中国普通外科杂志

• 临床研究 • 上一篇    下一篇

肝泡型包虫病根治性切除163例回顾性分析

张昀昊1,任利2,阳丹才让2,侯立朝2,周瀛2,王海久2,樊海宁2,王虎3,温浩4   

  1. (1. 青海大学研究生院,青海 西宁 810000;2. 青海大学附属医院 肝胆胰外科,青海 西宁 810000;3. 青海省卫生和 计划生育委员会,青海 西宁 810000;4.新疆医科大学第一附属医院 肝胆包虫外科,新疆 乌鲁木齐 830054)
  • 收稿日期:2015-10-16 修回日期:2016-01-15 出版日期:2016-02-15 发布日期:2016-02-15
  • 通讯作者: 樊海宁, Email: fanhaining@medmail.com.cn
  • 作者简介:张昀昊,青海大学研究生院硕士研究生,主要从事普通外科基础与临床方面的研究。
  • 基金资助:
    青海省包虫病重点实验室资助项目(NO-2016-4);青海省省级临床重点专科建设资助项目(2015-1101),青海大学昆仑学者资助项目(2014-37)。

Radical resection for hepatic alveolar echinococcosis: a retrospective analysis of 163 cases

ZHANG Yunhao1, REN Li2, YANGDAN Cairang2, HOU Lizhao2, ZHOU Ying2, WANG Haijiu2, FAN Haining2, WANG Hu3, Wen Hao4   

  1. (1. Graduate School, Qinghai University, Xining 810000, China; 2. Department of Hepatopancreatobiliary Surgery, Affiliated Hospital, Qinghai University, Xining 810000, China; 3. Qinghai Provincial Health and Family Planning Commission, Xining 810000, China; 4. Department of Hepatobiliary and Hydatid Surgery, the First Affiliated Hospital, Xinjiang Medical University, Urumqi 830054, China)
  • Received:2015-10-16 Revised:2016-01-15 Online:2016-02-15 Published:2016-02-15

摘要: 目的:探讨肝泡型包虫病根治性切除的治疗效果。 方法:回顾性分析2013年1月—至2015年6月163例行根治性切除肝泡型包虫病患者的临床资料。 结果:根治性手术平均时间(3.1±1.2)h,术中出血量(763±498)mL。术后携带腹腔引流管中位时间6 d,11例携带T管,术后1个月拔除。术后平均肛门排气时间(2.1±0.8)d、经口进食时间(2.7± 1.1)d、住院时间(7.9±3.4)d。8例出现术后并发症,其中5例术后胆瘘,1例术区感染,2例术后腹水。术后电话或门诊随访1~6个月无死亡及包虫复发情况。 结论:根治性切除是当前肝泡型包虫病患者的首选治疗方案。术前充分评估手术可行性,术中充分掌握肝脏血流控制、肝脏外科解剖、门静脉重建、胆管重建等技术,通过根治性手术切除可明显改善泡型包虫病患者的生存质量,延长患者的生存时间。

关键词: 棘球蚴病, 肝, 肝切除术, 回顾性研究

Abstract: Objective: To assess the therapeutic effect of radical resection of hepatic alveolar echinococcosis. Methods: The clinical data of 163 patients with hepatic alveolar echinococcosis undergoing radical surgical resection between January 2013 and June 2015 were analyzed retrospectively. Results: The average operative time for radical surgery was (3.1±1.2) h, and intraoperative blood loss was (763±498) mL. The median time for the retention of intraperitoneal drainage tube was 6 d, and 11 patients underwent T-tube drainage that was removed one month after operation. The mean time to first passage of flatus and oral intake was (2.1±0.8) d and (2.7±1.1) d, respectively, and length of postoperative hospitalization was (7.9±3.4) d. Postoperative complications occurred in 8 patients, which included bile leakage in 5 cases, surgical site infection in one case, and ascites in 2 cases. Telephone contact or outpatient clinic follow-up was conducted for one month to 6 months postoperatively, and no death or recurrent echinococcosis was reported. Conclusion: Radical resection is still the first treatment option for hepatic alveolar echinococcosis. Based on adequate preoperative evaluation of the feasibility, and knowledge about the intraoperative techniques such as hepatic blood flow control, liver anatomy, and portal vein and biliary reconstruction, radical surgical resection can improve the quality of life and extend the survival time of the patients.

