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肝包虫囊肿——诊断与治疗流程

Hepatic hydatid cyst - diagnose and treatment algorithm.

作者信息

Botezatu Cristian, Mastalier Bogdan, Patrascu Traian

机构信息

"Colentina" Clinical Hospital, General Surgery Clinic, Bucharest.

"Carol Davila" Medical University, Bucharest.

出版信息

J Med Life. 2018 Jul-Sep;11(3):203-209. doi: 10.25122/jml-2018-0045.

Abstract

the hydatic disease, caused by the larvae of Echinococcus granulosus, is a serious disease, potentially lethal, which can be found anywhere in the world, but especially in endemic areas such as the Mediterranean Basin, Australia, New Zealand, North Africa, Eastern Europe, the Balkans, Middle East and South America. The hydatic cyst is mainly found in the liver (75% of the cases), being asymptomatic in most cases and discovered accidentally on a routine abdominal ultrasound or an ultrasound performed for diagnosing other pathologies. The hepatic hydatid cyst therapy is multimodal, including medical, surgical, and, lately, minimally invasive techniques. 88 patients were diagnosed with liver hydatid cyst at the General Surgery Clinic of the Colentina Hospital in Bucharest where they were admitted from January 2014 to July 2017. Data collection was realized by consulting the patients' observation sheets, followed by organizing a database of clinical, paraclinical and treatment parameters. Age, gender, place of origin, year and duration of admission, symptoms and signs at admission, paraclinical serological tests relevant for liver function and E. granulosus infection, imaging investigations performed and their results, type of treatment received and post-treatment progress with the complications that occurred were taken in account. some of the results of the study showed some differences comparing to the data from specialty literature, the possible causes being the small number of patients, the paraclinical examinations that were not sufficiently detailed to allow the study of a phenomenon in all its complexity, the lack of information from the patients' first presentation to a doctor or from their previous admissions. patients with hepatic hydatid cyst form a heterogeneous group, semiology being poor and unspecific. Among the laboratory examinations, eosinophilia is a sign of concern but is present in less than half of the patients. Imaging findings are the basis for the diagnosis of hepatic hydatid cysts. Surgical treatment remains the "gold standard" in therapy, but minimally invasive methods with high applicability, less frequent complications and lower hospital requirements are starting to gain ground.

摘要

由细粒棘球绦虫幼虫引起的包虫病是一种严重的、可能致命的疾病,在世界任何地方都可能出现,但在地中海盆地、澳大利亚、新西兰、北非、东欧、巴尔干半岛、中东和南美洲等流行地区尤为常见。包虫囊肿主要见于肝脏(75%的病例),大多数情况下无症状,通常在常规腹部超声检查或为诊断其他病变而进行的超声检查中偶然发现。肝包虫囊肿的治疗是多模式的,包括药物治疗、手术治疗,以及最近出现的微创技术。2014年1月至2017年7月期间,88例被诊断为肝包虫囊肿的患者入住布加勒斯特科伦蒂纳医院普通外科诊所。通过查阅患者的观察记录来收集数据,随后建立一个包含临床、副临床和治疗参数的数据库。记录了患者的年龄、性别、出生地、入院年份和时长、入院时的症状和体征、与肝功能及细粒棘球绦虫感染相关的副临床血清学检查、所进行的影像学检查及其结果、接受的治疗类型以及治疗后的进展和出现的并发症。该研究的一些结果与专业文献中的数据相比存在差异,可能的原因是患者数量较少、副临床检查不够详细,无法全面研究某一现象的复杂性、缺乏患者首次就诊或既往住院时的信息。肝包虫囊肿患者构成一个异质性群体,症状学表现不佳且不具特异性。在实验室检查中,嗜酸性粒细胞增多是一个值得关注的迹象,但不到一半的患者出现这种情况。影像学检查结果是诊断肝包虫囊肿的依据。手术治疗仍然是治疗的“金标准”,但具有高适用性、并发症较少且住院要求较低的微创方法正开始逐渐普及。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f03/6197524/9fad7a874fab/JMedLife-11-203-g001.jpg

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