Guntz M, Coppo B, Lorimier G, Cronier P
Clinique Chirurgicale A, CHRU Angers.
J Chir (Paris). 1990 Aug-Sep;127(8-9):375-81.
The very late observation of an hydatid cyst of the liver, after clinical or fortuitous signs (intraoperative, ultrasound, CT) is a highly underestimated possibility. From 4 cases of hydatid cysts of the liver which were removed 10 to 22 year after a pulmonary hydatidosis, any possibility of parasitic reinfestation during this time being excluded, the authors propose a physiopathological explanation to an often very long clinical latency period of the liver hydatidosis. Indeed the pulmonary location of the hydatid disease means that the hepatic filter did not properly operate or was bypassed, but it does not exclude a simultaneous intrahepatic graft. The literature study shows a 4 to 8.4% rate of concomitant liver-lung location according to the statistical data provided by thoracic and digestive surgery departments. The percentage reaches 25% when ultrasounds and abdominal computed tomography are systematically used. The rapid growth of the hydatid cyst in the lung can be explained by the low resistance of the lung parenchyma and vasculo-bronchial structure to the intracystic pressure, whereas in the liver, the hydatid cyst growing is stopped by a dense parenchyma and the hepatobiliary capsules. When fissuring or large opening in the biliary tract occurs the intracystic pressure drops, the pericyst becomes sclerotic, calcified. The combination of these different factors all the more contributes to the cyst involution since it presents a central topography.
在出现临床症状或偶然体征（术中、超声、CT）之后才很晚发现肝包虫囊肿，这种可能性被严重低估了。从4例在肺包虫病发生10至22年后才切除的肝包虫囊肿病例来看，排除了在此期间寄生虫再次感染的任何可能性，作者针对肝包虫病通常很长的临床潜伏期提出了一种病理生理学解释。实际上，包虫病的肺部定位意味着肝脏的过滤功能未正常发挥或被绕过，但这并不排除同时存在肝内寄生。文献研究表明，根据胸外科和消化外科提供的统计数据，肝肺同时受累的发生率为4%至8.4%。当系统地使用超声和腹部计算机断层扫描时，这一百分比可达25%。肺内包虫囊肿的快速生长可归因于肺实质和血管支气管结构对囊内压力的低抵抗力，而在肝脏中，包虫囊肿的生长会因致密的实质和肝胆包膜而停止。当胆道出现破裂或大的开口时，囊内压力下降，包囊周围组织变硬、钙化。由于囊肿处于中央位置，这些不同因素的共同作用更有助于囊肿的退化。
