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目的探讨回顾总结我院2003年-2012年10年间82例肝恶性包虫病(肝泡球蚴病)的治疗体会。方法将本组82例按PNM分期分为早期、早-中期、中-晚期及晚期,早期(P0-1N0M0)11例,早-中期(P1-2N0-1M0)29例,中-晚期(P2-3N1M0)26例,晚期(P3-4N1M1)16例;根据手术方案,为根治性手术(早期,早-中期)36例,姑息性手术(中期、中-晚期)28例,化疗及综合治疗(晚期)19例,并对其疗效评价进行分析。结果(1)根治性切除病例随访3~5年,术后出现残腔积液感染2例,胆漏1例,肝功能衰竭2例,3年后复发1例,4年后远处转移2例,2例局部复发,均行化疗治愈;(2)姑息性手术治疗病例中,1年后死亡2例,两年后死亡3例,1年后局部复发3例,3年后远处转移3例,术后出现残腔感染11例,胆瘘9例,肝功能衰竭13例,均行化疗综合治疗,1年后再次行根治性手术2例,2年后再次行根治性手术1例,均恢复良好;(3)晚期病例均行化疗及综合治疗,其中4例因病灶中间液化灶较大并感染,给予手术置管引流,术后化疗2年后1例行根治性手术,5例在B超引导下PTC置管引流,术后化疗2年后1例行根治性手术。结论对早期、早-中期病例尽可能行根治性切除术+化疗可达到治愈目的,对中-晚期及晚期病例先化疗及综合治疗,待病情稳定或病灶缩小后争取根治性手术或有条件考虑行肝移植手术较为理想,对多脏器转移者先化疗,对脏器功能影响较大的泡球蚴病先行手术治疗,再行化疗为妥。
Objective To review and summarize 82 cases of malignant hydatidosis (hepatic alveolar echinococcosis) treated in our hospital from 2003 to 2012. Methods According to the PNM classification, 82 patients were divided into two groups: early, middle-early, middle-late, advanced-late, early-stage and early-stage (P1-1N0M0) 36 patients underwent radical surgery (early, early-middle stage), 28 patients underwent palliative surgery (mid-term, medium-late), chemotherapy and comprehensive treatment (Late) 19 cases, and its efficacy evaluation analysis. Results (1) The cases of radical resection were followed up for 3 to 5 years. There were 2 cases of residual effusion infection, 1 case of bile leakage, 2 cases of liver failure, 1 case of recurrence 3 years later and 4 years distant metastasis 2 2 cases of local recurrence, were treated with chemotherapy to cure; (2) palliative surgery cases, 1 died after 2 cases, 3 died after 2 years, 1 year after local recurrence in 3 cases, 3 years after the distant metastasis 3 cases, postoperative residual cavity infection in 11 cases, 9 cases of biliary fistula, 13 cases of liver failure, were treated with chemotherapy, radical surgery after 1 year again in 2 cases, 2 years after another radical surgery in 1 case , All recovered well; (3) Chemotherapy and comprehensive treatment were performed in the advanced stage, of which 4 cases were treated with catheterization and drainage due to the larger central lesion in the lesion and radical surgery after 2 years of postoperative chemotherapy, 5 In the case of B-guided PTC catheter drainage, postoperative chemotherapy 2 cases after radical surgery. Conclusions Radical resection combined with chemotherapy can achieve the goal of cure in early and early-middle-stage cases as far as possible. Chemotherapy and comprehensive treatment of middle-, late- and late-stage patients should be treated first and then treated conservatively or conditionally after condition stabilization or lesion reduction Liver transplantation surgery is more ideal for multiple organ metastasis of the first chemotherapy, the greater impact on organ function alveolar hydatid disease surgery, re-chemotherapy is appropriate.