Postgraduate School of Paediatrics, University of Florence.
Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy.
J Pediatr Gastroenterol Nutr. 2019 Feb;68(2):161-168. doi: 10.1097/MPG.0000000000002182.
Among parasitic hepatic cystic lesions, the most common disease is represented by cystic echinococcosis (CE), especially in high endemic countries. European epidemiology of CE in children is difficult to assess because of under-reporting but is increasing, because of high immigration flows from endemic countries and an increased awareness. Hydatidosis can be localized in every part of the body. The liver and lungs are the most common localizations in both children and adults. Multiorgan involvement is rarely reported in children. Different tests are available. Usually the sensitivity of serological screening tests is variable, ranging between 60% and 90%. The immunoblot assay is used as a confirmatory test because of its higher sensitivity and specificity. Radiological tests are the criterion standard for diagnosis of CE, with an ultrasound accuracy of approximately 90%. In case of inactive and uncomplicated cysts the watch-and-wait approach is recommended. Albendazole, currently used for 3 to 6 months consecutively represents the most commonly used drug in children even if there is limited experience in treating children younger than 6 years of age. Percutaneous treatment with the puncture, aspiration, injection, and reaspiration technique is a minimally invasive procedure. Surgery is indicated based on cyst characteristics in case of big cysts with multiple daughter cysts, single superficial cysts at risk of spontaneous or traumatic rupture, cysts related with the biliary tract in which the percutaneous treatment is contraindicated, and cysts compressing related structures.
在寄生性肝囊肿病变中，最常见的疾病是肝包虫病（CE），尤其是在高流行国家。由于报告不足，难以评估欧洲儿童的 CE 流行病学情况，但由于来自流行国家的移民流量增加和认识提高，该病的发病率正在上升。包虫病可以发生在身体的任何部位。肝脏和肺部是儿童和成人最常见的部位。多器官受累在儿童中很少见。有多种不同的检查方法。通常，血清学筛查试验的敏感性各不相同，范围在 60%到 90%之间。免疫印迹检测法被用作确诊试验，因为其敏感性和特异性更高。放射学检查是诊断 CE 的标准，超声检查的准确率约为 90%。对于无症状和无并发症的囊肿，建议采用观察等待方法。阿苯达唑目前已连续使用 3 至 6 个月，是儿童最常使用的药物，尽管治疗 6 岁以下儿童的经验有限。经皮穿刺抽吸注射术是一种微创治疗方法。如果囊肿较大且有多个子囊、有自发或外伤性破裂风险的单个浅表囊肿、经皮治疗禁忌的与胆道相关的囊肿、以及压迫相关结构的囊肿，则根据囊肿特征选择手术治疗。
