Aim: The aim of this study was to review our 18-year experience in the treatment of viable hydatid liver cysts (HLCs) with double percutaneous aspiration and ethanol injection (D-PAI) and to provide indications for the clinical management of HLCs.
Materials and methods: From January 1989 to December 2007, 127 patients (100 males; 13-80 years) with 184 viable HLCs (137 univesicular, 47 multivesicular; 2.8-20 cm) underwent D-PAI.
Results: Ultrasonography (US) showed complete disappearance of 125/184 (68%) cysts; in the remaining 59 cases, an inactive solid (37 cases, 20%) or liquid pattern (22 cases, 12%) was observed with volume decreases of 50-80%. The final US pattern was unmodified during the follow-up in 96.8%. Local recurrences were observed in 5 patients (3.9%): 4 patients with 8 multivesicular cysts and 1 patient with a bilocular cyst (with a solid pattern on US) that ruptured into the biliary tree 2 years after the procedure and disappeared after endoscopic sphincterectomy. The mortality rate was 0.8%, and the overall morbidity was 8.6%. The mean hospital stay was 2.9 days. The time of healing for smaller cysts (<5 cm) was shorter than that of large cysts (≥5 cm) (P < 0.001).
Conclusion: Our long-term results confirm the high effectiveness of D-PAI in the treatment of HLCs. These results suggest that multilocular cysts require closer follow-up than unilocular cysts.
Sommario SCOPO: Scopo di questo studio è stato quello di riportare i risultati a lungo termine del trattamento percutaneo delle cisti idatidee epatiche con doppia puntura – aspirazione – e iniezione di etanolo/(D-PAI). MATERIALI E METODI: Centoventisette pazienti con 184 cisti idatidee epatiche vitali (137 univescicolari, 47 multivescicolari) sono stati sottoposti a D-PAI. RISULTATI: All'esame ecografico si osservava restitutio ad integrum del parenchima epatico in 125 (68%) delle 184 cisti trattate. Per le rimanenti 59, era visibile una riduzione volumetrica del 50–80%. L'aspetto ecografico risultava immodificato per tutta la durata del follow-up nel 96,8% dei pazienti, fatta eccezione per 5 (3,9%) pazienti (4 con cisti multivescicolari, 1 con cisti biloculare) che presentavano recidive locali. CONCLUSIONI: I nostri dati confermano l'elevata efficacia della D-PAI nel trattamento percutaneo delle cisti idatidee epatiche e suggeriscono uno stretto follow-up nei pazienti con cisti multivescicolari.
Keywords: Double percutaneous aspiration and ethanol injection; Hydatid liver cysts; Interventional ultrasound; Percutaneous treatment; Puncture–aspiration–injection and re-aspiration.