Skip to main content
SpringerLink
Log in

Chirurgische Therapie bei Echinococcus-Zysten der Leber

Surgery for Echinococcus cysts in the liver

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Die Echinokokkose ist eine parasitäre Krankheit, die am häufigsten in der Leber lokalisiert ist, sie wird in manchen Ländern als eine endemische Krankheit betrachtet. Ihre Diagnose beruht auf radiologischen und serologischen Befunden. Obwohl das konservative therapeutische Vorgehen bei dieser Erkrankung Erfolg versprechend sein kann, so ist das Verfahren der Wahl die Operation der Hydatide. Ziele der chirurgischen Therapie sind: Abtötung der Zyste, Entfernen infektiöser Elemente der Zyste aus der Leber, Obliteration der Kavität sowie Verhindern eines Rezidivs und potenzielle Komplikationen.

Ein breites Spektrum der interventionellen und operativen Therapie steht zur Verfügung. Die laparoskopische Chirurgie nimmt in der Behandlung der Echinokokkose zunehmend einen Platz ein. Die vorliegende Arbeit behandelt insbesondere den aktuellen Status der chirurgischen Therapie bei Echinococcus-Zysten der Leber.

Abstract

Hydatid disease is a parasitic infection caused by Echinococcus granulosus, and the most frequently affected organ is the liver. Diagnosis is usually based on radiological and serological findings. Even though percutaneous drainage and medical therapies are suggested for selected cases, for the most part surgery is required. The surgical strategy consists of killing the cyst, removing its contagious elements from the liver, obliterating the cystic cavity, and preventing recurrence and complications. A large spectrum of operations – from simple drainage to liver transplantation – has been proposed for reaching these objectives. Laparoscopic surgery is used increasingly for hydatid disease. This article reviews the current status of hydatid disease surgery, with special emphasis on liver cysts.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Göksoy E, Kaner G, Ozyeğin A et al. (1992) Untersuchung der perizystischen Gewebe nach Scolices und Histopatologie bei Leberechinokokkose: Zystenevakuation und Omentoplastie versus Perizystektomie (Total Zystektomie). Langenbecks Arch Chir [Suppl]. Kongressbd: 574

  2. Göksoy E, Ulualp KM, Kaner G, Gökdogan C (1995) Hepatic echinococcosis: treatment without pericystectomy. Contemp Surg 47: 83

    Google Scholar 

  3. McManus DP, Zhang W, Li J, Bartley PB (2003) Echinococcosis. Lancet 362: 1295–1304

    Article  PubMed  Google Scholar 

  4. Cirenei A (1990) La pathologie du perikyste et la chirurgie de I’hydatidose hepatique. Etudes et experiences personnelles. Chirurgie 116: 72

    PubMed  CAS  Google Scholar 

  5. Androulakis GA (1986) Surgical management of complicated hydatid cysts of the liver. Eur Surg Res 18: 145

    Article  PubMed  CAS  Google Scholar 

  6. Hankins JR (1963) Management of complicated hepatic hydatid cysts. Ann Surg 158: 1020

    Article  PubMed  CAS  Google Scholar 

  7. Mottaghian H, Saidi F (1978) Postoperative recurrence of hydatid disease. Br J Surg 65: 237

    Article  PubMed  CAS  Google Scholar 

  8. Pissiotis CA, Wander JV, Condon RE (1972) Surgical treatment of hydatid disease. Prevention of complications and recurrences. Arch Surg 104: 454

    PubMed  CAS  Google Scholar 

  9. Chrieki M (2002) Echinococcosis–an emerging parasite in the immigrant population. Am Fam Physician 66: 817–820

    PubMed  Google Scholar 

  10. Kayaalp C, Bostanci B, Yol S, Akoglu M (2003) Distribution of hydatid cysts into the liver with reference to cystobiliary communications and cavity-related complications. Am J Surg 185: 175–179

    Article  PubMed  Google Scholar 

  11. Sbihi Y, Rmiqui A, Rodriguez-Cabezas MN et al. (2001) Comparative sensitivity of six serological tests and diagnostic value of ELISA using purified antigen in hydatidosis. J Clin Lab Anal 15: 14–18

