超声引导下微波消融术对肝包虫病的治疗效果及术后感染危险因素分析

摘要/Abstract

摘要： 目的探讨超声引导下微波消融术对肝包虫病的治疗效果及术后感染危险因素。方法回顾性分析2020年8月—2022年4月玉树市人民医院收治的80例肝包虫病患者相关临床资料,依照患者应用的不同治疗方法进行分组,将32例采用常规开腹手术治疗的患者分为对照组,将48例采用超声引导下微波消融术的患者分为观察组。对所有患者进行1年随访,比较其并发症发生率。随后将术后是否发生感染的患者分成两个亚组,即感染组（21例）和非感染组（59例）,分析影响肝包虫病术后感染的危险因素,并应用多因素Logistic回归分析分析肝包虫病术后感染的独立影响因素。结果两组总有效率比较,差异无统计学意义（P>0.05）。观察组术后感染、腹水、胆漏、肝功能不全等并发症发生率高于对照组,差异有统计学意义（P<0.05）。非感染组和感染组患者性别、病变部位、合并高血压、高血脂、其他相关基础疾病、包虫分型、术后膈下积液或残腔情况比较,差异无统计学意义（P>0.05）;非感染组和感染组患者年龄、合并糖尿病、手术方式、引流管留置时间、肝包虫病史情况比较,差异有统计学意义（P<0.05）。多因素Logistic回归分析,年龄、合并糖尿病、手术方式、引流管留置时间、肝包虫病史属于肝包虫病术后感染的独立危险因素（OR=2.774,95% CI=1.876~4.010,P=0.016;OR=0.371,95% CI=1.876~4.010,P=0.021;OR=0.544,95% CI=1.876~4.010,P=0.009;OR=0.747,95% CI=1.876~4.010,P=0.024;OR=0.526,95% CI=1.876~4.010,P=0.013）。结论超声引导下微波消融术与常规开腹手术治疗肝包虫病均具有明显治疗效果,但采取超声引导下微波消融术可降低患者术后并发症发生率。对于年龄较大、合并糖尿病、具有肝包虫病史的患者,尽量采取微波消融术、减少引流管留置时间来预防术后感染的发生。

关键词: 超声引导下微波消融术, 肝包虫病, 术后感染, 危险因素, 并发症

Abstract: Objective To explore the therapeutic effect of ultrasound guided microwave ablation on liver hydatid disease and the risk factors of postoperative infection. Method The clinical data of 90 patients with hepatic echinococcosis admitted to Yushu People's Hospital from August 2020 to April 2022 were retrospectively analyzed. The patients were grouped according to different treatment methods. 32 patients treated with conventional open surgery were divided into control group, and 48 patients treated with ultrasound-guided microwave ablation were divided into observation group. All patients were followed up for 1 year to compare the incidence of complications. Subsequently, the patients with postoperative infection were divided into two subgroups, namely infected group (n=21) and non-infected group (n=59). The risk factors affecting postoperative infection of hepatic hydatidosis were analyzed, and logistic regression analysis was applied to analyze the independent influencing factors of postoperative infection of hepatic hydatidosis. Result The total response rate of the observation group was 89.58%, the total response rate of the control group was 87.50%. There was no statistical difference between the two groups (P>0.05). The incidence of postoperative complications such as infection, ascites, bile leakage, and liver insufficiency in the observation group was higher than that in the control group (P<0.05). There were no significant differences in gender, lesion site, combined hypertension, hyperlipidemia, other related underlying diseases, hydatid types, postoperative subphrenic effusion or residual cavity between the non-infected group and the infected group (P>0.05). There was no statistical significance in age, proportion of patients diagnosed with diabetes, surgical method, drainage indentation time and hepatic hydatid history between the non-infected group and the infected group (P<0.05). Age, proportion of patients diagnosed with diabetes, operation method, drainage indentation time and hepatic hydatid history were independent risk factors for postoperative infection of hepatic hydatid (OR=2.774, 95% CI=1.876~4.010, P=0.016; OR=0.371, 95% CI=1.876~4.010, P=0.021; OR=0.544, 95% CI=1.876~4.010, P=0.009; OR=0.747, 95% CI=1.876~4.010, P=0.024; OR=0.526, 95% CI=1.876~4.010, P=0.013). Conclusion Both ultrasound-guided microwave ablation and conventional open surgery have significant therapeutic effects on liver hydatid disease, but adopting ultrasound-guided microwave ablation can reduce the incidence of postoperative complications in patients. In addition, for older patients with diabetes and a history of liver echinococcosis, microwave ablation should be used as far as possible to reduce the drainage tube retention time to prevent postoperative infection.

