Objective To investigate the diagnosis and treatment of the liver hydatidosis in nonpastureland. Methods Clinical features of 16 patients with liver hydatidosis were analyzed retrospectively. Results Only 8 of 16 patients possessed the clinical symptoms and 8 patients had had history of inhabitancy in epidemic area. Casoni test and indirect hemagglutination showed a sensitivity of 90% and the correct diagnostic rate of CT was higher than that of B-ultrasound examination. The main effective treatment of the liver hydatidosis was surgical, 15 out of 16 patients received surgical treatment. In this series, the curative effect was good without any death, allergic reaction and implantation. Conclusion The cystic lesion of liver should be considered as liver hydatidosis and Casoni test, indirect hemagglutination, together with CT and B-us examination can be used to comfirm the diagnosis though no clinical symptoms and history of inhabitancy in epidemic area presented. Surgical operation is the main effective treatment for liver hydatidosis.
Objective To summarize the research status of echinococcosis- specific vaccine antigens, analyze their sources and application prospects, and to provide new ideas for the development of echinococcosis vaccine antigens and drug treatment. Method Research on echinococcosis-specific vaccine antigens at home and abroad was searched and reviewed. Results Natural hydatid antigens, such as cystic fluid crude antigen, protoscolex segment, germinal layer, etc. often appear due to the difficulty of material acquisition and cumbersome preparation, resulting in unstable evaluation indicators such as sensitivity and specificity. The gene or protein sequences of a new recombinant hydatid antigen was accessible, the reproducibility and specificity were better, and it was more suitable for batch production testing, which was the main direction of current research, such as rAgB8/1, rEm18, rEm2, etc. Conclusions Vaccine development is one of the main directions for the elimination of hydatidosis. In the interaction between echinococcus and human or animal hosts, the natural structural proteins or excretion/secretion proteins of echinococcus stimulate the host to produce anti-parasites immunity and immune clearance, and the search for these specific protein antigens is of great significance for vaccine development, and new drug treatment.
Objective To study the cl inical characteristics of sacrum echinococcosis disease so as to provide a basis for its diagnosis and treatment. Methods Between July 1999 and August 2010, 14 cases of sacrum echinococcosis disease were treated and the cl inical data were analysed retrospectively. There were 6 males and 8 females with an average age of 28.7 years (range, 16-58 years). The median disease duration was 5.7 years (range, 6 months to 11 years). Twelve cases came from cattle area or had a history of close contact with dogs and sheep; 12 patients had a history of lung or l iver hydatid disease. The main clinical symptoms were lumbosacral and lower extremity pain, one or both lower extremities and perineal hypoesthesia, the gradual dysfunction of both lower extremities and neurogenic bladder and bowel, and decreased force of urination. The imaging examination showed multicystic bone erosion. The Casoni test was performed in 10 cases and the results were positive in 8 cases. The eight immunoserology markers of hydatidosis were detected in 4 cases, and the results were all positive. After entire debridement of the focus, defects were repaired with autogenous bone, allogeneic bone, artificial bone, or bone cement, and then albendazole was used as a routine treatment for 3 months. Results Incisions healed by first intention, and no compl ication occurred. All patients were followed up 6 months to 11 years with a median time of 5.7 years. The preoperative cl inical symptoms were rel ieved. Eight cases recurred at 6 months to 3 years after operation; after debridement (3 times in 5 and 5 times in 1) and the lesions marginal resection with a high-speed burr (2 cases), the symptoms were relieved in different degrees without recurrence. No hydatid disease occurred and spreaded. Conclusion The cl inical manifestation of sacrum is not typical, which is easy to be misdiagnosed. MRI is helpful to diagnosis sacrum echinococcosis disease; serological examination is the major method of identification diagnosis, and surgery is the main treatment method.
ObjectiveTo explore the clinical application of in vivo hepatectomy with preservation of retrohepatic inferior vena cava (IVC) for hepatic alveolar echinococcosis (HAE) with the invasion of IVC. MethodsThe clinicopathologic data of a complicated HAE patient with large lesion (maximum cross-section 12.6 cm×9.6 cm), infiltrative growth, unclear boundary with surrounding tissues, and invasions of diaphragm and IVC (invasion length up to 4.6 cm) admitted to the Department of Liver Surgery in the West China Hospital of Sichuan University in December 2021 was retrospectively collected. The three-dimensional reconstruction of the liver model was performed by Mimics Medical 21.0 software before operation. The invading IVC of the right liver lesion was measured and the resection was simulated. During the operation, the HAE lesion and the affected IVC were gradually separated from IVC by the hemostatic forceps, and the residual lesions were gradually removed. ResultsIn this patient, the HAE lesion of right liver was resected, the IVC was entirely preserved, and the resection of liver was consistent with the preoperative three-dimensional reconstruction plan. The operation time was 275 min, the bleeding was approximately 500 mL. On the first day after the operation, the alanine aminotransferase and aspartate aminotransferase were increased, no obvious abnormalities were observed in the plasma albumin and bilirubin, the patient recovered and was discharged on the seventh day after the operation. No complications occurred after the operation, and no recurrence or metastasis of HAE was observed during follow-up period. ConclusionsHepatectomy with preservation of retrohepatic IVC for HAE with invasion of IVC is safe and effective. Taking albendazole regularly after surgery will help maintain disease-free survival.
