Gomez I Gavara Concepción, López-Andújar Rafael, Belda Ibáñez Tatiana, Ramia Ángel José M, Moya Herraiz Ángel, Orbis Castellanos Francisco, Pareja Ibars Eugenia, San Juan Rodríguez Fernando
Concepción Gomez i Gavara, Rafael López-Andújar, Ángel Moya Herraiz, Francisco Orbis Castellanos, Eugenia Pareja Ibars, Fernando San Juan Rodríguez, Hepatobiliopancreatic Surgery and Transplantation Unit, La Fe University Hospital, 46026 Valencia, Spain.
World J Gastroenterol. 2015 Jan 7;21(1):124-31. doi: 10.3748/wjg.v21.i1.124.
A review was carried out in Medline, LILACS and the Cochrane Library. Our database search strategy included the following terms: "hydatid cyst", "liver", "management", "meta-analysis" and "randomized controlled trial". No language limits were used in the literature search. The latest electronic search date was the 7(th) of January 2014.
all relevant studies on the assessment of therapeutic methods for hydatid cysts of the liver were considered for analysis. Information from editorials, letters to publishers, low quality review articles and studies done on animals were excluded from analysis. Additionally, well-structured abstracts from relevant articles were selected and accepted for analysis. Standardized forms were designed for data extraction; two investigators entered the data on patient demographics, methodology, recurrence of HC, mean cyst size and number of cysts per group. Four hundred and fourteen articles were identified using the previously described search strategy. After applying the inclusion and exclusion criteria detailed above, 57 articles were selected for final analysis: one meta-analysis, 9 randomized clinical trials, 5 non-randomized comparative prospective studies, 7 non-comparative prospective studies, and 34 retrospective studies (12 comparative and 22 non-comparative). Our results indicate that antihelminthic treatment alone is not the ideal treatment for liver hydatid cysts. More studies in the literature support the effectiveness of radical treatment compared with conservative treatment. Conservative surgery with omentoplasty is effective in preventing postoperative complications. A laparoscopic approach is safe in some situations. Percutaneous drainage with albendazole therapy is a safe and effective alternative treatment for hydatid cysts of the liver. Radical surgery with pre- and post-operative administration of albendazole is the best treatment option for liver hydatid cysts due to low recurrence and complication rates.
在Medline、LILACS和Cochrane图书馆进行了一项综述。我们的数据库检索策略包括以下术语:“包虫囊肿”、“肝脏”、“治疗”、“荟萃分析”和“随机对照试验”。文献检索未设语言限制。最新电子检索日期为2014年1月7日。
所有关于肝包虫囊肿治疗方法评估的相关研究均纳入分析。社论、给出版商的信件、低质量综述文章以及动物研究的信息均排除在分析之外。此外,选取并接受相关文章结构良好的摘要进行分析。设计标准化表格用于数据提取;两名研究人员录入患者人口统计学、方法学、肝包虫病复发情况、平均囊肿大小及每组囊肿数量的数据。使用上述检索策略共识别出414篇文章。应用上述详细的纳入和排除标准后,选取57篇文章进行最终分析:1篇荟萃分析、9项随机临床试验、5项非随机对照前瞻性研究、7项非对照前瞻性研究以及34项回顾性研究(12项对照研究和22项非对照研究)。我们的结果表明,单纯抗蠕虫治疗并非肝包虫囊肿的理想治疗方法。文献中更多研究支持根治性治疗相较于保守治疗的有效性。带大网膜移植的保守手术在预防术后并发症方面有效。在某些情况下,腹腔镜手术方法是安全的。阿苯达唑治疗的经皮引流是肝包虫囊肿安全有效的替代治疗方法。术前和术后给予阿苯达唑的根治性手术是肝包虫囊肿的最佳治疗选择,因其复发率和并发症发生率较低。