Diagnosis And Management Of Postoperative Complications For The 190 Patients With Hepatic Cystic Echinococcosis

Objectives:To study the type, causes, management and prevention of post internal capsule excision complications in patients with hepatic cystic echinococcosis (CE), and to explore new surgical procedure, optimize clinical idea, improve, to large extent, surgical effectiveness and reduce the relative post operative complications. Timely, properly and properly manage the complications and improve their quality of life. Methods:The clinical data of 190 patients with hepatic CE from inside and outside of xinjiang who were admitted to our hospital during Jan 2004 to Jan 2010 were retrospectively analayzed. Results:The major post internal capsule excision complications include recurrence, residual cavity and biliary complications.1) In situ recurrence and abdominal cavity plant were the two major complications, accounting for 68.42%(130/90). All cases in this group underwent re-operation. Among them 50 cases received internal capsule excision+residual cavity drainage and reoccurred in 4 cases;65 cases received total cystectomy,13 patients received sub-total cystectomy and 2 cases received partial hepatectomy with no recurrence.2) Among thoses 35 patients with biliary compilication,25 patients (13.16) combined with residual cavity infection,6 cases with intractable bile leakage (3.16%),2 patients with residual cavity effusion (1.05%),2 cases with residual cavity calsification (1.05%) and 1 case with residual cavity and elimentary tract fistula. All cases in this group achieved clinical cure through abccess wall excision and drainage, bile duct decompression, ultrasonographic guided puncture and partial hepatectomy.3) Among the 28 cases with biliary complication,19 cases combined with suppurative cholangitis (10%),9 cases with biliary stricture (4.74%). All cases in this group achieved clinical cure through bile duct decompression and cholangiojejunostomy. Conclusions:All the 190 patients with post internal capsule complications who admitted in our hospital were received timely and properly clinical management and received fine clinical effectiveness.1) The internal capsule excision were still the most popular procedure in different rank hospitals with the advantages of minimally invasion, feasibility and easily implementation. However, it showed relatively high recurrence rate, abdominal cavity plant rate, biliary fistula and retained cavity infection rate and lead to poor post operative quality of life and even threatening their lives.2) Well acquainted with the classification and cause of possible and common post-operative complication will maximally reduce the recurrence rate and release their pain and improve the quality of life.3) Timely and properly diagnosis and management for the post-operative complications are important. In this study, total cystectomy in patients with post-operative recurrence showed obvious effect and can avoid recurrence and bile fistula caused by classic internal cavity excision.4) For those complicated hepatic CE patients in who the lesions are adjacent to major vessels, vital organs and poor anatomical levels, the sub-total cystectomy will help to abolish the cavity, reduces the operation risk and recurrence rate.5) Biliary decompression and jejunostomy are the first choice for the biliary complications, the abscess wall excision and drainage, biliary-jejunostmy and B ultrsonography guided puncture are effective for treating the retained cavity complications. In conclusion, different rank hospital could choose the radical operation as the first choice. For those patients with complicated surgical conditions sub-radical operation chould be alternative. As the basic surgical procedure for CE patients, the modified internal capsule excision couled be widely implemented to reduce the different post-operative complications and to improve the post-operative quality of life.