Infectious and Tropical Diseases, University Hospital Heidelberg, Heidelberg, Germany.
Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany.
BMJ Open Gastroenterol. 2023 Aug;10(1). doi: 10.1136/bmjgast-2023-001181.
Alveolar echinococcosis (AE) is a parasitic liver disease with infiltrative growth similar to solid organ malignancies. Major vascular damage is frequent and often remains untreated until catastrophic events precipitate. Detailed clinical and radiological assessment is required to guide individualised treatment decisions. Standardised radiological reporting templates of malignancies with profiles resembling AE are candidates for adaptation. Our objectives are to describe vascular pathology in AE and establish a framework for structured evaluation as the basis for treatment decisions and monitoring.
Retrospective case series.
69 patients (37.1%) had vascular involvement: portal vein (PV) 24.7%, hepatic vein (HV) 22.6% inferior vena cava (IVC) 13.4%. Significant stenosis/occlusion of vessels was present in 15.1% of PV, in 13.4% of HV and in 7.5% of IVC involvement. Vascular pathology needing specific treatment or monitoring was present in 8.6% of patients. The most frequent clinical presentation was high grade IVC stenosis or occlusion which was seen in 11 patients of the cohort.
Advanced AE requires early multidisciplinary assessment to prevent progressive impairment of liver function due to vascular damage. The focus at first presentation is on complete evaluation of vascular (and biliary) involvement. The focus in non-resectable AE is on prevention of vascular (and biliary) complications while suppressing growth of AE lesions by benzimidazole treatment to improve the quality of life of patients. We developed a framework for standardised vascular assessment and follow-up of patients with AE to recognise and treat complications early.
泡型包虫病（AE）是一种具有浸润性生长的寄生虫性肝脏疾病，类似于实体器官恶性肿瘤。大血管损伤很常见，并且经常在灾难性事件发生之前未得到治疗。需要进行详细的临床和放射学评估，以指导个体化的治疗决策。具有类似于 AE 特征的恶性肿瘤的标准化放射学报告模板是适应的候选者。我们的目标是描述 AE 中的血管病理学，并建立一个框架用于结构化评估，作为治疗决策和监测的基础。
回顾性病例系列。
69 例患者（37.1%）存在血管受累：门静脉（PV）24.7%，肝静脉（HV）22.6%，下腔静脉（IVC）13.4%。PV 中存在 15.1%的显著狭窄/闭塞，HV 中存在 13.4%，IVC 受累中存在 7.5%。需要特定治疗或监测的血管病理学存在于 8.6%的患者中。最常见的临床表现是高级别 IVC 狭窄或闭塞，在该队列的 11 例患者中可见。
晚期 AE 需要早期多学科评估，以防止血管损伤导致肝功能逐渐受损。初次就诊时的重点是全面评估血管（和胆道）受累情况。在不可切除的 AE 中，重点是预防血管（和胆道）并发症，同时通过苯并咪唑治疗抑制 AE 病变的生长，以提高患者的生活质量。我们制定了一个标准化的血管评估和 AE 患者随访框架，以早期识别和治疗并发症。
