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包虫囊肿的进行性生长会侵蚀其周围的器官和组织.作者从1974年至1994年共手术治疗了444例肝包虫病患者,本文回顾性研究了其中19例累及膈肌或经膈肌累及胸腔的肝膈面包虫病例,提出了本病的一种简易分级法及外科观点的一些改变.作者根据本病的发展过程及程度将患者分成5级.1级:囊肿与膈肌紧密粘连但未穿透;2级:囊肿穿透膈肌但仅轻微侵犯胸腔;3级:囊肿穿透膈肌,在胸腔生长并种植子囊;4级:病变累及肺实质;5级:合并慢性支气管瘘.肝膈面包虫囊肿若累及膈肌或经膈肌累及胸腔并靠近肝静脉、下腔静脉,手术风险就高.胸部平片、超声、CT及MRI可确定分级并可依此选择切口、决定手术方式及判断手术危险性.通常推荐的手术方法是经胸或胸腹联合切口行肝囊肿单纯引流,但近来提出的一种术式是经腹部右肋缘下大切口行闭合或开放式囊肿及其外囊全切或次全切除.本组19例患者中9例为1984年前采用胸膈腹联合切口显露术野,此后作者常规行延及左锁骨中线的左肋缘下大切口.其优点在于:(1)能充分显露术野,可以游离肝,能更完全地行肝囊肿及外囊的全切或次全切除;(2)探查胆道比较容易;(3)如果需要,可经膈肌切口将与肺粘连的囊肿切除或不规则切除肺组织;(4)减少胸膈腹联合切口的并发症.本组共治疗了19例患者的24个囊肿,16个全切,8
Progressive growth of hydatid cysts will erode the surrounding organs and tissues. From 1974 to 1994, a total of 444 patients with hepatic hydatid disease were treated surgically. In this retrospective study, 19 cases involving the diaphragm or diaphragmatic involvement of the thoracic cavity Of the liver diaphragmatic hydatid disease cases, put forward a simple classification of the disease and some changes in surgical point of view of the disease according to the development of the disease and the patient will be divided into five levels: Level 1: cyst and diaphragm adhesion but did not wear Level 2: The cyst penetrates the diaphragm but only slightly invades the thoracic cavity; Level 3: The cyst penetrates the diaphragm and grows in the thoracic cavity and grows astigmatism; Grade 4: Lesions involve the lung parenchyma; Grade 5: Combined with chronic bronchial fistula. If involving cyst involving the chest or diaphragm via the diaphragm and adjacent hepatic vein, inferior vena cava, the risk of surgery is high. chest radiography, ultrasound, CT and MRI may be so selected and determined classification incision, and the decision is determined surgical risk of surgery Often recommended surgery is a simple thoracotomy or thoracoabdominal incision hepatic cyst drainage, but recently proposed a surgical approach is through the abdominal right big margin under the right incision line closure or open cyst and its outer capsule cut or Times full In addition to this group of 19 patients, 9 cases of the use of the chest abdominal diaphragm incision combined with the operative field before 1984, after which the authors routine extension and left subclavian midline of the left costal incision with the following advantages: (1) to fully Revealed the surgical field, can free the liver, can more completely line hepatic cysts and outer capsular or subtotal resection; (2) exploration of the bile duct easier; (3) if necessary, Resection or irregular removal of lung tissue; (4) to reduce the complications of abdominal incision of the abdominal cavity in this group were treated in 19 patients with 24 cysts, 16 total, 8