A twenty-year history of alveolar echinococcosis: analysis of a series of 117 patients from eastern France
A twenty-year history of alveolar echinococcosis: analysis of a series of 117 patients from eastern France
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DOI：
10.1097/00042737-200012030-00011
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发表时间：
2000-03-01
影响因子：
2.1
通讯作者：
Miguet, JP
中科院分区：
文献类型：
--
作者：
Bresson-Hadni, S;Vuitton, DA;Miguet, JP
目的 肝泡型棘球蚴病是一种由多房棘球绦虫幼虫生长引起的非常罕见且严重的寄生虫病。本文旨在描述一项对法国东部泡型棘球蚴病的流行病学、临床和治疗方面进行的20年研究。
设计 对1972年至1993年在我们肝脏科室诊断并随访的117例连续病例进行了研究。
方法 将1983年以来随访的85例患者（B期）的数据与1972年至1982年收集的首批32例患者（A期）的数据进行比较；选择1983年作为分界年是因为此时该疾病的诊断、随访和治疗发生了许多变化，特别是引入了抗寄生虫的苯并咪唑类药物。
结果 1997年12月对患者随访结果进行了评估。A期累计患病率为每10万人2.5例，而B期达到每10万人6.6例。B期年平均发病率为7.3，而A期为2.7。B期29%的患者在诊断时无症状，而A期为10%。这种变化与肝脏病变较轻相关，且与腹部超声的广泛使用以及从1987年开始的血清学筛查有关。B期24%的病例进行了根治性切除，而A期仅为3%。从1986年起，A期有8例患者和B期有13例患者进行了肝移植。在B期，姑息性手术经常被放射学非手术方法取代来治疗脓肿和黄疸。从1982年起，73例患者接受苯并咪唑类药物治疗，时间从4个月到138个月不等。三分之二的患者观察到病变稳定。与A期患者相比，B期患者因门静脉高压导致的黄疸或消化道出血发作频率分别降低了31.5倍和11倍。在年龄相似的患者中，5年实际生存率从A期的67%提高到B期的88%。
结论 在过去十年中，泡型棘球蚴病的诊断和治疗发生了根本性变化。这些变化共同促进了受这种非常严重的寄生虫病影响的患者状况的改善。《欧洲胃肠病学与肝脏病学杂志》12:327 - 336（2000年）利平科特·威廉姆斯和威尔金斯出版社。
Objectives Alveolar echinococcosis of the liver is a very rare and severe parasitic disease due to the growth of the larva of Echinococcus multilocularis. The aim of this paper was to describe a 20-year study of the epidemiological, clinical and therapeutic aspects of alveolar echinococcosis in eastern France.Design One hundred and seventeen consecutive cases, diagnosed and followed in our liver unit, were studied from 1972 to 1993.Methods Data from 85 patients followed since 1983 (period B) were compared to data from a first series of 32 patients (period A) collected from 1972 to 1982; 1983 was chosen as the cut-off year because of the numerous changes that occurred in the diagnosis, follow-up and treatment of the disease at this time, in particular the introduction of parasitostatic benzimidazoles.Results The results of patient follow-up were evaluated in December 1997. The cumulative prevalence was 2.5 per 100 000 persons in period A whereas it reached 6.6 per 100 000 in period B. The annual incidence in period B was 7.3 on average, compared with 2.7 in period A. Twenty-nine pet cent of patients from period B were asymptomatic at the time of diagnosis compared with 10% in period A. This change was correlated with less advanced liver lesions, and was related to the extensive use of abdominal ultrasound, and from 1987, serological screening. Curative resections were performed in 24% of the cases in period B versus only 3% in period A. From 1986, liver transplantations were performed in eight patients from period A and 13 patients from period B. In period B, palliative surgery was frequently replaced by radiological non-operative procedures to treat abscesses and jaundice. From 1982, 73 patients received benzimidazoles for a period of time ranging from 4 to 138 months. Stabilization of the lesions was observed in two-thirds of the patients. Episodes of jaundice or digestive haemorrhage due to portal hypertension were 31.5 and 11 times less frequent respectively in patients from period B compared with period A. Actuarial survival at 5 years improved from 67% in period A to 88% in period B in patients of similar age.Conclusions Radical changes in the diagnosis and the management of alveolar echinococcosis have occurred during the last decade. Together they have contributed to an improvement in the status of the patients affected by this very severe parasitic disease. Eur I Gastroenterol Hepatol 12:327 - 336 (C) 2000 Lippincott Williams & Wilkins.