    Article  PubMed  CAS  Google Scholar 

  12. Biava MF, Dao A, Fortier B (2001) Laboratory diagnosis of cystic hydatic disease. World J Surg 25: 10–14

    Article  PubMed  CAS  Google Scholar 

  13. Gharbi HA, Hassine W, Brauner MW, Dupuch K (1981) Ultrasound examination of the hydatid liver. Radiology 139: 459–463

    PubMed  CAS  Google Scholar 

  14. Gossios KJ, Kontoyiannis DS, Dascalogiannaki M, Gourtsoyiannis NC (1997) Uncommon locations of hydatid disease: CT appearances. Eur Radiol 7: 1303–1308

    Article  PubMed  CAS  Google Scholar 

  15. Lomas DJ (2001) The liver. In: Grainger RG, Allison D, Adam A, Dixon AK (eds) Diagnostic radiology: a textbook of medical imaging. 4th edn. Churchill Livingstone, London, pp 1237–1275

  16. Kalovidouris A, Gouliamos A, Vlachos L et al. (1994) MRI of abdominal hydatid disease. Abdom Imaging 19: 489–494

    Article  PubMed  CAS  Google Scholar 

  17. Buttenschoen K, Carli Buttenschoen D (2003) Echinococcus granulosus infection: the challenge of surgical treatment. Langenbecks Arch Surg 388: 218–230

    Article  PubMed  CAS  Google Scholar 

  18. Galati G, Sterpetti AV, Caputo M et al. (2006) Endoscopic retrograde cholangiography for intrabiliary rupture of hydatid cyst. Am J Surg 191: 206–210

    Article  PubMed  Google Scholar 

  19. Simsek H, Ozaslan E, Sayek I et al. (2003) Diagnostic and therapeutic ERCP in hepatic hydatid disease. Gastrointest Endosc 58: 384–389

    Article  PubMed  Google Scholar 

  20. Belli L, Del Favero E, Marni A, Romani F (1983) Resection versus pericystectomy in the treatment of hydatidosis of the liver. Am J Surg 145: 239

    Article  PubMed  CAS  Google Scholar 

  21. Magistrelli P, Masetti R, Coppola R et al. (1991) Surgical treatment of hydatid disease of the liver. A 20-year experience. Arch Surg 126: 518

    PubMed  CAS  Google Scholar 

  22. Dawson JL, Stamatakis JD, Stringer MD, Williams R (1988) Surgical treatment of hepatic hydatid disease. Br J Surg 75: 946

    Article  PubMed  CAS  Google Scholar 

  23. Papadimitriou J, Mandrekas A (1970) The surgical treatment of hydatid disease of the liver. Br J Surg 57: 431

    Article  PubMed  CAS  Google Scholar 

  24. Rakas FS, El-Mufti M, Mehta PM et al. (1990) Omentoplasty or tube drainage for the management of the residual cavity following the removal of an hepatic hydatid cyst. Hepatogastroenterology [Suppl 11] 37: 55

  25. Saidi F, Nazarian I (1971) Surgical treatment of hydatid cysts by freezing of cyst wall and instillation of 0.5 percent silver nitrate solution. N Engl J Med 284: 1346

    PubMed  CAS  Google Scholar 

  26. Göksoy E, Düren M (2000) Surgical therapy of Echinococcus granulosus (cysticus). Chirurg 71: 21–29

    Article  PubMed  Google Scholar 

  27. Belli L, Romani F, Puttini M (1987) Easier and safer cystopericystectomy using Pringle maneuver. Surg Gynecol Obstet 164: 75

    PubMed  CAS  Google Scholar 

  28. Elhamel A (1990) Pericystectomy for the treatment of hepatic hydatid cysts. Surgery 107: 316

    PubMed  CAS  Google Scholar 

  29. Dervenis C, Delis S, Avgerinos C et al. (2005) Changing concepts in the management of liver hydatid disease. J Gastrointest Surg 9: 869–877

    Article  PubMed  Google Scholar 

  30. Romero-Torres R, Campbell JR (1965) An interpretive review of the surgical treatment of hydatid disease. Surg Gynecol Obstet 121: 851

    PubMed  CAS  Google Scholar 

  31. Barros JL (1978) Hydatid disease of the liver. Am J Surg 135: 597

    Article  PubMed  CAS  Google Scholar 

  32. Arıoğul O, Emre A, Alper A, Uras A (1989) Introflexion as a method of surgical treatment for hydatid disease. Surg Gynecol Obstet 169: 356

