Bull World Health Organ. 1996;74(3):231-42.
Summarized in this article are recent experiences in the treatment of human cystic echinococcosis (CE) and alveolar echinococcosis (AE) of the liver caused by the metacestode stages of Echinococcus granulosus and E. multilocularis, respectively. For CE, surgery remains the first choice for treatment with the potential to remove totally the parasite and completely cure the patient. However, chemotherapy with benzimidazole compounds (albendazole or mebendazole) and the recently developed PAIR procedure (puncture-aspiration-injection-re-aspiration) with concomitant chemotherapy offer further options for treatment of CE cases. Chemotherapy is not yet satisfactory: cure can be expected in about 30% of patients and improvement in 30-50%, after 12 months' follow-up. AE is generally a severe disease, with over 90% mortality in untreated patients. Radical surgery is recommended in all operable cases but has to be followed by chemotherapy for at least 2 years. Inoperable cases and patients who have undergone nonradical resection or liver transplantation require continuous chemotherapy for many years. Long-term chemotherapy may significantly prolong survival, even for inoperable patients with severe AE. Liver transplantation may be indicated as a life-saving measure for patients with severe liver dysfunction, but is associated with a relatively high risk of proliferation of intraoperatively undetected parasite remnants. Details of indications, contraindications, treatment schedules and other aspects are discussed.
本文总结了分别由细粒棘球绦虫和多房棘球绦虫的中绦期幼虫引起的人体肝囊型包虫病（CE）和泡型包虫病（AE）的近期治疗经验。对于CE，手术仍是首选治疗方法，有可能完全清除寄生虫并彻底治愈患者。然而，使用苯并咪唑类化合物（阿苯达唑或甲苯达唑）进行化疗以及最近开发的经皮穿刺抽吸注药再抽吸（PAIR）联合化疗为CE病例提供了更多治疗选择。化疗效果尚不尽人意：随访12个月后，约30%的患者有望治愈，30 - 50%的患者病情有所改善。AE通常是一种严重疾病，未经治疗的患者死亡率超过90%。所有可手术的病例均建议行根治性手术，但术后必须进行至少2年的化疗。无法手术的病例以及接受过非根治性切除或肝移植的患者需要长期化疗多年。长期化疗甚至对于无法手术的重症AE患者也可能显著延长生存期。对于严重肝功能不全的患者，肝移植可作为一种挽救生命的措施，但与术中未检测到的寄生虫残留增殖风险相对较高有关。文中讨论了适应证、禁忌证、治疗方案及其他方面的细节。
