包虫病影像诊断技术和手术治疗进展

Advancement of imaging diagnosis technique and surgery treatment of echinococcosis

包虫病是严重危害中国西部人群的人兽共患寄生虫病，手术仍为包虫病临床最主要的治疗手段。该文通过对囊型包虫病和泡型包虫病等两型肝包虫病的影像学诊断和各种术式回顾性分析总结后，综述如下：1）超声检查主要用在两型包虫病的诊断与鉴别诊断，尤其是在农牧区进行流行病学调查和普查时，超声以其便携低耗易行的特点成为首选。近来用超声对肝两型包虫病病灶在二维超声、彩色多普勒血流成像的基础上进行灰阶超声造影检查，超声造影可以更好地显示其病灶的确切范围，周边增值带微循环血供状态，为肝包虫病外科手术提供更多的诊断治疗信息。2）囊型包虫病CT／MRI均表现为境界清楚的囊肿，病程发展中出现子囊、囊膜剥离、囊壁及内容物钙化等特征；泡型包虫病CT／MRI均表现为非均质实性肿块，内部有小圈状和颗粒状钙化，中心常出现液化坏死，形成“地图状”外观。其类似肿瘤的浸润生长可压迫和侵蚀肝血管和胆管并伴远处血行转移。MRI水成像技术对不典型包虫病有独特的诊断效果；CT／MRI血管成像和胆系成像有利于诊断包虫并发症；CT／MRI灌注技术、MRI扩散成像和波谱成像有望实现活体无创的分子影像诊断。3）肝囊型包虫病：（1）肝包虫外囊完整剥除术是理想的治疗方法，值得推广的首选术式；（2）外囊次全切除术可有效消减残腔，避免胆瘘等，能减少手术时间及外囊完整剥除术所致手术风险；（3）肝内囊摘除术仍是主要方法，术中应经胆道或胆囊管美蓝造影以确认是否胆漏。4）肝泡型包虫病：（1）根治性肝切除是治疗首选方法；（2）姑息性病灶切除手术，因继发难治性肝切面胆瘘而宜慎重采用；（3）肝移植是治疗两型包虫病终末期最后手段，术后仍存在复发的可能，需酌情服用抗包虫药，如阿苯达唑片剂或其他剂型（乳剂、脂质体口服液等）。

Hydatid disease is a zoonosis seriously affecting the population in western China. Surgery is the primary treatment. Through the investgation on the imaging diagnosis and various surgical methods of cystic echinococcosis （CE） and alveolar echinococcosis （AE）, this review described： 1. Ultrasonic inspection is mainly used for diagnosis and differential diagnosis of CE and AE, especially during epidemic investigation and mass screening. It is the first choice for convenient carrying and low energy consuming. Lately, based on 2-dimensional ultrasound and Doppler color flow imaging （DCFI） , gray scale ultrasound opacifieation is performed for CE and AE. Ultrasound opacifieation can show focal compass and condition of microcirculation better, providing more therapy information for surgery of hepatic echinococcosis. 2. Granular echinococcusis appears as a cyst with clear boundary. The characteristic sighs of the lesion include daughter cyst, detached cystic membrane, wall or content calcification. AE is demonstrated as a map-like heterogenous mass with scattered calcification and center necrosis. The aggrevasion of the lesion may compress or destroy the hepatic vessels or bile ducts. MRI showes advantage in diagnosis of those untypical echinococcusis. CT/MRI angiography and eholangiography are used for detection of the complications. CT/MRI perfusion, diffusion wightted imaging and MRI spectrum may provide the molecular imaging to visualize the echinococcusis in vitro. 3. CE ： 3.1 Total cystectomy can be considered as radical and practicable surgical method for human CE, it is the first choice for both radical and conservative surgical operation. 3.2 Subtotal cystectomy may not only eliminate residual cavity, but also effectively decrease the risk of the total cystectomy. 3.3 In case that is not eligible for radical surgery, conservative surgery can be an effective alternative way to excise remaining cavity while in which retrograde methylene blue infusion technique can efficiently explore biliary communications. 4. AE： 4.1 The rational treatment for liver AE is radical hepatectomy and the prognosis of the patient may be good. 4.2 For liver unresectable case, palliative operation may be indicated. It should be used prudently for it may result in serious biliary fistula on liver surface. 4.3 Liver transplantation was the last choice for the terminal stage of CE and AE, however it still has possibility of post-operation recurrence. Effective drug treatment, such as liposmal albendazole, can be used for prolonging patients＇ life.