Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis, University of Pavia, via Brambilla 74, 27100 Pavia, Italy.
BMC Infect Dis. 2014 Sep 9;14:492. doi: 10.1186/1471-2334-14-492.
Available treatments for uncomplicated hepatic cystic echinococcosis (CE) include surgery, medical therapy with albendazole (ABZ), percutaneous interventions and the watch-and-wait (WW) approach. Current guidelines indicate that patients with hepatic CE should be assigned to each option based on cyst stage and size, and patient characteristics. However, treatment indications for transitional CE3b cysts are still uncertain. These cysts are the least responsive to non-surgical treatment and often present as indolent, asymptomatic lesions that may not warrant surgery unless complicated. Evidence supporting indications for treatment of this stage is lacking. In the attempt to fill this gap before the implementation of randomized clinical trials, we compared the clinical behavior of single hepatic CE3b cysts in 60 patients followed at the WHO Collaborating Centre for Cystic Echinococcosis of the University of Pavia.
We analyzed retrospectively data of 60 patients with hepatic CE3b cysts seen at our clinic over 27 years, who either received ABZ or were monitored with WW. Univariate and multivariate analysis were performed to investigate the effect on outcome (inactivation or relapse) of variables such as age, sex, origin, treatment, cyst size and presence of other echinococcal hepatic cysts using a multiple failure Cox proportional hazard model.
ABZ treatment was positively associated with inactivation (p < 0.001), but this was not permanent, and no association was found between therapeutic approach and relapse (p = 0.091). No difference was found in the rate of complications between groups.
In conclusion, our study shows that ABZ treatment induces temporary inactivation of CE3b cysts, while during WW cysts remain stable over time. As the rate of adverse events during periods of ABZ treatment and WW did not differ significantly in the follow-up period considered in this study (median 43 months, IQR 10.7-141.5), expectant management might represent a valuable option for asymptomatic CE3b cysts when strict indication for surgery is absent and patients comply with regular long-term follow-up.
复杂肝包虫病（CE）的现有治疗方法包括手术、阿苯达唑（ABZ）药物治疗、经皮介入和观察等待（WW）方法。目前的指南表明，应根据囊肿阶段和大小以及患者特征将肝 CE 患者分配到每种治疗方法。然而，CE3b 期过渡性囊肿的治疗指征仍不确定。这些囊肿对非手术治疗的反应性最差，通常表现为惰性、无症状病变，如果不合并其他并发症，可能无需手术。缺乏治疗该阶段的证据。在随机临床试验实施之前，为了填补这一空白，我们比较了在帕维亚大学世界卫生组织包虫病合作中心接受治疗的 60 名单一肝 CE3b 囊肿患者的临床行为。
我们回顾性分析了我们诊所 27 年来收治的 60 名肝 CE3b 囊肿患者的数据，这些患者要么接受 ABZ 治疗，要么接受 WW 监测。使用多因素失败 Cox 比例风险模型，对年龄、性别、来源、治疗、囊肿大小和其他肝包虫囊肿的存在等变量对结局（失活或复发）的影响进行单变量和多变量分析。
ABZ 治疗与失活呈正相关（p<0.001），但这种失活不是永久性的，治疗方法与复发之间没有关联（p=0.091）。两组之间的并发症发生率无差异。
总之，我们的研究表明，ABZ 治疗可诱导 CE3b 囊肿暂时失活，而在 WW 期间，囊肿随时间保持稳定。在本研究考虑的随访期间（中位数 43 个月，IQR 10.7-141.5），ABZ 治疗和 WW 期间不良事件的发生率无显著差异，因此当不存在严格的手术指征且患者遵守定期长期随访时，对于无症状的 CE3b 囊肿，期待管理可能是一种有价值的选择。
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