摘要
目的探讨小儿肝包虫囊肿内囊摘除术后并发症的预防及治疗方法。方法我院自1960年3月～2005年3月手术治疗小儿肝包虫囊肿149例,其中53例(35.5%)术后出现并发症,占我院同期所有肝包虫内囊摘除手术的5.23%(53/1014),术后主要并发症有:残腔感染25例(47.2%),残腔胆汁瘘17例(32.1%),黄疸、残腔过度纤维化及钙化而不愈合、肝包虫复发各3例(各占5.7%),术中过敏性休克1例(1.9%),术后囊腔出血1例。结果37例(69.8%)经再次手术治疗,其中4例经3次手术,1例经4次手术并最终死亡。死亡原因为感染及肝功能、肾功能衰竭,再次或第3次术后伤口感染4例(7.5%),腹腔感染3例(5.7%),肺部感染2例(3.8%),本组除1例死亡外,其余病例均痊愈出院,治愈率98.1%,随访期间3例复发,均经再次手术治愈。结论肝包虫囊肿内囊摘除、外引流术,目前仍为治疗本病的主要术式,但术后残留的外囊并发症可达10.8%～65.8%(本组35.6%),主要并发症为残腔感染、残腔胆汁瘘、残腔出血、黄疸、残留外囊经久不愈、复发及过敏性休克等。部分病例需再次甚至多次手术,术中适当的处理可以减少并发症的发生。
Objective To inverstigate provention and therapy for postoperative complications of liver hydatid cyst in younger children. Method 149 cases of liver hydatid cyst were treated by operation at the first hospital of Lanzhou University during from Mar 1960 to Mar 2005. 53 of them occured complications after the operation. These complications including residual cavity infection in 25 cases（47.2%）,cyst-biliary fistula in 17（32.1%）,jaundice,over-fibrosis of cyst residual cavity and calcification results in unhealing,liver echinococciasis recurrent in 3 cases respectivedly.Postoperation external cavity of hydatid bleeding in one case,anaphylactic shock in one child during the operation. Results 37 of them underwent reopreration.4 cases were operated in third times,one among had fourth operation,but final this child dead,a mortality was 1.9%.Postoperative the wound infection in 4 cases,intraobdominal infection in 3 cases,.pulmonary infection in 2 case.However,3 cases relapse in the follow up period,they were all cured by reoperation. Conclusions Removal internal capsule of hydatid cyst and external draining are mainly operation methods for the treatment of liver echinococciasis.But postoperative residual external capsule of cyst can reach up to 10.8%-65.8% complications,in this study is 35.6%.Main complications are infection,biliary fistula, bleeding of the residual cavity of liver hydatid cyst,others complications including jaundice,the residual capsule still unhealing for a long time after therapy,relapse and anaphylactic shock etc. Partial cases need re-operation,so fas as to multiple the operation.Proper management in the operation period can decrease these complications.Recently,there is evident support that between external cyst and liver tissues has a surgical membrane which benefited total removing the hydatid cyst.Author believe that total remove hydatid cyst depend on patient general as well as local condition and surgeon experience.
出处
《临床小儿外科杂志》
CAS
2005年第4期253-255,共3页
Journal of Clinical Pediatric Surgery
关键词
棘球蚴病
肝/外科学
手术后并发症
Echinococcosis,Hepatic/SU
Postoperative Complications
