تحول در روش هاي درماني كيست هيداتيد كبد

Evolution in treatment methods of hepatic hydatid cyst

Introduction: A large number of surgical and non-surgical treatment methods have been propounded for cystic echinococcosis of liver so far. For decades, surgical excision via conservative or radical approaches was the only known treatment method for this disease. Availability of chemotherapeutic agents with considerable activity against Echinococcus granulosus has made it possible to treat hydatid cysts with ultrasound- or computed tomography-guided transhepatic percutaneous drainage method, named Puncture, Aspiration, Injection, and Re-aspiration (PAIR). The aim of this study was to compare the older and newer treatment methods for liver hydatid cyst. Methods: A search was made on three decades later in four different data bases MEDLINE, Chohran Library, Web of Science and ScienceDirect with keywords: "hepatic hydatid cyst", "Albendazol"," Cystic echinococcosis ", "PAIR ", "metaanalysis ", Randomized controlled trial" Results: Three hundred and seven studies met our inclusion criteria. Most of these studies had considerably large-sized samples of patients with hepatic hydatid cyst. They were comprised of original research articles, case reports, review articles, and randomized controlled trials. These studies had assessed efficacy of conventional surgical methods as well as that of chemotherapy and PAIR. Conclusion: Surgery with different techniques aiming eradication and reduction of recurrence is considered as one the main treatment methods. However, use of percutaneous drainage and minimally invasive techniques is now growing. PAIR with albendazole appears to have higher clinical efficacy, and lower rates of major and minor complications, mortality, short and long term disease recurrence, and fewer days of hospitalization as compared with surgery. Therefore, it is preferable to surgery. Surgery is suggestible in cases for which PAIR is not feasible or complications of the cyst are an issue. Pre- and post-intervention chemotherapy reduces disease recurrence and intraperitoneal seeding of infection.