Ben Brahim Mohamed, Nouri Abdellatif, Ksia Amine, El Ezzi Oumama, Krichene Imed, Mekki Mongi, Belghith Mohsen
Department of Pediatric Surgery, Fattouma Bourguiba Hospital, 5000 Monastir, Tunisia.
J Pediatr Surg. 2008 Nov;43(11):2024-30. doi: 10.1016/j.jpedsurg.2008.04.024.
BACKGROUND/PURPOSE: Multiple echinococcosis (ME) is a severe disease in childhood inaccessible to an initial radical surgical treatment. The aim of this study was to evaluate the efficacy of Albendazole in ME and to discuss the role of surgery in this pathology.
Eleven patients were included in a prospective study between 1996 and 2004. ME was defined by the presence of 10 or more cysts in the same organ. Albendazole was given as 10 mg/kg daily continuously. Treatment outcome was defined as cure, improvement, stabilization or deterioration. Surgery was discussed after 1 year of treatment.
Our patients totalized 296 cysts located essentially on the liver (178 cysts) and the lungs (78 cysts). With exclusive Albendazole therapy, 57.7% pulmonary cysts and 96% peritoneal cysts were considered as cured. This rate was only 31.5% in hepatic localization. After surgical therapy, 67.4% of hepatic cysts were cured. No productive biliary fistula was observed. Two patients were operated laparoscpically. The total treatment duration ranged between 1 and 5 years. Parasitologic examination of operated cysts showed that 30% of them were viable even after 3 years of treatment.
Albendazole has proven a strong efficacy in pulmonary and peritoneal localizations. A complementary surgical treatment is often necessary in hepatic localizations and it is facilitated with previous Albenazole therapy. Combination of ABZ and surgery seems to have encouraging results and must be applied for those patients. The high rate of viable cysts after medical therapy is problematic and must incite to develop new antihelminthic agents.
背景/目的：多囊包虫病（ME）是一种儿童期的严重疾病，无法进行初次根治性手术治疗。本研究的目的是评估阿苯达唑治疗ME的疗效，并探讨手术在这种病理状况中的作用。
1996年至2004年间，11名患者纳入一项前瞻性研究。ME定义为同一器官内存在10个或更多囊肿。阿苯达唑每日按10mg/kg持续给药。治疗结果定义为治愈、改善、稳定或恶化。治疗1年后讨论是否进行手术。
我们的患者共有296个囊肿，主要位于肝脏（178个囊肿）和肺部（78个囊肿）。仅采用阿苯达唑治疗时，57.7%的肺囊肿和96%的腹膜囊肿被视为治愈。肝部囊肿的治愈率仅为31.5%。手术治疗后，67.4%的肝囊肿被治愈。未观察到有胆汁瘘形成。两名患者接受了腹腔镜手术。总治疗时长介于1至5年之间。对手术切除囊肿的寄生虫学检查显示，即使在治疗3年后，仍有30%的囊肿存活。
阿苯达唑已证明在肺部和腹膜部位有强效。肝部病变通常需要辅助手术治疗，而先前的阿苯达唑治疗有助于手术进行。阿苯达唑与手术联合似乎有令人鼓舞的结果，必须应用于这些患者。药物治疗后存活囊肿的高比例是个问题，必须促使研发新的抗蠕虫药物。
