经皮超声介入治疗肝棘球蚴病的研究进展

Percutaneous ultrasound intervention therapy for hepatic echinococcosis:a literature review

目的总结经皮超声介入治疗在肝棘球蚴病(又称“肝包虫病”)中的应用现状,为临床医务人员在介入治疗方法选择时提供一定的经验及参考。方法查阅国内外有关肝棘球蚴病采用经皮超声介入治疗的相关文献进行分析并总结。结果对于肝囊型棘球蚴病患者,行超声引导下经皮经肝引流术对于世界卫生组织非正式工作组分型CE 1型和CE 3a分型囊肿是安全有效的。对于肝泡型棘球蚴病患者,虽然根治性切除仍为金标准,但超声引导下微波消融术对于病灶直径<5 cm的患者术后恢复更好、创伤更小;关于超声引导下射频消融术治疗肝泡型棘球蚴病患者的疗效及安全性由于相关研究较少,还有待进一步探索;超声引导下经皮囊肿穿刺引流术用于囊腔坏死物质的外引流,能有效控制感染,清除坏死组织;经皮经肝胆道引流术用于治疗晚期肝泡型棘球蚴病合并梗阻性黄疸患者能有效解除胆道梗阻,改善肝功能,提高患者生活质量。结论对于肝囊型棘球蚴病患者行经皮超声介入技术需严格掌握其适应证和禁忌证;对于肝泡型棘球蚴病患者,病变早期病灶较小则优先考虑微波消融术,中晚期患者病灶较大且伴有腔内感染或黄疸,则在行经皮囊肿穿刺引流术、经皮经肝穿刺胆道引流术缓解症状,适合手术者再行二期手术治疗。

Objective To summarize the research status of percutaneous ultrasound interventional therapy for the patients with hepatic echinococcosis,and to provide some experience and reference for the treatment of disease in clinical medical personnel.Method The relevant literature on percutaneous ultrasound intervention therapy for hepatic echinococcosis both domestically and internationally was summarized and analyzed.Results For the patients with hepatic cystic echinococcosis(HCE),ultrasound-guided percutaneous transhepatic drainage is safe and effective for the World Health Organization Informal Working Group classification CE1 and CE3a cysts.For the patients with hepatic alveolar chinococcosis(HAE),although radical resection is still the gold standard,ultrasound-guided microwave ablation had better postoperative recovery and less trauma for patients with lesion diameter<5 cm;Due to limited research on the efficacy and safety of ultrasound-guided radiofrequency ablation for patients with HAE,further exploration is needed;Ultrasound guided percutaneous cyst puncture drainage is used for external drainage of necrotic material in the cyst cavity,which can effectively control infection and remove necrotic tissue;percutaneous transhepatic cholangial drainage(PTCD)could effectively relieve biliary obstruction,improve liver function,and enhance the quality of life of patients with advanced HAE complicated with obstructive jaundice.Conclusions Ultrasound-guided percutaneous interventional techniques have their own advantages and disadvantages in treatment of hepatic echinococcosis.For patients with HCE,strict indications and contraindications should be followed when performing percutaneous ultrasound interventions.For patients with HAE,early-stage small lesions should be prioritized for microwave ablation,and patients in the middle and late stages with larger lesions or those with intra-cyst infection or jaundice should be treated with percutaneous cyst puncture drainage and PTCD to alleviate symptoms,following the second stage operation.