中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2011年
4期
293-295
,共3页
吐尔干艾力·阿吉%邵英梅%蒋铁民%戴季彭%冉博%温浩
吐爾榦艾力·阿吉%邵英梅%蔣鐵民%戴季彭%冉博%溫浩
토이간애력·아길%소영매%장철민%대계팽%염박%온호
肝囊型包虫病%破入腹腔%诊断%治疗
肝囊型包蟲病%破入腹腔%診斷%治療
간낭형포충병%파입복강%진단%치료
Hepatic cystic echinococcosis%Rupture%Diagnosis%Treatment
目的 探讨肝囊型包虫病破入腹腔的诊断和治疗方法.方法 回顾性分析1994年1月至2009年12月新疆医科大学第一附属医院收治的109例肝囊型包虫病破入腹腔患者的临床资料.根据流行病学史、典型临床表现、典型影像学特征和血清免疫学检查结果进行诊断.根据不同手术方式将108例行手术治疗的患者分为传统组(传统内囊摘除,67例)和改良组(改良内囊摘除,41例),比较两组患者手术时间、术中出血量、术后平均住院时间、术后带管引流时间、术后残腔并发症、胸腔积液、包虫原位复发、腹腔播散种植、死亡等情况.计量资料采用t检验,组间率的比较采用x2检验.结果 超声、CT、MRI检查确诊率分别为93%(101/109)、99%(70/71)、7/7;血清免疫学检查阳性率为100%(61/61).109例肝囊型包虫病破入腹腔患者中,1例因过敏性休克经抢救无效死亡,其余生存.传统组和改良组患者手术时间、术中出血量分别为(3.2±0.3)h、(104.0±11.5)ml和(3.3±0.4)h、(110.0±23.8)ml,两组比较,差异无统计学意义(t=-1.474,-L 758,P＞0.05);术后平均住院时间、术后带管引流时间分别为(15.3±4.3)d、(28.0 ±4.6)d和(9.3±1.2)d、(7.6±0.8)d,两组比较,差异有统计学意义(t=8.628,28.088,P＜0.05).传统组患者术后残腔积液、残腔感染、胆汁漏、包虫原位复发、腹腔播散种植发生率均显著高于改良组(x2=4.335,3.888,5.691,4.581,10.153,P＜0.05).确诊包虫原位复发或严重并发症再次手术患者21例.结论 流行病学史、典型临床表现、典型影像学特征和血清免疫学检查对于肝囊型包虫病破入腹腔的诊断具有重要作用;改良内囊摘除术+高渗盐水反复冲洗腹腔+术后正规服用抗包虫药物是目前肝囊型包虫病破入腹腔较理想的治疗方式.
目的 探討肝囊型包蟲病破入腹腔的診斷和治療方法.方法 迴顧性分析1994年1月至2009年12月新疆醫科大學第一附屬醫院收治的109例肝囊型包蟲病破入腹腔患者的臨床資料.根據流行病學史、典型臨床錶現、典型影像學特徵和血清免疫學檢查結果進行診斷.根據不同手術方式將108例行手術治療的患者分為傳統組(傳統內囊摘除,67例)和改良組(改良內囊摘除,41例),比較兩組患者手術時間、術中齣血量、術後平均住院時間、術後帶管引流時間、術後殘腔併髮癥、胸腔積液、包蟲原位複髮、腹腔播散種植、死亡等情況.計量資料採用t檢驗,組間率的比較採用x2檢驗.結果 超聲、CT、MRI檢查確診率分彆為93%(101/109)、99%(70/71)、7/7;血清免疫學檢查暘性率為100%(61/61).109例肝囊型包蟲病破入腹腔患者中,1例因過敏性休剋經搶救無效死亡,其餘生存.傳統組和改良組患者手術時間、術中齣血量分彆為(3.2±0.3)h、(104.0±11.5)ml和(3.3±0.4)h、(110.0±23.8)ml,兩組比較,差異無統計學意義(t=-1.474,-L 758,P＞0.05);術後平均住院時間、術後帶管引流時間分彆為(15.3±4.3)d、(28.0 ±4.6)d和(9.3±1.2)d、(7.6±0.8)d,兩組比較,差異有統計學意義(t=8.628,28.088,P＜0.05).傳統組患者術後殘腔積液、殘腔感染、膽汁漏、包蟲原位複髮、腹腔播散種植髮生率均顯著高于改良組(x2=4.335,3.888,5.691,4.581,10.153,P＜0.05).確診包蟲原位複髮或嚴重併髮癥再次手術患者21例.結論 流行病學史、典型臨床錶現、典型影像學特徵和血清免疫學檢查對于肝囊型包蟲病破入腹腔的診斷具有重要作用;改良內囊摘除術+高滲鹽水反複遲洗腹腔+術後正規服用抗包蟲藥物是目前肝囊型包蟲病破入腹腔較理想的治療方式.
