Jabbour Nicolas, Shirazi Sherin K, Genyk Yuri, Mateo Rod, Pak Eddy, Cosenza D Carlos, Peyré Christian G, Selby Robert Rick
Division of Hepatobiliary/Pancreatic Surgery and Abdominal Organ Transplantation, University of Southern California, LAC/USC, Los Angeles, California 90033, USA.
Am Surg. 2002 Nov;68(11):984-8.
Increased worldwide travel and immigration have led to an increase in the incidence of hepatic hydatid disease outside of endemic areas. In nonendemic areas lack of familiarity with the disease may lead to a delay in diagnosis with increased risk for development of complicated disease. Complicated disease is defined as: infected cysts, cysts with a hyperechoic solid pattern or calcified walls, or cysts with biliary rupture. Over a 6-month period six patients with complicated hydatid disease were referred to our institution. All six patients were immigrants from endemic areas and were found to have complicated hepatic hydatid disease including cholangitis and intrabiliary rupture. Patients were treated with oral albendazole for 3 weeks before operation and oral praziquantel for 2 days preoperatively. Surgical therapy consisted of subtotal cystectomy, cholecystectomy in all patients, and cystic duct biliary decompression-drainage in five patients. The one patient without biliary drainage developed a postoperative bile leak that resolved with endoscopic biliary stenting. All patients received albendazole for 3 months postoperatively and were free of disease at 6 to 24 months follow-up. We conclude that although nonoperative management with percutaneous drainage or medical management alone may be successful in patients with uncomplicated disease operation remains the therapy of choice for complicated hydatid disease.
全球范围内旅行和移民的增加导致了非流行地区肝包虫病发病率的上升。在非流行地区，对该疾病缺乏了解可能导致诊断延迟，进而增加发生复杂疾病的风险。复杂疾病定义为：感染性囊肿、具有高回声实性模式或钙化壁的囊肿，或伴有胆管破裂的囊肿。在6个月的时间里，有6例复杂包虫病患者被转诊至我院。所有6例患者均为来自流行地区的移民，均被发现患有包括胆管炎和胆管内破裂在内的复杂肝包虫病。患者在手术前口服阿苯达唑3周，术前口服吡喹酮2天。手术治疗包括次全囊肿切除术，所有患者均行胆囊切除术，5例患者行胆囊管胆管减压引流术。1例未行胆管引流的患者术后发生胆漏，经内镜胆管支架置入后得以解决。所有患者术后均接受阿苯达唑治疗3个月，在6至24个月的随访中均无疾病复发。我们得出结论，尽管对于非复杂疾病患者采用经皮引流或单纯药物治疗的非手术管理可能会成功，但手术仍然是复杂包虫病的首选治疗方法。
