Percutaneous evacuation (PEVAC) of multivesicular echinococcal cysts with or without cystobiliary fistulas which contain non-drainable material: first results of a modified PAIR method

摘要: Background: Surgery is the treatment of choice in echinococcal cysts with cystobiliary fistulas. PAIR (puncture, aspiration, injection, and reaspiration scolecidals) contraindicated these cases. Aim: To evaluate a modified method for percutaneous multivesicular or without fistulas which contain non-drainable material. Patients: Twelve patients were treated: 10 contained material complicated by spontaneous intrabiliary rupture, secondary fistulas, cyst infection, obstructed portal hepatic veins; two large univesicular ruptured laminated membrane, one obstructing veins suspected fistula. Methods: The methods used, termed PEVAC (percutaneous evacuation content), involved following steps: ultrasound guided puncture aspiration fluid to release intracystic pressure thereby avoid leakage; insertion bore catheter; daughter endocyst injection isotonic saline; cystography; scolecidals only if no fistula was present; external drainage combined endoprosthesis sphincterotomy; catheter removal after complete collapse closure fistula. Results: In all 12 initial size 13.1 (6–20) cm (mean (range)). At follow up 17.9 (4–30) months PEVAC, seven had disappeared five decreased 2.4 (1–4) (p=0.002). eight cysts, fistula, 12.5 cm, time 72.3 (28–128) days, hospital stay 38.1 (20–55) days. 17.3 (4–28) up, six residual 1 2.9 respectively (p=0.012). four 14.4 (12.7–16) 8.8 (3–13) 11.5 (8–14) 19.3 (9–30) three 85 (69–94)% smaller (2.2 cm) (p=0.068). Conclusion: safe effective material.