Karaciğer Kist Hidatik Tedavisinde Güncel Yaklaşım Nasıl Olmalıdır?

Echinococcus granulosusun larva formu tarafından oluşturulan karaciğer kist hidatik hastalığı halen Türkiyede yaygın ve önemli bir sağlık sorunu olmaya devam etmektedir. Cerrahi yaklaşım en sık kullanılan ve en iyi bilinen seçenektir. Perkütan aspirasyon, injeksiyon ve reaspirasyon (PAİR) cerrahiye alternatif olarak kullanılmaktadır ve popüler hale gelmektedir. Bu yüzden kist hidatik tedavisinde geleneksel cerrahi yaklaşımdan daha az invaziv bir yöntem olan PAİRe doğru bir kayış söz konusudur. Cerrahi multipl kız kistleri olan geniş hepatik kistlerde, infekte kistlerde, biliyer kanallarla bağlantılı ve vital organlara basınca neden olan kistlerde ve tek yüzeyel yerleşimli kistlerde endikedir. Ameliyat öncesi uygulanan albendazol tedavisinin amacı cerrahi veya perkütan drenaj öncesi kistin canlılığını azaltmakken, işlem sonrası tedavinin amacı ise rekürrens riskini düşürmektir. PAİR ümit verici bir yöntem olarak görülmektedir, ancak uzun dönem sonuçları için daha fazla randomize çalışmaya ihtiyaç vardır. Bu çalışmanın amacı, karaciğer kist hidatik yönetiminde farklı tedavi seçeneklerinin etkinliklerini ve kullanım alanlarını değerlendirmektir.

What is the Current Concept for the Treatment of Liver Hydatid Disease?

Hydatid disease of the liver caused by the larval form of Echinococcus granulosus still remains a common and challenging problem in Turkey. Operative treatment is the most common and well known option. Percutaneous aspiration, injection and reaspiration (PAIR) has resulted as an alternative treatment to sur- gery and is becoming popular. Therefore, the treatment of hydatid cyst has been shifted from traditional surgical approach to less invasive PAIR. Large cysts with multiple daughter cysts, cysts communicating with the biliary tree, cysts exerting pressure on vital organs and single superficial hepatic cysts are indications for surgical treatment. While preoperative albendazol treatment is planned to decrease the cyst viability before surgery or percutanaeous drainage, postoperative chemotherapy is administered to reduce recurrence rates. PAIR is a promising treatment approach but randomised clinical trials with long follow- up are required to decide its efficiency. The aim of this study is to evaluate the effectiveness and indications of different treatment modalities in the management of liver hydatid cyst.

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