Key words: Echinococcosis, Hepatic, Hepatectomy, Retrospective Studies

中图分类号: 

  • R657.3

[1] Eckert J, Deplazes P. Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern[J]. Clin Microbiol Rev, 2004, 17(1):107-135.
[2] Kawamura N, Kamiyama T, Sato N, et al. Long-term results of hepatectomy for patients with alveolar echinococcosis: a single-center experience[J]. J Am Coll Surg, 2011, 212(5):804-812.
[3] 中国医师协会外科医师分会包虫病外科专业委员会. 肝两型包虫病诊断与治疗专家共识(2015版)[J]. 中华消化外科杂志, 2015, 14(4):253-264.
Chinese College of Surgeons (CCS) Chinese Committe. Expert consensus on the diagnosis and treatment of hepatic cystic and alveolar echinococcosis (2015 edition)[J]. Chinese Journal of Digestive Surgery, 2015, 14(4):253-264.
[4] Kern P, Wen H, Sato N, et al. WHO classification of alveolar echinococcosis: principles and application[J]. Parasitol Int, 2006, 55(Suppl):S283-287.
[5] Parray FQ, Ahmad SZ, Sherwani AY, et al. Primary paraspinal hydatid cyst: a rare presentation of echinococcosis[J]. Int J Surg, 2010, 8(5):404-406.
[6] Buttenschoen K, Kern P, Reuter S, et al. Hepatic infestation of Echinococcus multilocularis with extension to regional lymph nodes[J]. Langenbecks Arch Surg, 2009, 394(4):699-704.
[7] Brunetti E, Kern P, Vuitton DA. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans[J]. Acta Tropica, 2010, 114(1):1-16.
[8] 周瀛. 高海拔地区藏族人群肝包虫病的诊断及外科手术治疗观察[J]. 中国普通外科杂志, 2014, 23(7):1005-1008.
Zhou Y. Diagnosis and surgical treatment of hydatid liver cysts of Tibetan population in a high altitude region[J]. Chinese Journal of General Surgery, 2014, 23(7):1005-1007.
[9] Zhang W, McManus DP. Recent advances in the immunology and diagnosis of echinococcosis[J]. FEMS Immunol Med Microbiol, 2006, 47(1):24-41.
[10] Tawfeek GM, Elwakil HS, El-Hoseiny L, et al. Comparative analysis of the diagnostic performance of crude sheep hydatid cyst fluid, purified antigen B and its subunit (12 Kda), assessed by ELISA, in the diagnosis of human cystic echinococcosis[J]. Parasitol Res, 2011, 108(2):371-376.
[11] 张玉英, 宋书邦, 马钦风, 等. 肝泡型棘球蚴病结节与肝癌结节声像图鉴别的探讨[J]. 陕西医学杂志, 2004, 33(6):524-525.
Zhang YY, Song SB, Ma QF, et al. Differential diagnosis of the nodes of hepatic alveolar hydatidosis and hepatic cancer[J]. Shaanxi Medical Journal, 2004, 33(6):524-525.
[12] Nunnari G, Pinzone MR, Gruttadauria S, et al. Hepatic echinococcosis: clinical and therapeutic aspects[J]. World J Gastroenterol, 2012, 18(13): 1448-1458.
