From the The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Department of Pediatric Surgery, Soroka University Medical Center, Beer-Sheva, Israel.
Pediatr Infect Dis J. 2023 Mar 1;42(3):175-179. doi: 10.1097/INF.0000000000003793. Epub 2022 Dec 16.
Cystic echinococcosis (CE) treatment is complicated, relying on cysts characteristics, host factors and possible treatment adverse events. We assessed childhood CE treatment characteristics.
A retrospective cohort study, 2005-2021, which presents our experience with treating children with CE. We compared therapeutic interventions use in association with the location, size and number of cysts. Additionally, we assessed complications rate following those interventions.
Sixty six children had CE; 97% were Bedouins. Overall, 183 cysts were identified in 74 organs: liver (n = 47, 64%), lungs (n = 23, 31%), brain, para-ovarian, kidney and peritoneum (other-grouped, n = 4, 5%). Mean ± Standard deviation largest cyst size (per patient) was 6.6 ± 3.2 cm. Treatment with albendazole was administered to 94% of CE, while albendazole monotherapy was used in 27% (n = 18, including 4 cases with extra-hepatic cysts). Surgical interventions included drainage/puncture, aspiration, injection and reaspiration (PAIR; n = 20), mainly performed in hepatic-CE (40% vs. 4% in pulmonary-CE, and 0% in other-CE), excision and drainage (n = 34) and complete excision (n = 10), mainly done in other-CE (50% vs. 26% and 4% in pulmonary-CE and hepatic-CE, respectively). Larger cyst size was associated with complete excision compared with albendazole monotherapy. The number of cysts was not associated with the chosen intervention. Fever was recorded following 39% of surgical interventions. Local surgical complications were relatively rare.
Cysts location and size affected treatment choice among CE patients. Procedures with drainage had relatively higher rate of complications, including recurrence. Albendazole monotherapy may be a viable therapeutic option in selected CE cases.
包虫病（CE）的治疗较为复杂，需要考虑囊肿的特征、宿主因素和可能的治疗不良反应。本研究评估了儿童 CE 的治疗特征。
回顾性队列研究，2005 年至 2021 年，报告了我们治疗儿童 CE 的经验。我们比较了不同位置、大小和数量的囊肿与治疗干预措施的关系。此外，还评估了这些干预措施后的并发症发生率。
66 例儿童患有 CE，97%为贝都因人。共有 183 个囊肿存在于 74 个器官中：肝脏（n = 47，64%）、肺部（n = 23，31%）、脑、卵巢旁、肾脏和腹膜（其他器官，n = 4，5%）。每位患者的最大囊肿大小（平均 ± 标准差）为 6.6 ± 3.2 cm。94%的 CE 患者接受了阿苯达唑治疗，而阿苯达唑单药治疗用于 27%（n = 18，包括 4 例肝外囊肿）。手术干预包括引流/穿刺、抽吸、注射和再抽吸（PAIR；n = 20），主要用于肝囊肿（40% vs. 肺囊肿的 4%和其他器官囊肿的 0%）、切除和引流（n = 34）和完全切除（n = 10），主要用于其他器官囊肿（50% vs. 肺囊肿的 26%和肝囊肿的 4%）。与阿苯达唑单药治疗相比，较大的囊肿大小与完全切除相关。囊肿数量与所选干预措施无关。39%的手术干预后出现发热。局部手术并发症相对较少。
CE 患者的囊肿位置和大小影响治疗选择。引流相关的手术操作并发症发生率较高，包括复发。阿苯达唑单药治疗可能是某些 CE 病例的可行治疗选择。
