肝包虫囊肿压迫下腔静脉的外科治疗

Surgical treatment for compression of inferior vena cava by hepatic hydatid cyst

  • 摘要:
    目的 探讨肝包虫囊肿压迫下腔静脉的外科治疗。
    方法 采用回顾性描述性研究方法。收集2013年5月至2018年5月石河子大学医学院第一附属医院收治的10例肝包虫囊肿压迫下腔静脉病人的临床资料;男7例,女3例;年龄为(46±5)岁,年龄范围为38~51岁。根据术中肝包虫囊肿与下腔静脉的贴合程度以及囊肿完整切除的难易程度,分别行外膜内外囊完整切除术、外膜内外囊次全切除术、外膜内外囊完整切除联合下腔静脉部分切除术。观察指标:(1)手术情况。(2)术后情况。(3)随访情况。采用门诊和电话方式进行随访,于术后3、6、12、24个月门诊随访1次。行彩色多普勒超声检查了解病人肝包虫囊肿复发及下腔静脉栓塞情况。随访终点为术后2年,随访次要终点为肝包虫囊肿复发。随访时间截至2020年5月。正态分布的计量资料以x±s表示。计数资料以绝对数表示。
    结果 (1)手术情况:10例病人均顺利完成手术,7例行外膜内外囊完整切除术,2例行外膜内外囊次全切除术,1例行外膜内外囊完整切除联合下腔静脉部分切除术。10例病人术中无大出血及感染性休克发生。10例病人手术时间为(99±27)min;术中出血量为(99±48)mL。(2)术后情况:10例病人术后2~5 d拔除引流管,无术后出血、术后残腔感染、术后胆瘘发生,无围术期死亡病人,术后住院时间为(7.1±1.8)d。(3)随访情况:10例病人中,9例完成终点随访,随访时间内均无肝包虫囊肿复发及下腔静脉栓塞形成;1例病人于术后12个月,第3次随访失访,此病人术后3、6个月随访未发现肝包虫囊肿复发及下腔静脉栓塞。
    结论 外膜内外囊完整切除术、外膜内外囊次全切除术、外膜内外囊完整切除联合下腔静脉部分切除术均能完整切除肝包虫囊肿。

     

    Abstract:
    Objective To investigate the surgical treatment for compression of inferior vena cava (IVC) by hepatic hydatid cyst.
    Methods The retrospective and descriptive study was conducted. The clinical data of 10 patients with hepatic hydatid cyst compressing inferior vena cava who were admitted to the First Affiliated Hospital of School of Medicine of Shihezi University from May 2013 to May 2018 were collected. There were 7 males and 3 females, aged (46±5)years, with a range from 38 to 51 years. Patients underwent subadventitial close total pericystectomy, subadven-titial partial pericystectomy or subadventitial close total pericystectomy with partial IVC resection according to the relative distance between hepatic hydatid cyst and IVC, and the feasibility of total pericystectomy. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted using outpatient examination or telephone interview. Patients were followed up at the outpatient department at postoperative 3, 6, 12, 24 months using color Doppler ultrasound examination to detect the recurrence of hepatic hydatid cyst and inferior vena cava occlusion. The endpoint of follow-up was 2 years after operation, and the secondary endpoint of follow-up was recurrence of hepatic hydatid cyst. The follow-up time was up to May 2020. Measure-ment data with normal distribution were represent as Mean±SD, and count data were described as absolute numbers.
    Results (1) Surgical situations: 10 patients underwent surgery successfully without massive hemorrhage and septic shock during the operation, including 7 patients undergoing subadventitial close total pericystectomy, 2 patients undergoing subadventitial partial pericys-tectomy, and 1 patient undergoing subadventitial close total pericystectomy with partial IVC resection. The operation time and volume of intraoperative blood loss of 10 patients were (99±27)minutes and (99±48)mL, respectively. (2) Postoperative situations: the time to drainage tube removal and duration of postoperative hospital stay of 10 patients were 2-5 days and (7.1±1.8)days. None of patients underwent postoperative bleeding, residual cavity infection, biliary fistula, or perioperative death. (3) Follow-up: of 10 patients, 9 patients completed the endpoint of follow-up and no recurrence of hepatic hydatid cyst or inferior vena cava occlusion formation was detected. The other 1 patient was followed up at postoperative 3, 6 months but failed to be followed up at postoperative 12 months, and no recurrence of hepatic hydatid cyst or inferior vena cava occlusion formation was detected during the follow-up time.
    Conclusion Complete resection of hepatic hydatid cyst can be achieved by subadventitial close total pericystectomy, subadventitial partial pericystectomy or subadventitial close total pericystectomy with partial IVC resection.

     

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