AHMET RENCÜZOĞULLARI, İsmail Soner KOLTAŞ, Atılgan Tolga AKCAM, ABDULLAH ÜLKÜ, ORÇUN YALAV, Ahmet Gokhan SARİTAS, Kubilay DALCI, İsmail Cem ERAY

Challenges, Prognosis and Outcomes of Surgical Resection for Hepatic Alveolar Echinococcosis: A Single Centre Experience

Giriş: Alveolar ekinokokkoz (AE) primer olarak karaciğeri etkileyen ve tümör benzeri davranış gösteren, agresif ve potansiyel olarak fatal bir infeksiyondur. Bu infeksiyon için cerrahi prosedürlere ilişkin sonuçlar nadiren raporlanmıştır. Bu çalışmada hepatik AE'in cerrahi tedavisi ile ilişkili olarak uzun dönem sonuçları değerlendirmeyi amaçladık. Yöntemler: 2001 ve 2013 yılları arasında, metastaz durumuna bakılmaksızın hepatik AE nedeniyle komplet rezeksiyon için uygun bulunan hastaların yönetimi ve sonuçları tanımlandı. Tüm hastaların preoperatif AE tanısı klinik bulgular, görüntüleme teknikleri ve serolojik testelere göre konuldu. Echinococcus multilocularis metasestod antijenine karşı oluşan antikor düzeyleri, Western Blot tekniğiyle elde edilen AE serolojik tanısı için spesifik markırlarlar olarak kullanıldı. Oral albendazol protokolü komplet rezeksiyonun yapılabildiği tüm hastalara uygulandı. Bulgular: Çalışma periyodu boyunca patolojik olarak hepatik AE olduğu konfirme edilen 12 hastaya (K/E=7/5) komplet rezeksiyon uygulandı. Ortanca takip süresi 82 ay idi. En sık başlangıç semptomları karın ağrısı (n=9) ve sarılık (n=4) idi. Beyin, sürrenal, dalak ve kolon olmak üzere 4 hastada metastaz tespit edildi. Alınan uygun önlemlere karşın bir hastada mortalite gözlenirken, gelişen diğer komplikasyonların tamamı başarı ile tedavi edildi. Sonuç: İleri evre hepatik AE olgularında uzun dönemdeki olumlu sonuçlar, komplet cerrahi rezeksiyon ile birlikte yapılan Albendazol uygulaması ile elde edilebilir.

Hepatik Alveolar Ekinokokkoz Cerrahisinde Zorluklar, Prognoz ve Yönetim: Tek Merkez Deneyimi

Objective: Alveolar echinococcosis (AE) is an aggressive and potentially fatal infection, which affects the liver primarily and presents as a tumor-like lesion. Outcomes associated with surgical procedures for this infection have been rarely reported. In the present study, we aimed to evaluate long-term surgical treatment outcomes associated with hepatic AE. Methods: Between 2001 and 2013, the management and outcomes of twelve consecutive hepatic AE patients who were considered feasible for complete hepatic resection with/without metastasectomy were described. In all patients, pre-operative diagnosis of AE was based on clinical findings, imaging studies, and serological tests. Antibodies against antigens of Echinococcus multilocularis metacestodes were screened as specific markers for the serological diagnosis of AE by Western blot. The oral albendazole protocol was administered for hepatic AE patients who had complete resection. Results: Twelve patients (F/M=7/5) underwent complete resection for pathologically confirmed hepatic AE during the study period. Median follow-up was 82 months. The most common initial symptom was abdominal pain (n=9) followed by jaundice (n=4). Four patients had metastasis: Brain, surrenal, splenic and colon. One patient was lost due to massive pulmonary emboli despite appropriate interventions. All other complications that emerged were treated successfully. Conclusion: Long-term favorable outcomes can be achieved by complete surgical resection followed by chemotherapy with albendazole in advanced hepatic AE cases

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