Khuroo M S, Wani N A, Javid G, Khan B A, Yattoo G N, Shah A H, Jeelani S G
Department of Gastroenterology, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India.
N Engl J Med. 1997 Sep 25;337(13):881-7. doi: 10.1056/NEJM199709253371303.
In recent years percutaneous drainage has been used successfully to treat the hepatic hydatid cysts of echinococcal disease. We performed a controlled trial to compare the safety and efficacy of percutaneous drainage with those of surgical cystectomy, the traditional treatment.
In a prospective study, we randomly assigned 50 patients with hepatic hydatidosis to treatment with percutaneous drainage (25 patients) or cystectomy (25). Albendazole (10 mg per kilogram of body weight per day for eight weeks) was administered to the patients who underwent percutaneous drainage. Serial assessments included clinical and biochemical examinations, ultrasonography, and serologic tests of echinococcal-antibody titers.
The mean (+/-SD) hospital stay was 4.2+/-1.5 days in the drainage group and 12.7+/-6.5 days in the surgery group (P<0.001). Over a mean follow-up period of 17 months, the mean cyst diameter decreased from 8.0+/-3.0 to 1.4+/-3.5 cm (P<0.001) after percutaneous drainage and from 9.1+/-3.0 to 0.9+/-1.8 cm (P<0.001) after surgery. The final cyst diameter did not differ significantly between the two groups (P=0.20). The cysts disappeared in 22 patients (88 percent) in the drainage group and in 18 (72 percent) in the surgery group (P=0.29). After an initial rise, the echinococcal-antibody titers fell progressively and at the last follow-up were negative (<1:160) in 19 patients (76 percent) in the drainage group and 17 (68 percent) in the surgery group (P=0.74). There were procedure-related complications in 8 patients (32 percent) in the drainage group and 21 (84 percent) in the surgery group, 17 of whom had fever postoperatively (P<0.001).
Percutaneous drainage, combined with albendazole therapy, is an effective and safe alternative to surgery for the treatment of uncomplicated hydatid cysts of the liver and requires a shorter hospital stay.
近年来，经皮引流已成功用于治疗棘球蚴病的肝包虫囊肿。我们进行了一项对照试验，以比较经皮引流与传统治疗方法手术囊肿切除术的安全性和有效性。
在一项前瞻性研究中，我们将50例肝包虫病患者随机分为经皮引流治疗组（25例）和囊肿切除术组（25例）。对接受经皮引流的患者给予阿苯达唑（每日每千克体重10 mg，共8周）。连续评估包括临床和生化检查、超声检查以及棘球蚴抗体滴度的血清学检测。
引流组的平均（±标准差）住院时间为4.2±1.5天，手术组为12.7±6.5天（P<0.001）。在平均17个月的随访期内，经皮引流后囊肿平均直径从8.0±3.0 cm降至1.4±3.5 cm（P<0.001），手术后从9.1±3.0 cm降至0.9±1.8 cm（P<0.001）。两组最终囊肿直径差异无统计学意义（P=0.20）。引流组22例患者（88%）囊肿消失，手术组18例患者（72%）囊肿消失（P=0.29）。在最初上升后，棘球蚴抗体滴度逐渐下降，在最后一次随访时，引流组19例患者（76%）呈阴性（<1:160），手术组17例患者（68%）呈阴性（P=0.74）。引流组8例患者（32%）出现与手术相关的并发症，手术组21例患者（84%）出现并发症，其中17例患者术后发热（P<0.001）。
经皮引流联合阿苯达唑治疗是治疗单纯性肝包虫囊肿的一种有效且安全的替代手术方法，且住院时间较短。