    PubMed  Google Scholar 

  33. Karavias DD, Vagianos CE, Bouboulis N et al. (1992) Improved techniques in the surgical treatment of hepatic hydatidosis. Surg Gynecol Obstet 174: 176

    PubMed  CAS  Google Scholar 

  34. Langer JC, Rose DB, Keystone JS et al. (1984) Diagnosis and management of hydatid disease of the liver. A 15 year North American Experience. Ann Surg 199: 412

    Article  PubMed  CAS  Google Scholar 

  35. Yagci G, Ustunsoz B, Kaymakcioglu N et al. (2005) Results of surgical, laparoscopic, and percutaneous treatment for hydatid disease of the liver: 10 years experience with 355 patients. World J Surg 29: 1670–1679

    Article  PubMed  Google Scholar 

  36. Hamamci EO, Besim H, Sonisik M, Korkmaz A (2005) Occult intrabiliary rupture of hydatid cysts in the liver. World J Surg 29: 224–226

    Article  PubMed  Google Scholar 

  37. Dziri C, Haouet K, Fingerhut A (2004) Treatment of hydatid cyst of the liver: where is the evidence? World J Surg 28: 731–736

    Article  PubMed  Google Scholar 

  38. Ertem M, Uras C, Karahasanoglu T et al. (1998) Laparoscopic approach to hepatic hydatid disease. Dig Surg 15: 333–336

    Article  PubMed  CAS  Google Scholar 

  39. Kapan M, Yavuz N, Kapan S et al. (2004) Totally laparoscopic pericystectomy in hepatic hydatid disease. J Laparoendosc Adv Surg Tech A 14: 107–109

    Article  PubMed  Google Scholar 

  40. Altinli E, Saribeyoglu K, Pekmezci S et al. (2002) An effective omentoplasty technique in laparoscopic surgery for hydatid disease of the liver. JSLS 6: 323–326

    PubMed  Google Scholar 

  41. Loinaz C, Moreno-Gonzales E, Gömez R et al. (1997) Echinococcus granulosus liver hydatid disease and transplantation: The „12 de octobre“ hospital experience. European Congress of the International Hepato-Pancreato-Biliary Association Hamburg, June 8–12. HPB 1 [Suppl 1]. Isıs Medical Media, p 166

  42. Cottone M, Amuso M, Cotton PB (1978) Endocopic retrograde cholangiography in hepatic hydatid disease. Br J Surg 65: 107

    Article  PubMed  CAS  Google Scholar 

  43. Rodriguez AN, Sánchez del Río AL, Alguacil LV et al. (1998) Effectiveness of endoscopic sphincterotomy in complicated hepatic hydatid disease. Gastrointest Endosc 48: 593–597

    Article  PubMed  CAS  Google Scholar 

  44. Morris DL (1978) Pre-operative albendazole therapy for hydatid cyst. Br J Surg 74: 805

    Article  Google Scholar 

  45. Yalın R, Aktan AÖ, Açıkgözoğlu S (1989) Computed tomography and sonography of hydatid cysts of the liver after surgical management. J Med Imaging 3: 301

    Google Scholar 

  46. Belghiti J, Benhamou JP, Houry S et al. (1986) Caustic sclerosing cholangitis. A complication of the surgical treatment of hydatid disease of the liver. Arch Surg 21: 1162

    Google Scholar 

  47. Khodadadi DJ, Kurgan A, Schmidt B (1981) Sclerosing cholangitis following the treatment of echinococcosis of the liver. Int Surg 66: 361

    PubMed  CAS  Google Scholar 

  48. Teres J, Gomez-Moli J, Bruguera M et al. (1984) Sclerosing cholangitis after surgical treatment of hepatic echinococcal cysts. Report of three cases. Am J Surg 148: 694

    Article  PubMed  CAS  Google Scholar 

  49. Göksoy E, Düren M, Kapan M, Gökdoğan C (1994) Chirurgische Therapieverfahren bei Leberechinokokkose mit Ruptur in die Gallenwege. Langenbecks Arch Chir Suppl. Kongressbd: 1277

