Hydatid cyst of the liver - criteria for the selection of appropriate treatment
Hydatid cyst of the liver - criteria for the selection of appropriate treatment
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DOI：
10.1016/s0001-706x(02)00271-1
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发表时间：
2003-02-01
期刊：
影响因子：
2.7
通讯作者：
da Silva, AM
中科院分区：
文献类型：
--
作者：
da Silva, AM
肝包虫囊肿的适当治疗取决于几个因素，即患者，囊肿，治疗资源和医生。囊肿的特征，可以通过超声（US）描述。根据超声图像，我们可以根据幼虫寄生虫的进化阶段对包虫囊肿进行分类，并选择最合适的治疗方法。US对于评估治疗效果也很重要。在治疗方法上，手术一直是肝包虫囊肿唯一的治疗方法。从20世纪70年代开始，苯并咪唑、甲苯咪唑和阿苯达唑已被用于治疗包虫病，并且在20世纪80年代早期，随着诊断US的发展，评估了腹部囊肿的故意穿刺，特别是肝脏中的囊肿，这导致穿刺/抽吸，随后注射杀病毒剂，这成为称为穿刺、抽吸、注射和再抽吸（PAIR）。因此，根据超声评估的囊肿特征，我们可以制定治疗策略：I型和3型囊肿可以通过化疗治疗。替代治疗应该是PAIR，但只有当囊肿不能用苯并咪唑治疗时。如果有PAIR和化疗的禁忌症，则应手术治疗。2型包虫囊肿可以在苯并咪唑类药物初始治疗后通过PAIR治疗。如果PAIR不可行或化疗后没有退行性变化的证据，则需要手术。4型囊肿通常是不活跃的，在这些情况下，不需要治疗。如果有证据表明囊肿内容物仍有活力，则可以指示PAIR。如果PAIR不可行，手术是首选方法。第5类囊肿不需要治疗。(C)2002 Elsevier Science B. V.保留所有权利。
The appropriate treatment of hydatid cysts of the liver is determined by several factors, namely the patient, the cyst, the therapeutic resources and the physician. Characteristics of cysts, can be described by ultrasonography (US). Based on US images, we can classify hydatid cysts, according the evolutionary phase of the larval parasite and to choose the most appropriate therapeutic approach. US is also important to evaluate the efficacy of the treatment. Concerning the therapeutic methods, surgery had long been the only treatment available for the hydatid cyst of the liver. Beginning the 1970s benzimidazoles, Mebendazole and Albendazole, have been used for the treatment of the hydatid disease and in the early 1980s, with the development of diagnostic US, the deliberate puncture of abdominal cysts, particularly those in the liver, was evaluated this lead to puncture/aspiration, followed by injection of a scolicide which became a therapeutic method known as puncture, aspiration, injection and re-aspiration (PAIR). So, according to the cyst's characteristics based on US evaluation we can establish a therapeutic strategy: cysts type I and 3 may be treated by chemotherapy. Alternative treatment should be PAIR but only if the cysts cannot be treated with benzimidazoles. If there are contraindications for PAIR and chemotherapy the treatment should be surgical. Type 2 hydatid cysts can be treated by PAIR following initial treatment with benzimidazoles. If PAIR is not feasible or there is no evidence of degenerative changes after chemotherapy, surgery is indicated. Type 4 cysts are usually inactive and, in these cases, treatment is not indicated. If there is evidence that the cysts contents are still viable PAIR may be indicate. If PAIR is not possible, surgery is the method of choice. Cysts type 5 do not require treatment. (C) 2002 Elsevier Science B.V. All rights reserved.