목적 탐토간낭형포충병파입복강적진단화치료방법.방법 회고성분석1994년1월지2009년12월신강의과대학제일부속의원수치적109례간낭형포충병파입복강환자적림상자료.근거류행병학사、전형림상표현、전형영상학특정화혈청면역학검사결과진행진단.근거불동수술방식장108례행수술치료적환자분위전통조(전통내낭적제,67례)화개량조(개량내낭적제,41례),비교량조환자수술시간、술중출혈량、술후평균주원시간、술후대관인류시간、술후잔강병발증、흉강적액、포충원위복발、복강파산충식、사망등정황.계량자료채용t검험,조간솔적비교채용x2검험.결과 초성、CT、MRI검사학진솔분별위93%(101/109)、99%(70/71)、7/7;혈청면역학검사양성솔위100%(61/61).109례간낭형포충병파입복강환자중,1례인과민성휴극경창구무효사망,기여생존.전통조화개량조환자수술시간、술중출혈량분별위(3.2±0.3)h、(104.0±11.5)ml화(3.3±0.4)h、(110.0±23.8)ml,량조비교,차이무통계학의의(t=-1.474,-L 758,P＞0.05);술후평균주원시간、술후대관인류시간분별위(15.3±4.3)d、(28.0 ±4.6)d화(9.3±1.2)d、(7.6±0.8)d,량조비교,차이유통계학의의(t=8.628,28.088,P＜0.05).전통조환자술후잔강적액、잔강감염、담즙루、포충원위복발、복강파산충식발생솔균현저고우개량조(x2=4.335,3.888,5.691,4.581,10.153,P＜0.05).학진포충원위복발혹엄중병발증재차수술환자21례.결론 류행병학사、전형림상표현、전형영상학특정화혈청면역학검사대우간낭형포충병파입복강적진단구유중요작용;개량내낭적제술+고삼염수반복충세복강+술후정규복용항포충약물시목전간낭형포충병파입복강교이상적치료방식.
Objective To investigate the diagnosis and treatment of ruptured hepatic cystic echinococcosis (HCE).Methods The clinical data of 109 patients with HCE who were admitted to the First Affiliated Hospital of Xinjiang Medical University from January 1994 to December 2009 were retrospectively analyzed.The diagnosis was based on the results of serological examination,epidemiological history,clinical manifestation and imaging findings.Of the 108 patients who received surgical treatment,67 received classic endocystectomy(classic group)and 41 received improved endocystectomy(improved group).The operation time,operative blood loss,length of postoperative hospital stay,time of drainage,effusion and infection of residual cavity,biliary fistula,pleura]effusion,local recurrence,dissemination and implantation of HCE,and death of the 2 groups were compared.All data were analyzed using the t test and chi-square test.Results The diagnostic rates of ultrasound,computed tomography and magnetic resonance imaging were 93%(101/109),99%(70/71)and 7/7,respectively.The positive rate of serological examination was 100%(61/61).Of the 109 patients,1 died of anaphylactic shock.The operation time and operative blood loss were(3.2 ± 0.3)hours and(104.0 ± 11.5)ml in the classic group and(3.3 ±0.4)hours and(110.0 ±23.8)ml in the improved group,respectively.There were no significant differences in the operation time and operative blood loss between the 2 groups(t =-1.474,-1.758,P ＞0.05).The length of hospital stay and time of drainage were(15.3 ± 4.3)days and(28.0 ± 4.6)days in the classic group and(9.3 ± 1.2)days and(7.6 ± 0.8)days in the improved group,respectively.There were significant differences between the 2 groups in the length of hospital stay and time of drainage(t = 8.628,28.088,P ＜0.05).The incidence rates of effusion and infection of residual cavity,biliary leakage,local recurrence,dissemination and implantation of HCE of the classic group were significantly higher than those in the improved group(x2 =4.335,3.888,5.691,4.581,10.153,P ＜0.05).Twenty-one patients received reoperation because of HCE recurrence or severe complications.Conclusions Epidemiological history,clinical manifestation,imaging findings and serological examination are important for the diagnosis of ruptured HCE.Improved endocystectomy + peritoneal lavage with hypertonic saline + administration of anti-HCE drugs is the optimal treatment for ruptured HCE.