  50. İşcan M, Düren M (1991) Endoscopic sphincterotomy in the management of postoperative complications of hepatic hydatid disease. Endoscopy 23: 282

    Article  PubMed  Google Scholar 

  51. Kapan M, Kapan S, Goksoy E et al. (2006) Postoperative recurrence in hepatic hydatid disease. J Gastrointest Surg 10: 734–739

    Article  PubMed  Google Scholar 

  52. Amir-Jahed AK, Fardin R, Farzad A, Bakshandeh K (1975) Clinical echinococcosis. Ann Surg 182: 541

    Article  PubMed  CAS  Google Scholar 

  53. Little JM, Deane A (1988) Hydatid disease. In: Blumgart LH (ed) Surgery of the liver and biliary tract. Churchill Livingstone, Belirburg, p 955

  54. Pitt HA, Korzelius J, Tompkins RK (1986) Management of hepatic echinococcosis in Southern California. Am J Surg 152: 110

    Article  PubMed  CAS  Google Scholar 

  55. Erzurumlu K, Hokelek M, Gonlusen L et al. (2000) The effect of albendazole on the prevention of secondary hydatidosis. Hepatogastroenterology 47: 247–250

    PubMed  CAS  Google Scholar 

  56. Aktan AO, Yalin R (1996) Preoperative albendazole treatment for liver hydatid disease decreases the viability of the cyst. Eur J Gastroenterol Hepatol 8: 877–879

    PubMed  CAS  Google Scholar 

  57. Franchi C, Di Vico B, Teggi A (1999) Long-term evaluation of patients with hydatidosis treated with benzimidazole carbamates. Clin Infect Dis 29: 304–309

    Article  PubMed  CAS  Google Scholar 

  58. Kapan S, Turhan AN, Kalayci MU et al. (2008) Albendazole is not effective for primary treatment of hepatic hydatid cysts. J Gastrointest Surg 12: 867–871

    Article  PubMed  Google Scholar 

  59. Mohamed AE, Yasawy MI, Al Karawi MA (1998) Combined albendazole and praziquantel versus albendazole alone in the treatment of hydatid disease. Hepatogastroenterology 45: 1690–1694

    PubMed  CAS  Google Scholar 

  60. Yasawy MI, al Karawi MA, Mohamed AR (1993) Combination of praziquantel and albendazole in the treatment of hydatid disease. Trop Med Parasitol 44: 192–194

    PubMed  CAS  Google Scholar 

  61. Mueller PR, Dawson SL, Ferrucci IT, Nardi GL (1985) Hepatic echinococcal cyst: successful percutaneous drainage. Radiology 155: 627–628

    PubMed  CAS  Google Scholar 

  62. Bret PM, Fond A, Bretagnolle M et al. (1988) Percutaneous aspiration and drainage of hydatid cysts in the liver. Radiology 168: 617–620

    PubMed  CAS  Google Scholar 

  63. Polat K, Balik A, Oren D (2002) Percutaneous drainage of hydatid cyst of the liver: long-term results. HPB (Oxford) 4: 163–166

    Google Scholar 

  64. Ustünsöz B, Akhan O, Kamiloğlu MA et al. (1999) Percutaneous treatment of hydatid cysts of the liver: long-term results. AJR Am J Roentgenol 172: 91–96

    PubMed  Google Scholar 

  65. Peláez V, Kugler C, Correa D et al. (2000) PAIR as percutaneous treatment of hydatid liver cysts. Acta Trop 75: 197–202

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Allgemeinchirurgie der medizinischen Fakultät Cerrahpasa Istanbul Universität, Istanbul, Türkei

    E. Goksoy & K. Saribeyoglu

  2. Chirurgische Klinik und Poliklinik des Universitätsklinikums der RWTH-Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland

    M. Saklak & V. Schumpelick

Authors
  1. E. Goksoy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Saklak
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Saribeyoglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. V. Schumpelick
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Saklak.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Goksoy, E., Saklak, M., Saribeyoglu, K. et al. Chirurgische Therapie bei Echinococcus-Zysten der Leber. Chirurg 79, 729–737 (2008). https://doi.org/10.1007/s00104-008-1521-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-008-1521-y

Schlüsselwörter

Keywords

Search

Navigation