic cystic echinococcosis        WANG Qi，DUAN Jian，LIN Jie，et al. Organ Transplantation Center，the First Affiliated Hospital of Kunming Medical University，Kunming 650032，China
Corresponding author：ZENG Zhong, E-mail：zzong@medmail.com.cn
Abstract    Objective    Evaluate the clinical effect of different surgical methods of hepatic cystic echinococcosis.Methods    The clinical data of 77 cases of hepatic hydatid echinococcosis admitted between February 2010 and February 2015 in Organ Transplantation Center, the First Affiliated Hospital of Kunming Medical University were divided into three groups. A group of 31 cases(Internal capsule excision + ectocyst closed drainage). 27 cases in group B(Excision of external capsule).19 cases in group C(Partial hepatectomy) Intraoperative operation, postoperative recovery and short term recurrence were compared and analyzed among the three groups. Measurement data using   +S said, between the groups were compared with t test, between group rate using chi-square test. Results    The basic situation of the three groups were similar，and there was no significant difference among the three groups (P> 0.05). The operation time of the three groups was (82.4±22.4) min，(102.9±18.6) min and (200.5±21.2) min P=0.007. The amounts of intraoperative bleeding were (57.3+17.2) mL，(213.5+60.6) mL and (287.9±95.7) mL, P=0.006. Abdominal drainage time was (12.6±3.3) days，(7.7±1.6) days and (6.5±1.8) days, P=0.021. The residual cavity complications were 11.1%, 0  and 0. Local recurrence rates were 7.4%，0 and 0. Anal exhaust time was (2.3± 1.2)days, (2.6±1.5) days and (2.7±1.6) days（P=0.008）. Eating time was (2.5±1.2) days，(2.9±1.4) days and (3.0±1.4) days（P=0.048）. The time of hospitalization was (7.3±1.1) days, (9.3±1.6) days and (9.9± 1.4) days（P=0.005）. The patients were followed up by telephone every three months after the operation,The longest time is 6 years, the shortest time is 1 and a half years. The patients in the A group appeared two cases of recurrence, the B and C groups had norecurrence.  Conclusion    Treatments of hepatic hydatid echinococcosis are varied，which should choose reasonable individualized surgical plan to gain better therapeutic efficacy according to the specific condition of patients .

Key words: hepatic hydatid echinococcosis , internal capsule excision, excision of external capsule, partial hepatectomy