超声引导下穿刺引流联合手术切除治疗液化空洞型肝泡型包虫病的疗效及安全性

摘要

Objective To study the safety and efficacy of ultrasound-guided puncture combined with surgical resection for liquefied cavitary hepatic alveolar echinococcosis (HAE).Methods A retrospective study was conducted on 17 patients who had liquefied cavitary HAE and were treated at the Affiliated Hospital of Qinghai University from January 2014 to August 2016.Ten patients were treated with ultrasound-guided puncture combined with surgical resection (the case group),and 7 patients were treated with resection (the control group).The basic characteristics,operation time,blood loss during operation,preoperative and postoperative laboratory tests and complications were compared between the 2 groups.Results There were no significant differences between the 2 groups in basic characteristics,such as age,gender,and lesion diameter (P ＞ 0.05).The operation time and blood loss during operation showed significant differences between the 2 groups,(308.0 ± 23.0) min (389.0 ± 95.7) min and (1 360.0 ± 182.9) ml vs.(1 607.1 ± 205.0) ml,respectively (all P ＜ 0.05).The prothrombin time (PT) after day 3 of operation and alanine aminotransferase level after day 5 of operation showed significant differences between the 2 groups,(13.8 ±0.9) s vs.(15.5 ±1.7) s and (81.9 ±20.9) U/L vs.(108.1 ±29.5) U/L,respectively (all P ＜ 0.05).There was no significant difference in postoperative complications between the 2 groups.Conclusions Ultrasound-guided puncture combined with surgical resection shortened the operation time,reduced blood loss and avoided serious complications after surgery.This treatment is efficacious and safe for liquefied cavitary HAE.%目的 探讨超声引导下经皮肝穿刺引流联合手术切除治疗液化空洞型肝泡型包虫病(HAE)的疗效及安全性.方法 回顾性分析青海大学附属医院肝胆胰外科2014年1月至2016年8月收治的17例液化空洞型HAE患者资料.其中10例行超声引导下穿刺引流术联合手术切除治疗(病例组),7例行单纯手术切除治疗(对照组).比较两组患者一般资料、术中出血量、手术时间、术后恢复情况及术后并发症发生率.结果 两组患者基线临床特征(年龄、性别分布、病灶直径、生化指标等)无明显差异(P＞0.05).病例组手术时间及术中出血量少于对照组,分别为(308.0 ±23.0)min比(389.0±95.7)min和(1 360.0±182.9)ml比(1 607.1±205.0)ml,均P＜0.05.病例组患者穿刺前后肝功能无明显变化(P＞0.05).病例组术后第3天凝血酶原时间、术后第5天丙氨酸转氨酶水平低于对照组,分别为(13.8±0.9)s比(15.5±1.7)s和(81.9±20.9) U/L比(108.1±29.5) U/L(均P＜0.05).两组患者术后并发症发生率无明显差异(P＞0.05);术后随访所有患者均无复发.结论 超声引导下穿刺引流术联合手术切除治疗液化空洞型肝泡型包虫病可明显缩短手术时间、减少术中出血量,有助于术后肝功能的恢复,是一种安全有效的治疗方式.