Institute of Tropical Medicine and International Health, Charité University Medicine, Berlin, Corporate Member of Free University and Humboldt University, Augustenburgerplatz 1, 13353, Berlin, FR, Germany.
Department of Radiology, Charité University Medicine, Berlin, Corporate Member of Free University and Humboldt University, Berlin, Germany.
Clin J Gastroenterol. 2021 Jun;14(3):888-892. doi: 10.1007/s12328-021-01397-4. Epub 2021 Apr 13.
Therapy choices for cystic echinococcisis (CE) are stage-specific: surgical, minimally invasive, medical or observation without intervention. PAIR (percutaneous aspiration, instillation of a scolicide, and re-aspiration) has been considered the treatment of choice for uncomplicated echinococcal liver cysts. However, PAIR carries the risk of toxic cholangitis or hypernatremia and that the cyst frequently refills with bile after withdrawing the catheter. We treated a patient with a giant CE 1 liver cyst with puncture drainage (PD) under albendazole coverage. Drainage enabled us to monitor the morphology of protoscolices under praziquantel (PZQ) co-medication. Protoscolices degenerated within 5 days of PZQ 50 mg/kg/d. The cyst cavity solidified with no evidence of reactivation or secondary spread. Percutaneous treatments can replace surgery in a significant number or cases with hepatic CE. PD allows to assess microscopically the viability of protoscolices under co-medication with PZQ-albendazole and to avoid the instillation of topical scolicides.
棘球蚴病（CE）的治疗选择取决于其分期：手术、微创、药物或不干预的观察。PAIR（经皮穿刺抽吸、注入杀囊剂、再抽吸）被认为是治疗单纯性肝包虫囊肿的首选方法。然而，PAIR 存在胆汁性胆管炎或高钠血症的风险，并且在拔出导管后囊肿经常会重新充满胆汁。我们在阿苯达唑覆盖的情况下对一名巨大的 1 型肝包虫囊肿患者进行了穿刺引流（PD）治疗。引流使我们能够在联合使用吡喹酮（PZQ）的情况下监测原头蚴的形态。原头蚴在 PZQ 50mg/kg/d 治疗 5 天后退化。囊肿腔凝固，无复发或继发播散的证据。在相当数量的肝包虫病病例中，经皮治疗可以替代手术。PD 允许在联合使用 PZQ-阿苯达唑的情况下对原头蚴的活力进行显微镜评估，并避免局部注入杀囊剂。