[13] McManus DP, Zhang W, Li J, et al. Echinococcosis[J]. Lancet, 2003, 362(9392): 1295-1304.
[14] Graeter T, Ehing F, Oeztuerk S, et al. Hepatobiliary complications of alveolar echinococcosis: a long-term follow-up study[J]. World J Gastroenterol, 2015, 21(16):4925-4932.
[15] 阿依甫汗·阿汗, 曹峻, 吐尔干艾力, 等. 晚期肝泡型包虫病47例治疗分析[J]. 中华普通外科杂志, 2011, 26(7):617-618.
Ahan Ayifuhan, Cao J, Tuerganaili, et al. Treatment of end-stage hepatic alveolar echinococcosis: an analysis of 47 cases[J]. Chinese Journal of General Surgery, 2011, 26(7):617-618.
[16] 朱迎, 董健, 王万里, 等. 终末期肝病模型评分对评价肝癌患者肝切除围手术期风险的价值[J]. 中华肝胆外科杂志, 2014, 20(3):165-169.
Zhu Y, Dong J, Wang WL, et al. Meld score in the prediction of perioperative risks in patients who underwent partial hepatectomy for hepatocellular carcinoma[J]. Chinese Journal of Hepatobiliary Surgery, 2014, 20(3):165-169.
[17] Stavrou GA, Donati M, Ringe KI, et al. Liver remnant hypertrophy induction—how often do we really use it in the time of computer assisted surgery[J]. Adv Med Sci, 2012, 57(2):251-258.
[18] He YB, Bai L, Jiang Y, et al. Application of a three-dimensional reconstruction technique in liver autotransplantation for end-stage hepatic alveolar echinococcosis[J]. J Gastrointest Surg, 2015, 19(8):1457-1465.
[19] 冯志强, 朴龙松. 术前肝脏储备功能评估对于精准肝切除实施的意义[J]. 中国医刊, 2012, 47(4):16-18.
Feng ZQ, Pu LS. Significance of preoperative assessment of liver functional reserve in precise liver resection[J]. Chinese Journal of Medicine, 2012, 47(4):16-18.
[20] 何翼彪, 白磊, 吴磊,等. 数字化三维重建系统在肝泡型包虫病治疗中的应用[J]. 中华消化外科杂志, 2012, 11(2):120-123. DOI:10.3760/cma.j.issn.1673-9752.2012.02.008
He YB, Bai L, Wu L, et al. Application of a digital three-dimensional reconstruction technique in the diagnosis and treatment of hepatic alveolar echinococcosis[J]. Chinese Journal of Digestive Surgery, 2012, 11(2):120-123.
[21] Saito S, Yamanaka J, Miura K, et al. A novel 3D hepatectomy simulation based on liver circulation: application to liver resection and transplantation[J]. Hepatology, 2005, 41(6):1297-1304.
[22] 杜振双, 何谦, 林建泉, 等. 三维手术模拟系统在肝癌患者极量肝切除术中的应用: 35例报告[J]. 中华肝胆外科杂志, 2015, 21(3):152-155.
Du ZS, He Q, Lin JQ, et al. Application of a three-dimensional surgery simulation system in patients with liver cancer who underwent extended liver resections: experience in 35 patients[J]. Chinese Journal of Hepatobiliary Surgery, 2015, 21(3):152-155.
