Qu Bo, Guo Long, Sheng Guannan, Yu Fei, Chen Guannan, Wang Yupeng, Shi Yuan, Zhan Hanxiang, Yang Yi, Du Xiaoyan
Department of General Surgery, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Logistics University of Chinese People's Armed Police Forces, Tianjin, People's Republic of China.
Department of Hepatobiliary Surgery, Liver Transplantation Center, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Shaanxi, People's Republic of China.
Am J Trop Med Hyg. 2017 Mar;96(3):680-685. doi: 10.4269/ajtmh.16-0557. Epub 2017 Apr 6.
Radical resection is the first choice for hepatic alveolar echinococcosis (HAE). However, many patients with advanced HAE have no chance to be treated with curative resection owing to the long clinical latency. This study aimed to evaluate the necessity of aggressive operations, like palliative resection and orthotopic liver transplantation (OLT), in the management of advanced HAE. A retrospective study analyzed 42 patients with advanced HAE treated with palliative resection ( = 15), palliative nonresective procedures ( = 13), OLT ( = 3), or albendazole therapy alone ( = 11). The patients' condition before treatments was comparable among all the four groups. The overall 1-year, 3-year, and 5-year survival rates of the 42 cases were 81.0%, 45.2%, and 23.8%, respectively. No event occurred to end the follow-up during the 5-year observation period except death. The survival time (median ± standard error) of the palliative resection group (3.6 ± 1.4 years) was longer than that of the palliative nonresective procedures group (1.5 ± 0.2) and the albendazole therapy-alone group (1.0 ± 0.4). The 5-year survival rates after palliative resection and liver transplantation were 40.0% and 66.7%, compared with only 7.7% and 9.1% after palliative nonresective procedures or albendazole therapy alone. Therefore, we concluded that aggressive treatment with a multimodality strategy could contribute to prolonged survival in patients with advanced HAE. Moreover, the prognosis of the patients who received albendazole therapy alone or palliative nonresective procedures is poor.
根治性切除是肝泡型包虫病（HAE）的首选治疗方法。然而，由于临床潜伏期长，许多晚期HAE患者没有机会接受根治性切除治疗。本研究旨在评估在晚期HAE的治疗中，诸如姑息性切除和原位肝移植（OLT）等积极手术的必要性。一项回顾性研究分析了42例接受姑息性切除（n = 15）、姑息性非切除手术（n = 13）、OLT（n = 3）或单纯阿苯达唑治疗（n = 11）的晚期HAE患者。四组患者治疗前的病情具有可比性。42例患者的1年、3年和5年总生存率分别为81.0%、45.2%和23.8%。在5年观察期内，除死亡外，未发生其他事件结束随访。姑息性切除组的生存时间（中位数±标准误）为（3.6±1.4年），长于姑息性非切除手术组（1.5±0.2年）和单纯阿苯达唑治疗组（1.0±0.4年）。姑息性切除和肝移植后的5年生存率分别为40.0%和66.7%，而姑息性非切除手术或单纯阿苯达唑治疗后的5年生存率仅为7.7%和9.1%。因此，我们得出结论，采用多模式策略进行积极治疗有助于延长晚期HAE患者的生存期。此外，单纯接受阿苯达唑治疗或姑息性非切除手术的患者预后较差。
