目的 探讨合并囊内胆漏的肝细粒棘球蚴病患者有效的手术治疗方式。 方法 回顾性分析新疆维吾尔自治区第三人民医院2015年1月—2021年2月合并囊内胆漏的肝细粒棘球蚴病患者的临床资料,按照手术治疗方式不同分为3组,行肝细粒棘球蚴病内囊摘除残腔引流术为对照组,手术中加行经胆总管T管引流术为T管引流组,手术中行加经内镜胆道内支架引流术（ERBD）为ERBD组;3组患者术中均常规缝合残腔内可见胆漏。采用SPSS 22.0统计学软件对比分析3组间的手术时间、手术出血量、残腔引流管滞留时间、T管/内支架滞留时间、住院时间、总重返住院次数,以及术后短期并发症和并发症导致重返住院的发生率。 结果 共收集合并囊内胆漏的肝细粒棘球蚴病患者70例,其中男性44例,女性26例;对照组26例,T管引流组24例,ERBD组20例,3组间一般资料的差异无统计学意义（χ²_性别 = 0.24、F_年龄 = 1.12、χ²_病灶数量 = 1.56、χ²_{病灶最大直径} = 0.36、χ²_{病灶主要位置} = 0.45、χ²_病灶类型 = 2.61,P > 0.05）。对照组、T管引流组和ERBD组,手术时间分别为（154.42 ± 27.14）、（188.13 ± 17.62）和（205.00 ± 22.48）min,组间差异有统计学意义（F = 29.62,P < 0.05）;术中出血量分别为（203.85 ± 43.37）、（218.33 ± 43.61）和（210.00 ± 38.53）ml,组间差异无统计学意义（F = 0.74,P > 0.05）;残腔引流管滞留时间分别为（9.15 ± 9.95）、（2.38 ± 0.49）和（2.80 ± 0.83）周,T管引流组和ERBD组间差异无统计学意义（t = 2.60,P > 0.05）,两组均短于对照组（F = 9.55,P < 0.05）。T管引流组和ERBD组的T管/内支架滞留时间分别为（4.96 ± 0.69）和（7.15 ± 2.32）周,差异有统计学意义（t = 186.48,P < 0.05）。对照组、T管引流组和ERBD组的住院时间（首次 + 末次）分别为（4.04 ± 1.51）、（2.17 ± 0.38）和（3.65 ± 0.67）周,T管引流组和ERBD组间差异无统计学意义（t = 8.28,P > 0.05）,两组均短于对照组（F = 23.08,P < 0.05）。对照组、T管引流组和ERBD组的总重返住院次数分别为（0.58 ± 0.90）、（0.08 ± 0.28）和（1.10 ± 0.31）次,T管引流组少于对照组,ERBD组多于对照组（F = 29.62,P < 0.05）。术后短期并发症的患者,对照组18例、T管引流组8例、ERBD组10例,3组间差异无统计学意义（χ² = 3.35,P > 0.05）;并发症导致重返住院的患者对照组15例、T管引流组1例、ERBD组2例,T管引流组和ERBD组均低于对照组（χ² = 12.51、7.94,P < 0.05）,T管引流组和ERBD组的差异无统计学意义（χ² = 0.58,P > 0.05）。 结论 胆总管直径≥ 6 mm且合并囊内胆漏的肝细粒棘球蚴病患者,联合经胆总管T管引流术或联合ERBD术的内囊摘除残腔引流术均能提高临床治疗效果,缩短治疗周期。

Objective To explore an effective surgical intervention strategy for hepatic echinococcosis complicated with intracystic bile leakage. Methods The clinical data of patients of hepatic echinococcosis complicated with intracystic bile leakage were collected from January 2015 to February 2021 in the Third People Hospital of Xinjiang and analyzed retrospectively. The patients were divided into 3 groups according to different surgical procedures. The cases that had experienced residual cavity drainage after inner cyst excised were categorized into the control group. The cases that had received additional T-tube drainage via common bile duct during operation were categorized into the drainage group. The cases that had received endoscopic retrograde biliary drainage were categorized into the endoscopic retrograde biliary drainage (ERBD) group. Of all three groups of patients, visible bile leaks in the residual cavity were routinely sutured. Operation time, amount of blood loss during operation, indwelling time of residual drainage tube, indwelling time of T-tube/inner stent, time length of hospital stay, the total number of hospital re-entry, post-surgery short-term complication rate and the occurrence rate of returning to hospital due to complication were compared, using SPSS 22.0 statistical software. Results A total of 70 patients hepatic echinococcosis complicated with intracystic bile leakage were enrolled, including 44 males and 26 females, 26 in the control group, 24 in the drainage group, and 20 in the ERBD group. The differences in patient characteristics between the three groups were not statistically significant (χ²_Gender = 0.24, F_Age = 1.12, χ²_{No. lesion} = 1.56, χ²_{Max diameter of lesion} = 0.36, χ²_{Primary location of lesion} = 0.45, χ²_{Type of lesion} = 2.61; P > 0.05). The operative time for the control group, the drainage group and the ERBD group were (154.42 ± 27.14), (188.13 ± 17.62), and (205.00 ± 22.48) min, respectively, with statistically significant difference between the goups (F = 29.62, P < 0.05). The volume of blood loss during operation for the control group, the drainage group and the ERBD group were (203.85 ± 43.37), (218.33 ± 43.61) and (210.00 ± 38.53) ml, showing no significant difference between the groups(F = 0.74, P > 0.05). The indwelling time of residual drainage tube for the control group, the drainage group and the ERBD group were (9.15 ± 9.95), (2.38 ± 0.49) and (2.80 ± 0.83) weeks respectively, presenting no significant difference between the drainage group and the ERBD group (t = 2.60, P > 0.05). However, the indwelling time in the drainage group and ERBD group was significantly shorter than that in the control group (F = 9.55, P < 0.05). The indwelling time of T-tube or stent in the drainage group and the ERBD group were (4.96 ± 0.69) and (7.15 ± 2.32) weeks respectively, of which the difference was statistically significant (t = 186.48, P < 0.05). The length of hospital stay (first + last) of the control group, the drainage group and the ERBD group were (4.04 ± 1.51), (2.17 ± 0.38) and (3.65 ± 0.67) weeks respectively, there was no significant difference between the drainage group and the ERBD group (t = 8.28, P > 0.05). However, the time length of hospital stay of drainage group and the ERBD group were both significantly shorter than that of the control group (F = 23.08, P < 0.05). The total number of hospital re-entry for the control group, the drainage group and the ERBD group were (0.58 ± 0.90), (0.08 ± 0.28) and (1.10 ± 0.31), among which the re-entry time of the drainage group was fewer than the control group, while the ERBD group showed more times (F = 29.62, P < 0.05). Eighteen patients had postsurgery short-term complications in the control group, 8 cases in the drainage group and 10 cases in the ERBD group, between them no significant difference was found (χ² = 3.35, P > 0.05). Fifteen patients were readmitted to hospitals due to related complications in the control group, 1 patient in the drainage group and 2 patients in the ERBD group. Readmission in the drainage group and the ERBD group were both significantly fewer than that in the control group (χ ² = 12.51, 7.94, P < 0.05), and there was no significant difference between the drainage group and the ERBD group (χ ² = 0.58, P > 0.05). Conclusion The technique of residual cavity drainage for inner cyst excision in combination with T-tube drainage via common bile duct or ERBD could significantly improve the clinical treatment efficacy and shorten the treatment cycle for those hepatic echinococcosis patients complicated with intracystic bile leakage with common bile duct larger than 6 mm in diameter.