Valutazione ecografica della vitalità/fertilità nell’idatidosi epatica come indicazione alla pericistectomia

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COD: 223-232 Categorie: ,

Oreste Nardello, Giovanni Bortoletti, Marilena Muggianu, Maria Conchedda, Marino Cagetti

Ann. Ital. Chir., 2006; 77: 223-231

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Hepatic hydatidosis is still now a frequently observed pathology and the total pericistectomy, for surgical difficulties, often
request a subtotal pericistectomy with complications such as biliary fistula, haemorrhage and subphrenic abscesses.
The Authors reconsidered their hepatic hydatidosis cases to evaluate the indication to the surgery that in their opinion,
should have to consider first of all the functional state of the cysts.
Infact, only the vital and the fertil ones, less frequent even if rarely found, should have indications to the surgery, because
more likely complicated.
The dead and steril ones, instead being asymptomatic, should go under periodic control, since destined to degeneration
and calcification.
Are also compared the pre-surgery data with the parasitologic exam, to evaluate ETG reliability to determine the functional
state of the cyst.
Twenty one cysts out of 76 were operated correctly because vital/fertile and in 19 of these the ultrasound indications
were correct (90.5%). 55 didn’t have indications to the surgery since dead/steril and for 51 (92.7%) the ultrasound
indication was correct. So we can say that morphological ultrasound data permitted a correct surgery indication for 70
cyst’s on their functional state (93.4% of total). In this way the post-operative complication were reduced of 5%.
The Authors found morphologic and/or functional ultrasound error for 6 cysts (7.9%), and in only 3 cases (3.9%) the
error were both morphological and functional
Infact we believe that a ultrasound morphologic classification should have a functional corrispective for the surgical indication
So only the unilocular and multivescicular cysts, vital and fertil one, should have indication to the surgery. On
the contrary the solid ones should have an ultrasound follow up and treated by chemotherapy if necessary.

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