| Object:To explore and reaserch the clinical effect and safety of liposomal albendazole in treating cystic echinococcosis (CE) and alveolar echinococcosis (AE), and to evaluate its clinincal effect for the treatment of complex and multi-organs involved echinococcosis with surgery. Methods:1) Reviewing clinical data for 269 cases of cystic echinococcosis treated by medicine in our hospital between 1998 and 2008, by using retrospective case-contral method, based on special cretia of exclusion and inclusion, two group patierts who taking liposomal albendazole and tablet albendazole were analyzed.51 cases were excluded by the method, and 218 cases entered this research. Based on clinical symptoms?imaging check and serum test, the effect and safety of medicine were compared to analyze.2) To analyze the clinical data retrospectively about 26 cases of complex liver alveolar echinococcosis who treated with liposmal albendazole, by same cretia of inclusion, to evaluate the clinical effect and safty of patents involved by liver alveolar echinococcosis who treated with liposomal albendazole single or liposomal albendazole after palliative surgery.3) Reviewing clinical data for 17 cases of alveolar echinococcosis by 1?7 years follow-up in our hospital in 2000 to 2009, by analyzing patients' clinical feature, stepping to explore clinical experences the treatment of mutli-organs alveolar echinococcosis with liposomal albendazole and surgery. Results:1) In 218 patients with cystic echinococcosis who entered our study, the result were analyzed as following by statistical metheds:?In short-term effect of evaluation, the total rate and cure rate of group liposomal albendazole and tablet-albendazole is 77.9%, 49.1%; 28.44%,13.88%, the effect of group liposomal albendazole was better than group tablet-albendazole, showing remarkable statistical difference in total effective rate and in curative rate (P=0.000; P=0.0067), The effect of group liposomal albendazole were better than group tablet-albendazole.?In long-term effect of evaluation, the total rate and cure rate of group liposomal albendazole and tablet-albendazole is 81.8%,49.0%; 54.16%,20.58%, the two groups all showed remarkable statistical difference in total effective rate and curative rate (P=0.009; P=0.0001). The effect of group liposomal albendazole were better than group tablet-albendazole obviously.?In contrast of different cystic types, Comparing with different types of cystic echinococcosis in two groups, First, In short-term effect of evaluation, the total rate of single cyst (CE1), multiple daughter cyst (CE2) and cyst with detachment of laminated membrane (CE3) treated with liposomal albendazole is better than its treated with tablet-albendazole (P< 0.05). And second, In long-term effect of evaluation, the total rate of single cyst (CEj), multiple daughter cyst (CE2) and cyst with detachment of laminated membrane (CE3) treated with liposomal albendazole show no remarkable statistical difference with group tablet-albendazole (P>0.05).?In contrast of different cystic types, f In contrast of different cystic types, the cure rate and total effective rate of three types in two groups is: CEi:the rates of T-ABZ is 50%,56.6%in short-term, and is 58.3%,70%in long-term; the rates of L-ABZ is 47.3%,92.1%in short-term, and is 79.3%,96.5%in long-term; CE2:the rates of T-ABZ is 8.7%,35.1%in shoer-term; and is 28.5%,69.0%in long-term; the rates of L-ABZ is 12.2%,65.3%in short-term, and is 35.9%,84.%in long-term; CE3:the rates of T-ABZ is 33.3%,61.9%in short-term, and is 70%,100%, the rates of L-ABZ is 61.5%, 76.9%'in short-term, and is 50%,100%in long-term., The effect of simple cyst (CE1) being closed to cyst with detachment of laminated membrane (CE3) (P>0.05) is more sensitive than the effect of multiple daughter cyst (CE2) in rate of cure and total effective rate in short-term and long-term follow-up, showing remarkable statistical difference (P<0.05).?In observation of adverse reaction (ADR), The rate of ADR in the two groups of liposomal albendazole and tablet-albendazole were 11.1%(12/108),12%(14/109) respectively, There is no statistical significant difference between the two groups.2) In line with grouping analyzing for 26 patients involved with complex liver alveolar echinococcosis who entered our study by same inclusion criteria,13 of 26 patients treated by liposmal albendazole alone, and another 13 patients treated by palliative surgery adding liposmal albendazole, there are no statistic significance between two therapeutic procedures (P=0.8335).furthermore,19 of 26 patients with long-time chemotherapy still alive with health.3) In total 17 cases,8 cases showing good effect after taking L-ABZ,3 cases for operation of radical hepatectomy and 1 case for pneumonectomy showing better effect, lcase under palliative liver transplantation being found lung metastasis also taking L-ABZ for a long time. Another case under liver transplantation enduring long-time chemotherapy after operation of finding with lung and brain metastasis.3 cases doing operation for serious liver and brain complications, and enduring long-time chemo-therapy, one of three cases died of serious brain complications after half year follow-up, furthermore,1 of 17 cases died without treatment after bing out of hospital automatically. For two more organs being involved by lesion of alveolar echinococcosis, It is very difficult to diagnose and to cure alvelor echinococcosis in mult-organs radically by operation, so, the life quality and long-time live of patients endured serious difficulty. Conclutions:1) Tablet albendazole is effective medicine for anti-hydatid admitted by domestic and overses, effect confirmed, liposomal albendazole is a new medicine of albenzle, can be absorded better, and show lower toxic and side-effect, having advantages of contraled relasing, slower degradation of medicine and passive targeting effect. In our study, it showed better effect for all different types of cystic echinococcosis, by contrast of short-term effect and long-term effect for the two, the effect of group of liposomal albendazole were better than group of tablet-albendazole about effective rate and curative rate. In contrast of different cystic types, reaction for medicine of daughter cyst echinococcosis is lower than its of single cyst echinococcosis and cyst with detachment of laminated membrane, effect of it is not good enough.But, whether group of liposomal albendazole or group of tablet albendazle, adverse reaction is all lower and all is safe. Thus, liposomal albendazole show better clinical effect in treating cystic echinococcosis, safe and have better effect, providing a now way for synthetical treatment of echinococcosis.2) It is safe and effective for liposmal albendazole treating complex liver alveolar echinococcosis, and can be taking long time. Meanwile, by contrast of two groups, And it may be there are no significant difference between chemotherapy alone and palliative surgery with chemotherapy. But, it is evitable of effective and long-time chemotherapy for complex liver alveolar echinococcosis, whether palliative surgery for such complex liver alveoar echinococcosis being done or not.3) patients who with mutli-organs involved is rare in clinic, surgical treatment hard to cure, doing operation just for rasolving serious complications.the treatment of liposmal albendazole aline with palliative operation for such patients is active and effective, Based on operation solving serious complications, to some extent, with synthetical medical treatment, patients'life can be prolonged and improved obviously, thus, showing greater clinical value. |
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