[23] Atanasov G, Benckert C, Thelen A, et al. Alveolar echinococcosis-spreading disease challenging clinicians: a case report and literature review[J]. World J Gastroenterol, 2013, 19(26):4257-4261.
[24] Partensky C, Valette PJ, Bret PM, et al. Hepatic resection for alveolar echinococcosis[J]. Chirurgie, 1991, 117(5/6):347-350.
[25] Kasai Y, Koshino I, Kawanishi N, et al. Alveolar echinococcosis of the liver; studies on 60 operated cases[J]. Ann Surg, 1980, 191(2):145-152.
[26] 温浩, 刘文亚, 邵英梅, 等. 包虫病影像诊断技术和手术治疗进展[J]. 国际医学寄生虫病杂志, 2009, 36(5):299-306.
Wen H, Liu WY, Shao YM, et al. Advancement of imaging diagnosis technique and surgery treatment of echinococcosis[J]. International JOurnal of Medical Parasitic Diseases, 2009, 36(5):299-306.
[27] 阿依甫汗·阿汗, 吐尔干艾力, 邵英梅, 等. 肝包虫病的外科治疗现状[J]. 肝胆外科杂志, 2009, 17(1):13-14.
Ahan Ayifuhan, Tuerganaili, Shao YM, et al. Current status of hepatic alveolar echinococcosis treatment[J]. Journal of Hepatobiliary Surgery, 2009, 17(1):13-14.
[28] 邵英梅, 蒋铁民, 吐尔干艾力·阿吉, 等. 根治性及准根治性手术治疗终末期肝泡型包虫病[J]. 中华消化外科杂志, 2011, 10(4):296-298.
Shao YM, Jiang TM, Tuerganaili AJ, et al. Radical and quasi-radical hepatectomy for the treatment of end-stage hepatic alveolar echinococcosis[J]. Chinese Journal of Digestive Surgery, 2011, 10(4):296-298.
[29] Kadry Z, Renner EC, Bachmann LM, et al. Evaluation of treatment and long-term follow-up in patients with hepatic alveolar echinococcosis[J]. Br J Surg, 2005, 92(9):1110-1116.
[30] Buttenschoen K, Carli Buttenschoen D, Gruener B, et al. Long-term experience on surgical treatment of alveolar echinococcosis[J]. Langenbecks Arch Surg, 2009, 394(4):689-698.
[31] 阿依甫汗·阿汗, 曹峻, 吐尔干艾力, 等. 肝泡型包虫病的手术治疗:附43例病例分析[J]. 中华肝胆外科杂志, 2011, 17(3):213-215.
Ahan Ayifuhan, Cao J, Tuerganaili, et al. [J]. Analysis of surgical therapy on 43 cases of hepatic alveolar echinococcosis[J]. Chinese Journal of Hepatobiliary Surgery, 2011, 17(3):213-215.
[32] 陈孝平, 陈义发. 合理利用外科新技术减少肝切除术中出血量[J]. 中国普通外科杂志, 2008, 17(1):1-2.
Chen XP, Chen YF. Rational use of new surgical technology to decrease intraoperative bleeding during hepatectomy[J]. Chinese Journal of General Surgery, 2008, 17(1):1-2.
[33] 魏晓明, 程智礼. 肝创面对拢缝合与创面敞开短期临床结局的对比研究[J]. 中华普通外科学文献:电子版, 2015, 9(4):300-303.
Wei XM, Cheng ZL. Comparative study of short-term clinical outcome of hepatic cutting surface by suture and open management[J]. Chinese Archives of General Surgery: Electronic Edition, 2015, 9(4):300-303.

