Traitement percutané du kyste hydatique du foie

Abstract

Until recently, the main treatment for the hepatic hydatid cyst (HHC) was surgery. Such treatment is associated with a considerable morbidity and even mortality. The development of medical imaging, particularly the echography, has facilitated the diagnosis of HHC, and the disease is now percutaneously treated. This treatment is based on two techniques: the puncture-aspiration-injection and re-aspiration (PAIR) of a scolicid product, and the puncture-aspiration with drainage (PAIR-PD). The second technique is essentially used for large HHCs. The percutaneous treatment is chosen essentially for Gharbi grade I or grade II HHC (79% of treated HHC). Grade III or IV HHC may be successfully treated by the percutaneous technique, but given the small number of grade III and IV treated HHD, it remains too early to make it an indication. Main contraindications for percutaneous treatment are the sub-capsular superficial HHC, and the HHC broken in the biliary tract. Whichever the technique, satisfactory results are obtained, with a rate of success from 70% to 100% with the PAIR technique, and 100% with the PAIR-PD technique). The mortality is close to zero (0.3%), and morbidity is low, about 14.9%. Serious complications are exceptional (1.4%) (anaphylactic shock and spreading). Compared to surgery, the percutaneous treatment showed a higher efficacy, with lower associated morbidity and mortality. All these reasons suggest that the percutaneous treatment is a good alternative for surgery, and should be considered as first-line therapy for grade I and II HHCs.