Hepatic echinococcosis: A review.
Hepatic echinococcosis: A review.
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DOI：
10.1016/j.amsu.2018.10.032
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发表时间：
2018-12
期刊：
影响因子：
--
通讯作者：
Kajal P
中科院分区：
文献类型：
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作者：
Bhutani N;Kajal P
囊状棘球蚴病是一种由细粒棘球绦虫后绦虫感染引起的地方性蠕虫病，由犬传播。E.颗粒虫是世界上某些地区常见的寄生虫，并且存在于除南极洲之外的每个大陆上。因此，受行政长官影响的人很多。在人类中，该疾病的特征是通常发生在肝脏和肺部的缓慢生长的囊肿。临床表现以右上腹疼痛、肿块感、肝肿大、压痛为主。囊肿可能并发感染或破裂，并可能导致过敏反应。诊断取决于临床怀疑。它们以两种方式出现：一般（全身）症状和基于幼虫定居的部位和器官的局部症状。虽然囊肿有时会自发恢复，但在免疫抑制的个体中观察到更严重的临床表现。血清学支持的超声检查是主要的诊断方法。治疗方法从手术干预到微创治疗（经皮引流）或药物治疗不等。手术仍然是最好的治疗方式。经皮囊肿引流是一个很好的选择在选定的情况下。在过去的10年里，人们开发了新的敏感和特异的诊断方法和有效的治疗方法。虽然棘球蚴囊肿相当罕见，但在肝囊肿的鉴别诊断中应加以考虑。血清抗体测定通常具有低灵敏度，但抗原测定可能有价值。影像学检查在确定囊肿分期、大小、位置和并发症方面至关重要。简单的活动性囊肿可以单独使用化疗或与PAIR方法联合使用。非活动性囊肿可以用“观察和等待”策略来管理。当存在膀胱胆瘘和明显肝外延伸且穿孔风险高时，手术是首选。
Cystic echinococcosis (CE) is a widely endemic helminthic disease caused by infection with metacestodes (larval stage) of the Echinococcus granulosus tapeworm and transmitted by dogs. E. granulosus are common parasites in certain parts of the world, and are present on every continent with the exception of Antarctica. As a result, a large number of people are affected by CE. In humans, the disease is characterized by slowly growing cyst commonly occurring in liver and lungs. Clinical features are mainly right upper quadrant pain, feeling of lump and enlarged tender liver. The cyst may be complicated by infection or rupture and may lead to anaphylactic reaction. The diagnosis depends on clinical suspicion. They appear in two ways as general (systemic) symptoms, and local symptoms based on the site and organ on which the larva settles. While cysts sometimes recover spontaneously, more severe clinical presentations are observed in immunosuppressed individuals. Ultrasonography supported by serology is the main diagnostic modality. The treatment varies from surgical intervention to minimally invasive treatments (percutaneous drainage) or medical therapies. Surgery is still the best treatment modality. Percutaneous drainage of the cyst is a good option in selected cases. New sensitive and specific diagnostic methods and effective therapeutic approaches against echinococcosis have been developed in the last 10 years. Echinococcal cysts, although fairly uncommon, should be considered in the differential diagnosis of hepatic cysts. Serum antibody assays generally have low sensitivities, but antigen assays may be of value. Imaging is crucial in determining cyst stage, size, location and complications. Uncomplicated active cysts can be managed with chemotherapy alone or in combination with a PAIR approach. Inactive cysts can be managed with the “watch-and-wait” strategy. Surgery is the first choice when there is cystobiliary fistula and significant extra-hepatic extension with high risk of perforation.