CAJ | 학술논문

目的探讨肝囊型包虫病破入腹腔和胆道的急诊诊治疗效.方法根据2002年新疆医科大学第一附属医院包虫病专业组提出包虫病规范化治疗方案,本院1994年至2009年急诊收治的185例肝囊型包虫病破裂患者分为两组,对其临床资料进行回顾性分析,并加以对比.结果肝囊型包虫病破入腹腔患者中,传统内囊摘除组(A1组)术后残腔并发症、带管引流时间、术后平均住院天数、原位复发率、腹腔播散种植等均显著高于改良内囊摘除组(B1组)(P＜0.05),而A1组与B1组手术耗时、术中出血量等无差异(P＞0.05).肝囊型包虫病破入胆道患者中,传统内囊摘除组(A2组)术后残腔并发症、带管引流时间、术后平均住院天数、原位复发率等亦明显高于改良内囊摘除组(B2组)(P＜0.05),而A2组与B2组手术耗时、术中出血量、腹腔播散种植等无差异(P＞0.05).在185例肝囊型包虫病破裂患者中,因过敏性休克抢救无效死亡1例,死亡率为0.54％.结论肝囊型包虫病破裂患者应在积极抗休克、抗感染、抗过敏治疗的同时,积极完善术前检查实施急诊手术.改良内囊摘除术的术后复发、残腔并发症等明显低于传统内囊摘除术.肝囊型包虫病破裂患者术后应服用抗包虫药,以防治复发.
목적 탐토간낭형포충병파입복강화담도적급진진치료효.방법 근거2002년신강의과대학제일부속의원포충병전업조제출포충병규범화치료방안,본원1994년지2009년급진수치적185례간낭형포충병파렬환자분위량조,대기림상자료진행회고성분석,병가이대비.결과 간낭형포충병파입복강환자중,전통내낭적제조(A1조)술후잔강병발증、대관인류시간、술후평균주원천수、원위복발솔、복강파산충식등균현저고우개량내낭적제조(B1조)(P＜0.05),이A1조여B1조수술모시、술중출혈량등무차이(P＞0.05).간낭형포충병파입담도환자중,전통내낭적제조(A2조)술후잔강병발증、대관인류시간、술후평균주원천수、원위복발솔등역명현고우개량내낭적제조(B2조)(P＜0.05),이A2조여B2조수술모시、술중출혈량、복강파산충식등무차이(P＞0.05).재185례간낭형포충병파렬환자중,인과민성휴극창구무효사망1례,사망솔위0.54％.결론 간낭형포충병파렬환자응재적겁항휴극、항감염、항과민치료적동시,적겁완선술전검사실시급진수술.개량내낭적제술적술후복발、잔강병발증등명현저우전통내낭적제술.간낭형포충병파렬환자술후응복용항포충약,이방치복발.
Objective To study the results of emergency treatment of ruptured hepatic cystic echinococcosis (HCE).Methods A standardized management protocol for hepatic echinococcosis was introduced by the First Hospital of Xinjiang Medical University in 2002.This study included 185 patients who received emergency treatment for ruptured HCE between 1994 and 2009.The patients were divided into group A (from 1994 to 2001) and group B (from 2002 to 2009).The clinical characteristics and surgical treatment results were compared retrospectively.Results In patients with ruptured HCE into the abdomen,classical endocystectomy (Group A1 ) resulted in significantly more postoperative complications in residual hepatic cavity,time of drainage,postoperative hospital stay,recurrence and peritoneal seeding than improved endocystectomy (Group B1 ) (P＜0.05).The operation time and blood loss were not significantly different between group A1 and B1 (P＞0.05).For patients with ruptured HCE into the biliary tree,classical endocystectomy (Group A2 ) resulted in significantly higher postoperative complications in residual hepatic cavity,time of drainage,postoperative hospital stay and recurrence than improved endocystectomy (B2) (P＜0.05).Operation time,blood loss and peritoneal seeding were not significantly different between group A2 and B2 (P ＞ 0.05). Only one patient (0.54％) died from allergic shock in this series of patients.Conclusions Improved endocystectomy was an efficacious surgical treatment for ruptured HCE and it is recommended for emergency surgery.