Odev K, Paksoy Y, Arslan A, Aygün E, Sahin M, Karaköse S, Baykan M, Arikoğlu H, Aksoy F
Department of Radiology, Selçuk University, Faculty of Medicine, 42080 Konya, Turkey.
J Clin Ultrasound. 2000 Nov-Dec;28(9):469-78. doi: 10.1002/1097-0096(200011/12)28:9<469::aid-jcu4>3.0.co;2-f.
The purpose of this study was to evaluate the safety and efficacy of sonographically guided percutaneous drainage and irrigation of hepatic hydatid cysts.
Sixty-one patients with 84 hepatic hydatid cysts were treated using the puncture, aspiration, injection, and reaspiration (PAIR) technique under sonographic guidance. Patients with cysts larger than 6 cm in diameter underwent PAIR followed by percutaneous drainage (PAIR-PD). The cysts were sterilized by the injection of 1 of 2 scolicidal agents, 20% hypertonic saline solution (38 patients) or 0.5% silver nitrate (23 patients). All patients underwent follow-up examinations for 1 month-6 years after aspiration. Clinical and radiologic examinations and laboratory analyses were performed every month for the first 6 months and then at 3-month intervals.
Serial sonographic examinations revealed a heterogeneous echo pattern in 78 cysts (93%); a progressive decrease in diameter in 76 cysts (90%); calcification of the cyst wall, cystic contents, or both in 10 cysts (12%); and complete disappearance of 1 cyst (1%) in a patient who had been monitored for over 6 years. Five patients developed urticaria, and 6 developed fever. One patient developed a biliary fistula after the first aspiration attempt. Two patients developed infection of the cyst cavity after PAIR-PD and were successfully treated with oral antibiotics. An anaphylactic reaction developed in 2 patients and was successfully treated with antiallergenic medication. No recurrence of hydatid disease after PAIR or PAIR-PD was observed in any patient over the follow-up period of 72 months (mean, 26 +/- 27 months).
Percutaneous drainage of hydatid cysts is a safe, effective, and reliable treatment. Antiallergenic medication is required before PAIR or PAIR-PD. Both sclerosing agents, hypertonic saline and silver nitrate solutions, gave excellent results.
本研究旨在评估超声引导下经皮肝包虫囊肿穿刺引流及灌洗的安全性和有效性。
对61例患有84个肝包虫囊肿的患者在超声引导下采用穿刺、抽吸、注射及再抽吸（PAIR）技术进行治疗。直径大于6 cm的囊肿患者先接受PAIR，然后进行经皮引流（PAIR-PD）。通过注射两种杀头节剂之一对囊肿进行消毒，即20%高渗盐水溶液（38例患者）或0.5%硝酸银（23例患者）。所有患者在抽吸后接受1个月至6年的随访检查。最初6个月每月进行临床、影像学检查及实验室分析，之后每3个月进行一次。
系列超声检查显示，78个囊肿（93%）回声不均匀；76个囊肿（90%）直径逐渐减小；10个囊肿（12%）囊肿壁、囊内容物或两者出现钙化；1例接受超过6年监测的患者囊肿完全消失（1%）。5例患者出现荨麻疹，6例出现发热。1例患者在首次抽吸尝试后发生胆瘘。2例患者在PAIR-PD后出现囊肿腔感染，经口服抗生素成功治疗。2例患者发生过敏反应，经抗过敏药物成功治疗。在72个月（平均26±27个月）的随访期内，未观察到任何患者在PAIR或PAIR-PD后出现包虫病复发。
经皮肝包虫囊肿引流是一种安全、有效且可靠的治疗方法。在PAIR或PAIR-PD前需要使用抗过敏药物。两种硬化剂，即高渗盐水和硝酸银溶液，效果均良好。
