Lewall D B
Department of Medical Imaging, King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia.
Clin Radiol. 1998 Dec;53(12):863-74. doi: 10.1016/s0009-9260(98)80212-2.
Rupture and the sequellae of rupture are more important than the mass effect of hydatid cysts, except in the brain where the mass effect by itself has severe consequences. The biology of hydatid disease, including the complex interaction between primary and secondary hosts, is reviewed. The hydatid cyst always starts as a fluid-filled, cyst-like structure (Type I) which may proceed to a Type II lesion if daughter cysts and/or matrix develop. In some instances the Type II lesion becomes hypermature and due to starvation dies to become a mummified, inert calcified Type III lesion. Type I and II lesions may undergo three types of rupture: contained, communicating and direct. Contained rupture is clinically silent, but communicating rupture may cause biliary obstruction and evacuation or infection of the cyst. Direct rupture has the greatest clinical consequences which include anaphylaxis, dissemination of hydatid disease (secondary hydatosis) within the host, and bacterial infection of the pericyst cavity. The clinical implications of the hydatid disease at different stages are discussed. A plea is made for the development of an international medical hydatid registry employing uniform nomenclature and consistent reporting in order to allow more rational comparisons of different types of management.
除了在脑部，包虫囊肿的占位效应本身会产生严重后果外，破裂及破裂后遗症比包虫囊肿的占位效应更为重要。本文综述了包虫病的生物学特性，包括终末宿主和中间宿主之间的复杂相互作用。包虫囊肿最初总是一个充满液体的囊样结构（I型），如果出现子囊和/或基质，可能发展为II型病变。在某些情况下，II型病变会过度成熟，由于营养缺乏而死亡，成为木乃伊化的、惰性的钙化III型病变。I型和II型病变可能经历三种类型的破裂：局限性破裂、交通性破裂和直接破裂。局限性破裂在临床上没有症状，但交通性破裂可能导致胆管梗阻以及囊肿内容物排出或感染。直接破裂具有最严重的临床后果，包括过敏反应、包虫病在宿主体内播散（继发性包虫病）以及包虫囊腔的细菌感染。本文讨论了包虫病不同阶段的临床意义。呼吁建立一个采用统一命名法和一致报告方式的国际医学包虫病登记处，以便更合理地比较不同类型的治疗方法。
