AJR:172, January 1999 91 PercutaneousTreatment of Hydatid Cysts of the Liver: Long-Term Results Bahri Ust#{252}ns#{246}z1 Okan Akhan2 MehmetAli KamiIo lu1 Ibrahim SomunCu1 Mehmet ahin U ureI1 Saadettin #{231}etiner3 OBJECTIVE. The purpose of the study was to present the long-term results of percutane- ous treatment of liver hydatid cysts. SUBJECTS AND METHODS. Seventy-two patients (44 male and 28 female, ranging in age between 10 and 69 years; mean age, 35 years) with 106 liver hydatid cysts underwent percutaneous treatment with albendazole prophylaxis. Puncture, aspiration. injection. and reaspiration (PAIR) were used for hydatid cysts smaller than 6 cm (n = 66). Larger cysts (ii = 40) were treated by catheterization. Hypertonic saline solution and absolute alcohol were used as the cytotoxic and sclerosing agents. Sonographic guidance with or without fluoros- copy was used in all patients. Follow-up was mainly by sonography every third month of the first year, every sixth month of the second year. and once a year thereafter. The mean follow- up time was 37 months. RESULTS. The mean reduction in volume at the time ofthe first follow-up was 87.0% and 73.5% in catheterization and PAIR patients. respectively. The immediate sonographic changes after treatment were detachment of the endocyst and disappearance of the regular endocyst, with a reduction in the fluid component. The solid appearance of the cyst remnant indicated complete cure as the cyst wall became irregular and thicker. The average time for develop- ment ofa solid appearance was 19 months in PAIR patients and 26 months in catheterization patients. Seventy of 72 patients were cured, whereas two recurrences (2.8C/e) were observed. No mortality, abdominal dissemination, or tract seeding occurred. Minor complications were urticaria and fever in eight patients (11 . I %). Major complications were infection of the cyst cavity in two patients (2.8%) and development ofbiliary tistula in four patients (5.6%). Mean hospitalization times were I7 days for complicated cases and I day for uncomplicated cases. CONCLUSION. The long-term results of percutaneous liver hydatid cyst treatment ac- cord with short-term results, indicating that the procedure is efficient and safe and offers com- plete cure in selected patients with a short hospitalization. Received February 12, 1998; accepted after revision June 29, 1998. 1 Department of Radiology, GUlhane Military Medical Academy, 06018 Etlik, Ankara 06100, Turkey. Address correspondence to B. UstUnsdz. 2DepartmentofRadiology, Hacettepe University, Faculty of Medicine, Sihhiye, Ankara 06100, Turkey. 3Department of Surgery, GUlhane Military Medical Academy, 06018 Etlik, Ankara 06100, Turkey. AJR 1999;172:91-96 0361 -803X/99/1721--91 © American Roentgen Ray Society H ydatid disease caused by Eehino- (‘Ot’(’ttS granulosus is endemic and a common health problem in Med- iterranean countries, the Middle East. South America. New Zealand, and Australia I I 1. The disease may be asymptomatic, or. rarely. pa- tients may clinically present with life-threaten- ing anaphylactic shock from cyst rupture 121. Surgical treatment of hydatid disease is tradi- tional and carries a higher risk of complica- tions, death. and lengthy hospitalization than does nonsurgical treatment 13-51. Nonsurgical treatment such as percutaneous. endoscopic. and medical procedures and combinations such as percutaneous plus medical or percuta- neous plus endoscopic procedures have been novel for the last two decades [6-9]. Large studies with long-term results are lacking. Among nonsurgical treatments. medical ther- apy with benzimidazole compounds (albenda- zole or mebendazole) is not usually curative [8, 10]. Endoscopic treatment has limited mdi- cations, with a role mostly in biliary hydatid cysts [9. 1 1 1. Percutaneous treatment of hy- datid cysts has been gaining acceptance be- cause of its positive short-term results since it was first introduced in I 985 by Mueller et al. I I 2]. We present our long-term results from percutaneous treatment. Subjects and Methods From February 1992 to February 1997. 72 pa- tients (44 male and 28 female: age range, 10-69 years: mean age. 35 years) with 106 hydatid cysts underwent percutaneous treatment. All patients were regularly k)llowed up every 3 months in their Downloaded from www.ajronline.org by 52.73.204.196 on 05/16/22 from IP address 52.73.204.196. Copyright ARRS. For personal use only; all rights reserved