多脏器复发性包虫病术后再发伴膀胱及结肠侵犯一例

A Case of Recurrent Polymorphic Hydatidosis with Bladder and Colon Involvement after Multiple Operations

摘要: 总结多灶性肝包虫病(细粒棘球蚴病)青少年患者的临床特点、影像学表现、外科手术策略及围手术期管理经验，为边疆地区复杂多灶包虫病的诊疗提供临床参考。方法：回顾性分析阿勒泰地区人民医院收治的1例12岁回族男性多灶性肝包虫病患者的完整临床资料，包括病史采集、影像学检查、实验室检验、手术过程、术后随访及预后情况，梳理诊疗思路并总结手术要点。结果：患者以间歇性上腹痛半年、进行性加重为主要表现，腹部增强CT提示肝内多发囊性占位，考虑肝包虫病；完善术前评估后行右肋缘下反L切口开腹肝包虫外囊完整切除术 + 胆囊切除术，术中完整剥离多发包虫病灶，手术过程平稳，术后复查CT提示病灶切除完整，患者恢复顺利出院。结论：多灶性肝包虫病在儿童青少年人群中相对罕见，依靠影像学早期明确病灶分布、精准规划手术入路与切除范围，采用外囊完整剥除术可有效降低术后复发及囊液播散风险，对于北疆牧区青少年复杂包虫病具有良好的临床疗效。

Abstract: A retrospective analysis was performed on the complete clinical data of a 12-year-old male Hui patient with multifocal hepatic echinococcosis admitted to Altay Prefectural People’s Hospital, including medical history collection, imaging examinations, laboratory tests, surgical procedures, postoperative follow-up and prognosis. The diagnostic and therapeutic workflow was sorted out, and key surgical techniques were summarized. Results: The patient presented with intermittent upper abdominal pain for half a year with progressive aggravation as the chief complaint. Contrast-enhanced abdominal computed tomography (CT) revealed multiple cystic space-occupying lesions in the liver, highly suggestive of hepatic echinococcosis. After comprehensive preoperative evaluation, open complete pericystectomy of hepatic echinococcosis plus cholecystectomy was performed via an inverse L-shaped subcostal right incision. All multifocal echinococcal lesions were completely enucleated intraoperatively with stable surgical procedure. Postoperative CT reexamination confirmed total resection of lesions, and the patient recovered uneventfully and was discharged. Conclusions: Multifocal hepatic echinococcosis is relatively rare in children and adolescents. Early identification of lesion distribution via imaging allows precise planning of surgical approach and resection range. Complete pericystectomy can effectively reduce the risks of postoperative recurrence and cyst fluid spillage, yielding satisfactory clinical outcomes for complex echinococcosis in adolescents from pastoral areas of northern Xinjiang.