肝细粒棘球蚴包囊急性破裂入胆道21例临床分析

doi:10.12140/j.issn.1000-7423.2020.04.023

摘要/Abstract

摘要：

回顾性分析2015年12月-2018年11月石河子大学医学院第一附属医院行外囊次全切除术治疗的21例肝细粒棘球蚴包囊急性破裂入胆道患者的疗效。男性14例,女性7例;原发18例,复发3例。21例患者均为急性破裂,入院时均出现黄疸症状（14例为持续性进行性黄疸,7例为间歇性黄疸）,且有寒战、高热、腹膜刺激征、恶心、呕吐等症状。4例患者在包囊破裂入胆道的同时还出现了原头节种植于腹腔的情况。患者手术平均耗时2.7 h,术中平均出血量75 ml。所有患者均于术中放置了T管,11例患者在放置T管的同时放置了腹腔引流管,3例患者在放置T管的同时放置了残腔引流管,3例患者同时放置了腹腔引流管、残腔引流管以及T管。1例患者于术后出现残腔感染,3例患者于术后出现胆漏,余均未出现相关并发症。随访1~3年,未见复发病例。外囊次全切除术治疗肝细粒棘球蚴包囊急性破裂入胆道效果较好。

关键词: 肝细粒棘球蚴病, 包囊, 破裂, 外囊次全切除术, 胆道

Abstract:

To retrospectively analyze the therapeutic effect of partial pericystectomy in 21 cases of acute intrabiliary rupture of hepatic Echinococcus granulosus cyst performed from December 2015 to November 2018 in the First Affiliated Hospital of Shihezi University, Xinjiang Uygur Autonomous Region. The 21 patients included 14 males and 7 females; 18 of primary onset and 3 relapsed. All of the cases were admitted as the cases of acute hydatid cyst rupture, and showed jaundice at admission (14 had persistent progressive jaundice and 7 had intermittent jaundice) accompanied by symptoms of shiver, high fever, peritoneal irritation sign, nausea, and vomiting. In 4 patients, when the cyst ruptured into biliary tract. E. granulosus protoscoleces were found being seeded in the abdominal cavity. The operations spent 2.7 h on average, and the average intraoperative blood loss was 75 ml. Duing the operation, all patients were inserted with T-tube for drainage, 11 patients were concurrently placed with abdominal drainage tube, 3 patients with residual cavity drainage tube, and 3 patients with abdominal drainage tube/residual cavity drainage tube. One patient developed postoperative residual cavity infection, and 3 patients developed postoperative bile leakage. No other related complications occurred. During 1-3 years of follow up, no relapse cases were reported. The partial pericystectomy has good therapeutic effect for intrabiliary rupture of hydatid cyst.

Key words: Hepatic hydatid, Cyst, Rupture, Partial pericystectomy, Biliary tract

中图分类号:

R532.32

高宇, 吴向未, 阿布都瓦依提, 刘桂生. 肝细粒棘球蚴包囊急性破裂入胆道21例临床分析[J]. 中国寄生虫学与寄生虫病杂志, 2020, 38(4): 524-527.

GAO Yu, WU Xiang-wei, ABU Duwaiti, LIU Gui-sheng. Clinical analysis on 21 cases of acute intrabiliary rupture of hepatic Echinococcus granulosus cyst[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2020, 38(4): 524-527.

图/表 1

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