探讨肝包虫囊肿破裂的相关因素及疗效。

计算机检索1988年1月至2014年12月在PubMed、ISI Web of Knowledge、CNKI、Google Scholar、EMBASE、万方数据库、维普公开发表的关于肝包虫囊肿破裂文献50篇。中英文检索词：肝包虫囊肿、破裂、hydatid cyst echinococcosis、rupture。纳入27篇文献分析，包括国外9篇，国内18篇，共2 511例，其中发生肝包虫囊肿破裂731例。分析囊肿破裂的相关因素、诊治措施及疗效。

731例肝包虫囊肿破裂患者中，男467例，女264例；年龄11～69岁，中位年龄32岁。中国690例，土耳其25例，印度15例，非洲1例。囊肿位于肝右叶者200例，肝左叶36例，未提供者495例。发生破裂的囊肿直径>10 cm者103例，5～10 cm者8例，未提供者620例。外伤性破裂93例，自发性破裂42例，医源性破裂4例，腹内压增高2例，未提供者590例。处理以急诊手术为主，破入胆道者以胆道清洗+T管引流为主；破入腹腔者以内囊摘除术、肝部分切除术+腹腔灌洗为主。术后多使用阿苯达唑1.5～12.0个月。术后随访时间0.5～4.0年。随访期间复发28例，未复发404例，未提供者299例。存活447例，误诊、死亡22例，未提供者262例。

肝包虫囊肿破裂多见于流行地区中青年男性，位于肝右叶、囊肿直径>10 cm、外伤为破裂的主要相关因素；紧急手术彻底清除病灶及囊液是治疗关键，术后应用阿苯达唑可有效预防肝包虫囊肿复发。

To investigate the relevant factors and treatment effect of liver hydatid cyst rupture.

Fifty literatures related to liver hydatid cyst rupture published between January 1988 and December 2014 were electronically retrieved from PubMed, ISI Web of Knowledge, CNKI, Google Scholar, EMBASE, Wanfang database and VIP database. The Chinese and English keywords were liver hydatid cyst, hydatid cyst echinococcosis and rupture. Twenty-seven literatures consisted of 9 foreign studies and 18 domestic studies. Among 2 511 patients, 731 cases were diagnosed with liver hydatid cyst rupture. The relevant factors, diagnostic and therapeutic measures and treatment effect of liver hydatid cyst rupture were analyzed.

Among 731 patients with liver hydatid cyst rupture, 467 cases were male and 264 were female, aged 11-69 years old with a median age of 32 years old. Among them, 690 cases were from China, 25 from Turkey, 15 from India and 1 from Africa. The liver hydatid cysts of 200 cases were found in the right lobe and 36 cases in the left lobe, while no information about 495 cases. 103 cases were found with the ruptured cysts diameter >10 cm, 8 cases were 5-10 cm, while no information about 620 cases. Among them, 93 cases were diagnosed with traumatic rupture, 42 with spontaneous rupture, 4 with iatrogenic rupture, 2 with intra-abdominal pressure elevation and no data in 590. Emergency surgery was primarily adopted. Biliary tract irrigation combined with T catheter drainage was performed for patients with biliary tract involvement, and endocystectomy or partial hepatectomy combined with peritoneal lavage was performed for patients with abdominal cavity involvement. Postoperatively, albendazole was administered for 1.5-12.0 months in most patients. The postoperative follow-up time was 0.5-4.0 years. During follow-up, liver hydatid cyst recurred in 28 cases, no recurrence in 404 and no data in 299. For the treatment effect, 447 cases survived, 22 were misdiagnosed or died and no data in 262.

Liver hydatid cyst rupture is mainly found in middle aged males in endemic area. Locating in the right lobe of liver, cyst diameter >10 cm and trauma are the primary relevant factors for rupture. Emergency operation to thoroughly eliminate the lesions and cystic fluid is the crucial procedure. Postoperative administration of albendazole can effectively prevent the recurrence of liver hydatid cyst.