Abstract：
To investigate the efficacy and safety of percutaneous treatment in cystic echinococcosis (CE) type 1 and 3a giant cysts (with at least one diameter>10 cm) according to the World Health Organization classification and to evaluate the management of complications, especially cystobiliary fistulas (CBFs).
This retrospective study included 66 patients with 68 CE1 and CE3a giant cysts treated with percutaneous catheterization between January 2016 and December 2021. The characteristics of the cysts, major and minor complications, time to catheter removal, and length of hospital stay were recorded.
Among the 68 cysts, CBFs occurred in 35 (51.5%), cavity infections in 11 (16.1%), recollection in five (7.4%), and anaphylaxis in three (4.5%). There was no mortality. Biliary drainage was observed intraoperatively in 20 (29.4%) and only postoperatively in 15 (22.1%) of the 35 cysts with CBFs. A plastic biliary stent was placed in 18 (51.5%) of the 35 cysts with CBFs. The patients with CBFs had a longer hospital stay and time to catheter removal than those without fistulas (15.3 ± 10.9 vs. 6.1 ± 2.6 days and 32.7 ± 51.8 vs. 6.2 ± 3.1 days, respectively; P < 0.001). Of the patients who developed recollection, three were treated with secondary catheterization, and two underwent surgery. In total, three patients underwent surgery. The rate of clinical success was 95.4%. All cysts were followed up for an average of 19.1 (range, 12-60) months, and there was an average 88.8% reduction in cyst volume compared to the initial evaluation.
CE1 and CE3a giant cysts can be treated effectively and safely with high clinical success using the catheterization technique. Contrary to what has previously been reported for these patients, the rate of CBFs is high, but these patients can successfully be treated with percutaneous drainage and/or endoscopic retrograde cholangiopancreatography without the requirement of surgery.
This retrospective study included 66 patients with 68 CE1 and CE3a giant cysts treated with percutaneous catheterization between January 2016 and December 2021. The characteristics of the cysts, major and minor complications, time to catheter removal, and length of hospital stay were recorded.
Among the 68 cysts, CBFs occurred in 35 (51.5%), cavity infections in 11 (16.1%), recollection in five (7.4%), and anaphylaxis in three (4.5%). There was no mortality. Biliary drainage was observed intraoperatively in 20 (29.4%) and only postoperatively in 15 (22.1%) of the 35 cysts with CBFs. A plastic biliary stent was placed in 18 (51.5%) of the 35 cysts with CBFs. The patients with CBFs had a longer hospital stay and time to catheter removal than those without fistulas (15.3 ± 10.9 vs. 6.1 ± 2.6 days and 32.7 ± 51.8 vs. 6.2 ± 3.1 days, respectively; P < 0.001). Of the patients who developed recollection, three were treated with secondary catheterization, and two underwent surgery. In total, three patients underwent surgery. The rate of clinical success was 95.4%. All cysts were followed up for an average of 19.1 (range, 12-60) months, and there was an average 88.8% reduction in cyst volume compared to the initial evaluation.
CE1 and CE3a giant cysts can be treated effectively and safely with high clinical success using the catheterization technique. Contrary to what has previously been reported for these patients, the rate of CBFs is high, but these patients can successfully be treated with percutaneous drainage and/or endoscopic retrograde cholangiopancreatography without the requirement of surgery.
摘要：
目的：根据世界卫生组织分类，研究1型和3a型囊性包虫病（CE）巨大囊肿（至少一个直径>10cm）的经皮治疗的有效性和安全性，并评估并发症的处理方法。尤其是胆管瘘（CBFs）。
方法：这项回顾性研究包括2016年1月至2021年12月间接受经皮导管插入术治疗的66例CE1和CE3a巨大囊肿患者。囊肿的特点，主要和次要并发症，拔除导管的时间，并记录住院时间。
结果：在68个囊肿中，CBF发生在35（51.5%），11例（16.1%），五个人的回忆(7.4%)，和三个（4.5％）的过敏反应。没有死亡。术中观察到胆管引流的35个CBF囊肿中有20个（29.4％），仅在术后观察到15个（22.1％）。在35个CBF囊肿中的18个（51.5％）中放置了塑料胆道支架。与没有瘘管的患者相比，有CBFs的患者住院时间和导管拔除时间更长（15.3±10.9vs.6.1±2.6天和32.7±51.8天vs.6.2±3.1天，分别；P<0.001)。在回忆的病人中，三人接受二次导管插入术治疗，两人接受了手术。总的来说,三名患者接受了手术。临床成功率为95.4%。所有囊肿均随访平均19.1（范围，12-60)个月，与初始评估相比，囊肿体积平均减少88.8%。
结论：CE1和CE3a巨大囊肿使用导尿技术可以有效和安全地治疗，具有很高的临床成功率。与以前报道的这些患者相反，CBF的比率很高，但是这些患者可以通过经皮引流和/或内镜逆行胰胆管造影术成功治疗，而无需手术。
方法：这项回顾性研究包括2016年1月至2021年12月间接受经皮导管插入术治疗的66例CE1和CE3a巨大囊肿患者。囊肿的特点，主要和次要并发症，拔除导管的时间，并记录住院时间。
结果：在68个囊肿中，CBF发生在35（51.5%），11例（16.1%），五个人的回忆(7.4%)，和三个（4.5％）的过敏反应。没有死亡。术中观察到胆管引流的35个CBF囊肿中有20个（29.4％），仅在术后观察到15个（22.1％）。在35个CBF囊肿中的18个（51.5％）中放置了塑料胆道支架。与没有瘘管的患者相比，有CBFs的患者住院时间和导管拔除时间更长（15.3±10.9vs.6.1±2.6天和32.7±51.8天vs.6.2±3.1天，分别；P<0.001)。在回忆的病人中，三人接受二次导管插入术治疗，两人接受了手术。总的来说,三名患者接受了手术。临床成功率为95.4%。所有囊肿均随访平均19.1（范围，12-60)个月，与初始评估相比，囊肿体积平均减少88.8%。
结论：CE1和CE3a巨大囊肿使用导尿技术可以有效和安全地治疗，具有很高的临床成功率。与以前报道的这些患者相反，CBF的比率很高，但是这些患者可以通过经皮引流和/或内镜逆行胰胆管造影术成功治疗，而无需手术。
