胆瘘与肝棘球蚴病晚期复发:膀胱-胆道沟通的作用:一项前瞻性多中心研究。

Tamer A A M Habeeb, Mauro Podda, Boris Tadic, Vishal G Shelat, Yaman Tokat, Mohamed Ibrahim Abo Alsaad, Abd-Elfattah Kalmoush, Mohammed Shaaban Nassar, Fawzy Metwally Mustafa, Mahmoud Hassib Morsi Badawy, Mohamed Sobhy Shaaban, Tarek Zaghloul Mohamed, Mohammed Ibrahim El Sayed Henish, Hamdi Elbelkasi, Mahmoud Abdou Yassin, Abdelshafy Mostafa, Amr Ibrahim, Waleed A-Abdelhady, Tamer Mohamed Elshahidy, Mohamed Ibrahim Mansour, Adel Mahmoud Moursi, Mohamed Abdallah Zaitoun, Ehab Shehata Abd-Allah, Ashraf Abdelmonem Elsayed, Rasha S Elsayed, Ahmed M Yehia, Amr Abdelghani, Mohamed Negm, Heba Alhussein Abo-Alella, Mostafa M Elaidy
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引用次数: 0

摘要

背景:棘球蚴病(HCD)在某些地方很常见。手术与术后胆瘘(POBF)和复发有关。本研究的主要目的是确定隐匿性胆膀胱通讯(CBC)是否可以预测复发性HCD。第二个目的是评估囊性液体胆红素和碱性磷酸酶(ALP)水平在预测POBF和复发性HCD中的作用。目的:确定隐匿性CBC是否可以预测复发性HCD。次要目的是评估囊性液体胆红素和ALP水平在预测POBF和复发性HCD中的作用。单变量逻辑回归分析评估了决定胆道并发症和复发的独立因素。结果:囊液生化指标与胆道并发症的发生之间存在高度统计学意义的相关性(P≤0.001)(在16例POBF患者中,15例患者的囊液胆红素和ALP水平较高),其中胆红素和ALP水平较高的患者发生胆道并发症的可能性高出3405倍。胆道并发症、生化指标和复发性HCD的发生之间存在高度统计学意义的相关性(P≤0.001)(在30例复发性HCCD患者中,15例患者的囊肿液胆红素和ALP较高;所有16例POBF患者后来都发展为复发性HCD),出现胆道并发症和高胆红素ALP的患者复发性棘球蚴囊肿的可能性分别是前者的244.6倍和214倍。结论:隐性CBC可预测复发性HCD。囊肿液胆红素和ALP水平升高可预测POBF和复发性HCD。
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Biliary fistula and late recurrence of liver hydatid cyst: Role of cysto-biliary communication: A prospective multicenter study.

Background: Hydatid cyst disease (HCD) is common in certain locations. Surgery is associated with postoperative biliary fistula (POBF) and recurrence. The primary aim of this study was to identify whether occult cysto-biliary communication (CBC) can predict recurrent HCD. The secondary aim was to assess the role of cystic fluid bilirubin and alkaline phosphatase (ALP) levels in predicting POBF and recurrent HCD.

Aim: To identify whether occult CBC can predict recurrent HCD. The secondary aim was to assess the role of cystic fluid bilirubin and ALP levels in predicting POBF and recurrent HCD.

Methods: From September 2010 to September 2016, a prospective multicenter study was undertaken involving 244 patients with solitary primary superficial stage cystic echinococcosis 2 and cystic echinococcosis 3b HCD who underwent laparoscopic partial cystectomy with omentoplasty. Univariable logistic regression analysis assessed independent factors determining biliary complications and recurrence.

Results: There was a highly statistically significant association (P ≤ 0.001) between cystic fluid biochemical indices and the development of biliary complications (of 16 patients with POBF, 15 patients had high cyst fluid bilirubin and ALP levels), where patients with high bilirubin-ALP levels were 3405 times more likely to have biliary complications. There was a highly statistically significant association (P ≤ 0.001) between biliary complications, biochemical indices, and the occurrence of recurrent HCD (of 30 patients with recurrent HCD, 15 patients had high cyst fluid bilirubin and ALP; all 16 patients who had POBF later developed recurrent HCD), where patients who developed biliary complications and high bilirubin-ALP were 244.6 and 214 times more likely to have recurrent hydatid cysts, respectively.

Conclusion: Occult CBC can predict recurrent HCD. Elevated cyst fluid bilirubin and ALP levels predicted POBF and recurrent HCD.

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