Cilinical Analysis For The Patients With Hepatic Cystic Echinococcosis Combined In The Lungs

Objective:To discuss the efficiency and its clinical significance of on Hepatic cystic echinococcosis (HCE) combined in the Lung. Methods:Retrospective analyze the data of32cases of patients with HCE combined in the lungs which underwent one stage and two stage approaches from January2009to January2012Retrospective study on the data for32HCE patients with combined in the lungs has been analyzed which underwent one stage and two stage surgery from January1999to December2012, And all the cases divided into two groups as follows:Group A approach as one stage surgery and Group B as two stages surgery according to the operation approaches. The average hospitalization days, the average drainage time, average operation time, average length of incision, the residual cavity complications after surgery (biliary fistula, bronchial fistula and effusion), pneumonia and postoperative recurrence rate are compared between two groups. Evaluate treatment effects and meaning of one stage and two stage surgery. Surgical approaches including one stage and two stages surgery, Group A was one stage surgical treatments group(underwent operation procedures by abdomino-thracic incision at the same time), and Group B two stage surgical treatment group (namely two incision group, first underwent surgical treatment on pulmonary cystic echinococcosis,after from patient’s recovery the second operation procedure is underwent on hepatic hydatid cyst). There are two ways of one stage surgery-The chest incision hepatopulmonary hydatid cyst surgery and the abdominal incision hepatopulmonary hydatid cyst surgery. In the chest incision hepatopulmonary hydatid cyst surgery Endocystectomy is chief operative procedures for hepatic hydatid cyst,pulmonohydatid cyst surgery include the Pulmonohydatid cyst (PHC) Endocystectomy,closed drainage of chest, Wedge-shaped excision of lung. In the abdominal incision hepatopulmonary hydatid cyst surgery endocystectomy is most common procedure for pulmonary cyst, hepatic cyst surgery include endocystectomy, Partial pericystectomy, pericystectomy.liver resection ect. In two stages surgery Types of pulmonary cyst surgery methods same with one stage chest incision pulmonary cyst surgery, Types of hepatic hydatid cyst surgery methods same with one stage abdominal incision hepatic hydatid cyst surgery. By using statistics compared intraoperative situation and postoperative complication between the two groups, the hospitalization days, total number of drainage tubes, drainage times, average hospital expenses, total operation times, total intraoperative blood losing are compared by T test, the residual cavity complications after surgery (biliary fistula, bronchial fistula, effusion), pneumonia, postoperative liver function and postoperative recurrence rate are compared by Χ2test and discus the differences of surgical efficiency of two types surgery.Results:There were no statistical difference on age and gender between Group A and Group B. In Group A the hospitalization day16.69±7.85day, the total of drainage time14.00±11.91day, the cost of hospitalization23062.95±4135.60Yuan, average number of drainage tubes2.19±0.40,the mean operative time3.91±1.20hour, the total length of incision15.63±4.03cm, In Group B the hospitalization day26.56±12.89day, the total drainage time17.44±3.81day, cost of hospitalization39856.14±7203.75Yuan, the number of drainage tubes3.19±0.75, mean operation time4.75±0.82hours, total length of incision26.38±5.68cm, there is significant statistical differences between two groups (P<0.05); Blood losing were148.13±218.67ml and237.50±142.95ml respectively in each group, there is no significant differences between two groups (P>0.05),residual cavity complications (biliary fistula, bronchial fistula, residual cavity infection), incidence of pleural effusion, pneumonia, there is no significant differences between two group(P>0.05). Conclusions: One stage approach can be considered as feasible for the HCE cases combined in the lungs as same side, single lesion and hepatic cyst nearer to diaphragm. The chest incision one stage hepato-pulmonary HC surgery was also tractable for the patients Pulmonary CE ruptured and located under the lower lobes of lungs and mediastinum, The abdominal incision one stage hepato-pulmonary CE surgery approach as ideal for the situation like pulmonary CE smaller than that hepatic CE, and single concomitant larger, multiple liver lesions, lesions were adjacent to large blood vessels or bile duct, For the patients like two parts of CE lesions showing not on the same side, the mutual locations are farther and critical two stage operation ideal procedure. But HCE combined in the lungs more complex than single hepatic cyst or pulmonary cyst, there is no complete operation mode. Therefore, choosing the appropriate surgical approach and surgical method on basis of disease is the best way to improve the cure rate, prevent the recurrences.