[1] 王煜, 王锋, 张爱芸, 张旭, 马娟. 肝癌肝切除术后感染的病原学特征与影响因素分析[J]. 中国普通外科杂志, 2019, 28(6): 762-767.
[2] 李兰, 谢萍. 成人肝脏间叶性错构瘤的超声表现1例报告并文献复习[J]. 中国普通外科杂志, 2019, 28(5): 645-648.
[3] 文宇, 张子建, 颜世超, 刘翔, 周江蛟, 熊力, 李清龙. 理想小鼠结直肠癌肝转移模型的建立及研究进展[J]. 中国普通外科杂志, 2019, 28(4): 484-490.
[4] 曹利军, 孙昀, 张频捷, 付路. 急性胰腺炎相关性肝门静脉积气2例报告并文献复习[J]. 中国普通外科杂志, 2019, 28(3): 313-319.
[5] 周承汇, 罗慧, 李嘉荣, 陈泽国, 李年丰. 腹腔镜辅助与开腹ALPPS治疗肝癌的近期疗效比较[J]. 中国普通外科杂志, 2019, 28(3): 366-370.
[6] 张清军, 陈芸, 徐强, 孙建. ICC肝切除治疗术中经大网膜静脉注射丝裂霉素的临床价值[J]. 中国普通外科杂志, 2019, 28(3): 371-376.
[7] 宁克, 殷香保. 肝细胞癌免疫治疗的研究进展[J]. 中国普通外科杂志, 2019, 28(2): 234-240.
[8] 张瑞芳, 王子航, 张宇, 张学森, 李军, 张俊晶. 腹腔镜经胆囊管微切开一期缝合治疗胆囊管肝总管汇合部结石:附8 例报告[J]. 中国普通外科杂志, 2019, 28(2): 153-158.
[9] 王烁, 陈波, 苗雄鹰. 谷胱甘肽过氧化物酶1在肝癌组织中的表达及其意义的生物信息学分析[J]. 中国普通外科杂志, 2019, 28(2): 179-187.
[10] 代柏树, 雷世雄, 杨振宇, 杜锡林. 肝癌合并门静脉癌栓患者术后肝动脉化疗栓塞术联合门静脉化疗的有效性及安全性[J]. 中国普通外科杂志, 2019, 28(2): 188-194.
[11] 苏艳, 张磊, 任龙飞, 魏花萍, 甄海燕, 王芳昭, 李汛, . 快速康复外科在开腹肝癌切除术中应用的Meta分析[J]. 中国普通外科杂志, 2019, 28(2): 195-205.
[12] 李琪, 黄晓珺, 刘利平, 李明岳, 刘嘉林. 纳米炭注射液在壶腹部癌淋巴结清扫中的应用[J]. 中国普通外科杂志, 2019, 28(2): 206-211.
[13] 李雪鹏, 刘苏来, 蒋波. 肝内胆管癌分子水平研究进展[J]. 中国普通外科杂志, 2019, 28(2): 219-226.
[14] 江松, 王兆映, 欧明瑞, 庞青, 崔培元. 腹腔镜与开腹右半肝切除治疗肝肿瘤疗效比较的Meta分析[J]. 中国普通外科杂志, 2019, 28(1): 1-9.
[15] 孙为民, 查勇. 乙肝病毒X 蛋白调控肝癌干细胞维持肝细胞癌生物学行为的研究进展[J]. 中国普通外科杂志, 2019, 28(1): 92-98.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 徐进, 卜献民, 戴显伟 . 妊娠中晚期伴发急性胰腺炎的临床特点及治疗经验[J]. 中国普通外科杂志, 2008, 17(3): 2 -209 .
[2] 栾正刚, 何忠野, 张成, 董明, 马晓春, 郭仁宣 . 丙酮酸乙酯对重症急性胰腺炎大鼠肠黏膜HMGB1表达的影响[J]. 中国普通外科杂志, 2008, 17(3): 4 -218 .
[3] 程石, 杨彬, 闫文貌, 史敬东, 宋茂民 . 抗TNF-α治疗对重症急性胰腺炎肺损伤NF-κB信号通路的影响[J]. 中国普通外科杂志, 2008, 17(3): 5 -223 .
[4] 马宁, 葛春林, 栾凤鸣, 胡朝军, 李宁, 刘永锋 . 应用SELDI质谱技术筛选胰腺癌患者的血清标志蛋白[J]. 中国普通外科杂志, 2008, 17(3): 10 -245 .
[5] 丁会民, 秦锡虎, 朱峰, 周新军, 吴宝强 . 胰十二指肠切除术后并发症分析[J]. 中国普通外科杂志, 2008, 17(3): 14 -260 .
[6] 钱建忠, 李世兰, 赵可, 徐洪明. 胃腺癌淋巴结转移危险因素的分析[J]. 中国普通外科杂志, 2009, 18(10): 1 .
[7] 安杰, 刘伟, 刘艳丽, 张文, 李慧. 腹腔冲洗细胞学检查对胃癌预后的临床评估及意义[J]. 中国普通外科杂志, 2009, 18(10): 4 .
[8] 寸英丽, 查勇. 残胃癌的临床病理特征[J]. 中国普通外科杂志, 2009, 18(10): 5 .
[9] 黄国民, 郑连文, 房学东, 刘林林. 胃癌穿孔的外科治疗[J]. 中国普通外科杂志, 2009, 18(10): 7 .
[10] 刘英, 文继舫, 丁矢, 李雪兰. 应用SELDI-TOF-MS技术筛选TGF-β1刺激胃癌细胞分泌蛋白的研究[J]. 中国普通外科杂志, 2009, 18(10): 8 .