Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
Section of Clinical Tropical Medicine, University Hospital Heidelberg, Heidelberg, Germany.
PLoS Negl Trop Dis. 2021 May 12;15(5):e0009365. doi: 10.1371/journal.pntd.0009365. eCollection 2021 May.
In patients with hepatic cystic echinococcosis (CE), treatment effectiveness, outcomes, complications, and recurrence rate are controversial. Endocystectomy is a conservative surgical approach that adequately removes cyst contents without loss of parenchyma. This conservative procedure has been modified in several ways to prevent complications and to improve surgical outcomes. This systematic review aimed to evaluate the intraoperative and postoperative complications of endocysectomy for hepatic CE as well as the hepatic CE recurrence rate following endocystectomy.
A systematic search was made for all studies reporting endocystectomy to manage hepatic CE in PubMed, Web of Science, and Cochrane CENTRAL databases. Study quality was assessed using the methodological index for non-randomized studies (MINORS) criteria and the Cochrane revised tool to assess risk of bias in randomized trials (RoB2). The random-effects model was used for meta-analysis and the arscine-transformed proportions were used to determine complication-, mortality-, and recurrence rates. This study is registered with PROSPERO (number CRD42020181732).
Of 3,930 retrieved articles, 54 studies reporting on 4,058 patients were included. Among studies reporting preoperative anthelmintic treatment (31 studies), albendazole was administered in all of them. Complications were reported in 19.4% (95% CI: 15.9-23.2; I2 = 84%; p-value <0.001) of the patients; biliary leakage (10.1%; 95% CI: 7.5-13.1; I2 = 81%; p-value <0.001) and wound infection (6.6%; 95% CI: 4.6-9; I2 = 27%; p-value = 0.17) were the most common complications. The post-endocystectomy mortality rate was 1.2% (95% CI: 0.8-1.8; I2 = 21%; p-value = 0.15) and the recurrence rate was 4.8% (95% CI: 3.1-6.8; I2 = 87%; p-value <0.001). Thirty-nine studies (88.7%) had a mean follow-up of more than one year after endocystectomy, and only 14 studies (31.8%) had a follow-up of more than five years.
Endocystectomy is a conservative and feasible surgical approach. Despite previous disencouraging experiences, our results suggest that endocystectomy is associated with low mortality and recurrence.
在肝包虫病（CE）患者中，治疗效果、结局、并发症和复发率存在争议。内囊切除术是一种保守的手术方法，可以在不损失实质的情况下充分清除囊内容物。为了预防并发症和改善手术结局，这种保守的手术方法已经在几个方面进行了修改。本系统评价旨在评估肝包虫内囊切除术的术中及术后并发症，以及内囊切除术后肝包虫的复发率。
在 PubMed、Web of Science 和 Cochrane CENTRAL 数据库中对所有报道内囊切除术治疗肝 CE 的研究进行系统检索。使用非随机研究方法学指数（MINORS）标准和 Cochrane 修订工具评估研究质量（RoB2）来评估偏倚风险。采用随机效应模型进行荟萃分析，采用 arcsine 变换比例来确定并发症、死亡率和复发率。本研究已在 PROSPERO（编号 CRD42020181732）注册。
在 3930 篇检索到的文章中，纳入了 54 项研究，共报道了 4058 例患者。在报道术前驱虫治疗的研究中（31 项研究），所有研究均使用了阿苯达唑。19.4%（95%CI：15.9-23.2；I2=84%；p 值<0.001）的患者出现并发症；最常见的并发症是胆漏（10.1%；95%CI：7.5-13.1；I2=81%；p 值<0.001）和伤口感染（6.6%；95%CI：4.6-9；I2=27%；p 值=0.17）。内囊切除术后死亡率为 1.2%（95%CI：0.8-1.8；I2=21%；p 值=0.15），复发率为 4.8%（95%CI：3.1-6.8；I2=87%；p 值<0.001）。39 项研究（88.7%）的平均随访时间超过内囊切除术后 1 年，仅有 14 项研究（31.8%）的随访时间超过 5 年。
内囊切除术是一种保守且可行的手术方法。尽管之前有过令人失望的经验，但我们的结果表明，内囊切除术与低死亡率和低复发率相关。
