肝包虫病手术治疗后并发症的临床及发病机制分析

F. Nazyrov, A. Babadjanov, F. R. Yakubov
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引用次数: 0

摘要

的目标。目的:根据囊肿的位置、大小和发展阶段,确定影响肝包虫病手术入路疗效的因素。材料和方法。分析了2015 ~ 2017年98例肝包虫病经皮(PAIR - 23例,PEVAC - 29例)和腹腔镜(46例)干预的手术治疗经验。PAIR术后,1例(16.7%)单独使用CE3囊肿出现并发症。3例(60%)囊肿穿刺长度大于4cm,出现各种并发症,其中2例合并CE2和CE3。进行PEVAC技术时,排出囊肿内容物的平均时间为5天。引流液中出现出血性液体占6.9%,胆道瘘占13.8%。残留腔内积液和化脓占34.5%。考虑到囊肿的大小,囊肿≤6cm的PEVAC术后并发症发生率为9.1%,而囊肿≤6cm的发生率为50%。腹腔镜棘球蚴切除术中操作的各种困难在CE2-4中更为常见。因此,CE4患者更容易出现抽吸或囊肿内容物切除的困难。引流术后并发症发生率为17.9%,其中积液占14.3%,残留腔化脓占3.6%。美国的标准,主要适应症和战术和技术方面的执行PAIR和PEVAC方法,以及进行腹腔镜包膜切除术,并评估所需的包膜切除量的标准,以充分腹部纤维囊化。
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Clinical and pathogenetic aspects of the complications after surgical treatment of hepatic echinococcosis
Aim. To identify factors influencing effectiveness of surgical approaches in hepatic echinococcosis, depending on the location, size and stage of development of the cyst.Material and methods. From 2015 to 2017 the experience of surgical treatment of 98 patients with liver echinococcosis who underwent percutaneous (PAIR – 23 and PEVAC – 29 patients) and laparoscopic (46 patients) interventions was considered.Results. After the PAIR, a complication was noted in 1 (16.7%) case of isolated use with a CE3 cyst. Various complications were noted in 3 (60%) cases with a cyst puncture of more than 4 cm, and in 2 of them with CE2 and CE3. The average time for evacuating the cysts contents when performing the PEVAC technique was 5 days. Hemorrhagic fluid in drainage was noted in 6.9% of cases, biliary fistula – in 13.8%. Accumulation of fluid and suppuration in the residual cavity were identified in 34.5%. Taking into account the size of the cysts, the complication rate after PEVAC was 9.1% for cysts ≤6 cm vs 50% for cysts >6 cm. Various difficulties with manipulations during laparoscopic echinococcectomy were noted more often with CE2–4. So, difficulties with aspiration or removal of cyst contents more often arose with CE4. The incidence of complications after drainage removal was 17.9%, of which fluid accumulation was in 14.3% and residual cavity suppuration in 3.6% of cases.Conclusion. The US criteria, main indications and tactical and technical aspects for performing PAIR and PEVAC methods, as well as for performing laparoscopic echinococcectomy, and criteria for assessing the required volume of percytectomy for an adequate abdominalization of fibrous capsule have been clarified.
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Annals of HPB Surgery
Annals of HPB Surgery Medicine-Gastroenterology
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