Bedioui H, Ayari H, Bouslama K, Maghrebi H, Hsairi H, Jouini M, Kacem J-M, Safta Z Ben
Service de chirurgie, hôpital La Rabta, faculté de médecine de Tunis, Tunis, Tunisie.
Bull Soc Pathol Exot. 2012 Oct;105(4):265-9. doi: 10.1007/s13149-012-0243-z. Epub 2012 Sep 7.
Cystic echinococcosis is a public health problem. Surgery represents the basic treatment and the surgeon is regularly faced with the choice of the appropriate surgical procedure (radical versus conservative surgical approach). The conservative procedure is safe and easy but can lead to a recurrence in the site of residual cavity. The aim of this study was to evaluate the predictive factors of the recurrence of hepatic hydatid cysts, to optimize surgical management and to implement preventive measures. The current retrospective study included 391 patients with hepatic hydatid cysts operated at our institution from 1996 to 2006. The diagnosis of recurrence was suspected by radiological survey and confirmed at laparotomy. The univariate study of predictive factors of recurrence was based on the Fisher test and the multivariate one on the logistic regression model. The recurrence rate reached 12% in our study with an average period of 50 months. Univariate analysis showed that the predictive factors of recurrence were: the rural origin of patients, the voluminous cysts larger than 7 cm, and unilocular hydatid cyst. Multivariate analysis showed that only voluminous cysts and unilocular ones were the predictive factors of recurrence. The unilocular and voluminous hydatid cysts represent the cysts that relapse frequently because of their immunogenic character and the presence of exocysts in the pericysts. This is very important for the therapeutic strategy the main aim of which is to prevent the recurrence.
囊性棘球蚴病是一个公共卫生问题。手术是基本的治疗方法，外科医生经常面临选择合适手术方式（根治性手术与保守性手术）的问题。保守性手术安全且操作简单，但可能导致残余腔隙部位复发。本研究的目的是评估肝包虫囊肿复发的预测因素，优化手术管理并实施预防措施。当前的回顾性研究纳入了1996年至2006年在我们机构接受手术的391例肝包虫囊肿患者。通过影像学检查怀疑复发，并在剖腹手术时得到证实。复发预测因素的单因素研究基于Fisher检验，多因素研究基于逻辑回归模型。在我们的研究中，复发率达到12%，平均复发时间为50个月。单因素分析显示，复发的预测因素为：患者来自农村、囊肿体积大于7 cm以及单房性包虫囊肿。多因素分析显示，只有体积较大的囊肿和单房性囊肿是复发的预测因素。单房性和体积较大的包虫囊肿因其免疫原性特征以及包囊周围存在外囊而成为经常复发的囊肿。这对于主要目的是预防复发的治疗策略非常重要。