Key words: ultrasound guided microwave ablation, hepatic hydatid disease, postoperative infection, risk factors, complication

中图分类号:

R656

更尕仁青. 超声引导下微波消融术对肝包虫病的治疗效果及术后感染危险因素分析[J]. 中华养生保健, 2024, 42(3): 45-49.

Genggarenqing. The Therapeutic Effect of Ultrasound-Guided Microwave Ablation on Hydatid disease of the Liver and Analysis of Risk Factors on Postoperative Infection[J]. ZHONGHUA YANGSHENG BAOJIAN, 2024, 42(3): 45-49.

参考文献

[1] AMAROZZI F, SILVA R, FITTIPALDO V A, et al.Serology for the diagnosis of human hepatic cystic echinococcosis and its relation with cyst staging: A systematic review of the literature with meta-analysis[J]. PLoS Negl Trop Dis,2021,15(4):e0009370.
[2] MÖNNINK G L E, STIJNIS C, VAN DELDEN O M, et al. Percutaneous Versus Surgical Interventions for Hepatic Cystic Echinococcosis: A Systematic Review and Meta-Analysis[J]. Cardiovasc Intervent Radiol,2021,44(11):1689-1696.
[3] AL-SAEEDI M, RAMOUZ A, KHAJEH E, et al.Endocystectomy as a conservative surgical treatment for hepatic cystic echinococcosis: A systematic review with single-arm meta-analysis[J]. PLoS Negl Trop Dis,2021,15(5):e0009365.
[4] 任国亮,李连生,苏伟,等.早期泡型肝包虫病患者超声引导下微波消融术后肝功能及营养指标变化[J].中西医结合肝病杂志,2022,32(6):506-508,512.
[5] 周留馨,郭雅,袁佳琪,等.肝包虫微波消融术后胆管支气管瘘1例报告[J].临床肝胆病杂志,2021,37(7):1673-1675.
[6] 于鹏,段绍斌.术前MELD评分对肝包虫病患者手术后并发症和远期预后的评估价值[J]. 肝脏,2023,28(2):229-232,237.
[7] 温浩,吐尔干艾力·阿吉,邵英梅.肝两型包虫病诊断与治疗专家共识(2019版)[J].中华消化外科杂志,2019,18(8):711-721.
[8] 魏倩,王艳,游岚岚,等.超声引导下微波消融治疗早期泡型肝包虫病患者疗效初步研究[J].实用肝脏病杂志,2020,23(4):593-596.
[9] 程晓雪,周臻涛,罗可.超声引导微波消融术个体化方案在危险部位肝癌治疗中的应用[J].中国医师杂志,2019,21(8):1139-1142.
[10] 徐奇奇,朱卫华,甘丽云,等.微波消融与手术切除治疗小肝癌的综合疗效比较[J].中华普通外科杂志,2021,36(9):649-652.
[11] 刘刚,甘郑宁,薛长菊,等.MRI在肝泡型包虫病患者微波消融术后疗效评估中的应用分析[J].中国CT和MRI杂志,2021,19(8):106-109.
[12] 赵永玲,王凯,王梅英,等.肝包虫病手术部位感染直接经济损失1∶1匹配病例对照研究[J].中国感染控制杂志,2023,22(3):322-327.
[13] 赵永玲,王梅英,王凯,等.肝包虫病患者手术部位感染危险因素的logistic回归分析[J].中国感染控制杂志,2022,21(3):280-286.
[14] 杨令鹏,邱逸闻,杨先伟,等.泡型肝包虫病手术安全切除距离的初步研究[J].中国普外基础与临床杂志,2022,29(4):512-516.
[15] 王正业,卡迪力亚·库尔班,吴淼,等.基于YOLOv5l的囊型肝包虫病病灶检测研究[J].电子技术应用,2022,48(7):25-29.