肝囊性包虫病术后复发胆囊并发症的影响因素探讨
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摘要
目的:分析、探讨肝囊性包虫术后复发患者胆囊并发症的影响因素。方法:回顾性分析2006年1月至2008年4月来我院肝胆包虫科就诊的84例复发的肝囊性包虫病患者胆囊并发症临床资料,多元回归和卡方检验分析可能的影响因素。结果:有手术指征的胆囊并发症的发生率为58.3%(49/84)。Logistic回归显示近第一肝门包虫囊直径(P=0.022)、包虫病病程(P=0.037)是肝囊性包虫病术后复发患者具有胆囊切除指征的并发症发生的重要影响因素(P<0.05),而包虫囊的数目、单个包虫囊最大直径、包虫囊直径总和与患者胆囊并发症的发生没有发现差异有显著性意义(P>0.05);χ2检验显示包虫囊在肝脏的位置也是患者胆囊严重并发症的影响因素(P<0.05)。结论:近第一肝门包虫囊直径越大、包虫病病程越长,患者胆囊严重并发症的发病率越高;包虫病灶在不同肝段对胆囊并发症也会产生影响,包虫囊位于肝脏Ⅰ段的患者胆囊严重并发症的发生率较高。同时由于胆囊并发症发生率较高,可以对患者常规行胆囊切除术。
Objective:To analyze and approach the impacted factors of gallbladder complications of patients with the recurrence of hepatic cyst echinococcosis(HCE).Methods :The clinical data of 84 patients with the recurrence of hepatic cystic echinococcosis between Jan.2006 and Apr.2008 were analyzed retrospectively in our hospital.Multivariate logistic regression analysis and chi-square criterion were used to investigate the correlation of some possible risk factors and gallbladder complications of these patients.Results:The total incidence of patients with gallbladder complications which had operation indication was 58.3%(49/84)in this research.Diameter of ectocyst of HCE near porta hepatis(P =0.022)、history of HCE (P =0.037) were related to the incidence of gallbladder complications of HCE by using multivariate logistic analysis; however, there was no significant difference in the incidengce of gallbladder complications of HCE among the number of ectocyst of HCE、the largest diameter of ectocyst and the diameter sumation of ectocyst; The location of cystic echinococcosis (P<0.05) also was the impacted factor for gallbladder complications of HCE by chi-square criterion Conclusion:It is indicated that diameter of ectocyst of HCE near porta hepatis、history of HCE were the impacted factors for higher incidence of serious gallbladder complications;What’s more,the location of cystic echinococcosis can also affected the incidence of serious gallbladder complications, especiallyⅠlobe in liver. And the patients should be rountely taken cholecystectomy because of high incidence of gallbladder complications.
Objective:To analyze and approach the impacted factors of gallbladder complications of patients with the recurrence of hepatic cyst echinococcosis(HCE).Methods :The clinical data of 84 patients with the recurrence of hepatic cystic echinococcosis between Jan.2006 and Apr.2008 were analyzed retrospectively in our hospital.Multivariate logistic regression analysis and chi-square criterion were used to investigate the correlation of some possible risk factors and gallbladder complications of these patients.Results:The total incidence of patients with gallbladder complications which had operation indication was 58.3%(49/84)in this research.Diameter of ectocyst of HCE near porta hepatis(P =0.022)、history of HCE (P =0.037) were related to the incidence of gallbladder complications of HCE by using multivariate logistic analysis; however, there was no significant difference in the incidengce of gallbladder complications of HCE among the number of ectocyst of HCE、the largest diameter of ectocyst and the diameter sumation of ectocyst; The location of cystic echinococcosis (P<0.05) also was the impacted factor for gallbladder complications of HCE by chi-square criterion Conclusion:It is indicated that diameter of ectocyst of HCE near porta hepatis、history of HCE were the impacted factors for higher incidence of serious gallbladder complications;What’s more,the location of cystic echinococcosis can also affected the incidence of serious gallbladder complications, especiallyⅠlobe in liver. And the patients should be rountely taken cholecystectomy because of high incidence of gallbladder complications.
引文
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[4] Zaouche A,Haouet K,Jouini M,et al.Management of liver hydatid cysts with a large biliocystic fistula:multicenter retrospective study [J] . World J Surg,2001,25 :28-39.
[5]吐尔干,邵英梅,赵晋明,等.37例肝囊型包虫破入胆道诊治分析[J].新疆医科大学学报,2006,29(5):431-342.
[6] Nurullah BULBULLER, Yavuz Selim LHAN, Cuneyt KIRKIL,et al.The results of surgical treatment for hepatic hydatid cysts in an endemic area[J].Turk J Gastro- enterol,2006,17(4):273-278.
[7] Goksoy E.,Saklak M, Saribeyoglu K, et al .Chirurgische Therapie bei Echinococcus- Zysten der Leber[J].Der Chirurg,2008,79(8):729-737.
[8]马旭阳,姜辉,张兴武.肝包虫术后残腔并发症的防治体会[J].宁夏医学院学报2008,30(2):220.
[9]赵玉元.肝包虫术后残腔并发症的防治(附173例报告)[J].兰州大学学报(医学版),2005,31(1):24-26.
[10] Benedetti, Nancy J. BS; Desser, Terry S. MD; Jeffrey, R. Brooke MD Imaging of Hepatic Infections. [J] Ultrasound Quarterly. 2008,24(4):267-278.
[11] Falagas ME,Bliziotis IA. Albendazole for the treatment of human echinococcosis: a review of comparative clinical trials. [J] American Journal of the Medical Sciences. 2007,334(3):171-9.
[12] Gabriel MS,DNB,MNAMS,et al.DNB+Management of Hydatid Disease (Echinoco- ccosis) in Pregnancy. [J] Obstetrical & Gynecological Survey. 2008, 63(2):116-123.
[13] Matthew E. MD, MSc, DSc; Bliziotis, Ioannis A. MD Albendazole for the Treatment of Human Echinococcosis: A Review of Comparative Clinical Trials. [J] American Journal of the Medical Sciences. 2007,334(3):171-179.
[14]洪源有,朱红燕.B超观察急性病毒性肝炎胆囊壁改变的临床价值[J].浙江中医药大学学报,2008,32(5):638-639.
[15]王姗.新疆民族地区脂肪肝与无脂肪肝患者胆结石发病率调查分析[J].中国疗养医学, 2005,14(1):30.
[16]周连锁,石景森,郝秀原,等.胆囊息肉样病变612例临床分析[J].华人消化杂志,1998,6(3):260.
[17] Zhao Feng-1in,Shi Jing-sen,Chen Ge,et al.Clinical Study on relationship between gallbladder carcinoma and gallstone[J].Chinese Journal of General Surgery,2001,10 (1):738-41.
[18]邹声泉,张林.全国胆囊癌临床流行病学调查报告[J].中国实用外科杂志,2000,20(1):43-45.
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