ObjectiveTo analyze findings of 3.0 T diffusion weighted magnetic resonance (MR) in hepatic alveolar echinococcosis and evaluate potential role of apparent diffusion coefficients (ADC) in hepatic alveolar echinococcosis. MethodsThe clinical data of 26 patients with hepatic alveolar echinococcosis from November 2013 to January 2015 in this hospital were analyzed retrospectively. Hepatic MR scannings with diffusion weighted imaging (DWI) sequences (b-value=0, 600, 1 000, and 1 200 s/mm2) were performed in 26 patients with hepatic alveolar echinococcosis. The data of all the patients were stored to the PACS. The lesion features including type, size, distribution, location, and calcification (on the CT) were assessed by two deputy radiologists. TheADCvalues of marginal area, centre area, surrounding area of liver parenchyma tissue were measured at different b values (0, 600, 1 000, and 1 200 s/mm2) and compared. Results①There were 26 patients with a total of 29 lesions, of which involved multiple liver segments, 21 (72%) lesions located in the right lobe, 4 lesions involved simultaneously the left and right lobes. Twenty-four lesions invaded the hepatic vein or portal vein, 20 lesions invaded the intrahepatic bile duct, 10 lesions invaded the right adrenal gland. Seven patients occurred hilar and retroperitoneal lymph nodes metastases, 5 patients occurred pulmonary metastasis, 3 patients occurred brain metastasis, while 3 patients occurred lung and brain metastases simultaneously. ②There were 20 liquefied necrotic lesions, of which 5 lesions marginal area had multiple small round cysts in T2WI, 15 were only solid and without small cyst; The DWI of the centre area in 12 lesions showed a high signal, 8 lesions showed a low signal. There were 9 solid lesions, of which 2 lesions marginal area had multiple small round cysts in T2WI, 7 lesions marginal area were only solid and without cyst in T2WI. The DWI of the solid lesions showed a low signal, there was a "ring" high signal in the edge of lesions. ③At the same b value, theADCvalue of the centre area in the liquefied necrosis lesions were significantly higher than that in the solid lesions (P<0.01). At different b values, theADCvalue of the surrounding liver parenchyma tissue was significantly lower than that of the marginal area (P<0.01) and the centre area (P<0.01) in the liquefied necrosis lesions; theADCvalue of the centre area was significantly higher than that of the marginal area or surrounding liver parenchyma tissue (P<0.05, P<0.01) in the solid lesions. ConclusionsDWI could clearly distinguish structure and composition of hepatic alveolar echinococcosis and has a higher value in distinguishing from other liver dieases. The averageADCvalue of centre area in liquefied necrotic lesions is higher than that in solid lesions.
We reviewed the research progress of anesthesia management in hepatic echinococcosis surgery in recent years, including the key technologies, practical experience, and research progress of anesthesia management in hepatic echinococcosis surgery, so as to guide clinical practice. Firstly, in the selection of anesthesia, the general anesthesia combined with epidural block or regional nerve block is recommended to improve surgical safety and patients’ comfort. At the same time, the importance of intraoperative continuous monitoring, including key indicators such as hemodynamics and respiratory function, is emphasized, and transesophageal echocardiography and brain function monitoring techniques are introduced to optimize anesthesia management. Finally, the concept of enhanced recovery after surgery is promoted, and measures such as preoperative optimization, intraoperative heat preservation, refined fluid management, and postoperative analgesic management are implemented to promote the rapid recovery of patients. At the same time, some challenges and unsolved problems in the current research also are pointed out, such as complex case evaluation, complications prevention, and teamwork, etc., which need to be further studied in the future to optimize the anesthesia strategy.
ObjectiveTo summarize the surgical technique and indications for liver masses involving the second and the third porta hepatis.MethodsThirteen cases of liver mass involving the second and the third porta hepatis, who underwent surgery in West China Hospital of Sichuan University from June 2013 to September 2016 were collected retrospectively, then made a statistical analysis, including patients’ information, characteristics of liver masses, operation information, and result of followed-up.ResultsOf the 13 cases, there were 3 cases of hepatic alveolar echinococcosis, 4 cases of hepatocellular carcinoma, 4 cases of intrahepatic cholangiocarcinoma, and 2 cases of liver metastasis induced by colon cancer. The mean tumor diameter was 12.5 cm (7–21 cm). Preoperative imaging examinations showed that mass had involved the second and the third porta hepatis, and all masses were resected by surgery without perioperative death, including 7 cases of right three hepatectomy resection, 1 case of left three hepatectomy resection, 4 cases of right hepatectomy resection, and 1 case of left hemi hepatectomy resection; among them, 9 cases were performed caudal lobectomy resection. The mean of operative time was 313 min (210–450 min), the mean of intraoperative blood loss was 592 mL (300–1 100 mL). Four cases received blood transfusion with 300–450 mL (mean of 338 mL). The total hepatic blood inflow occlusion time was 25–55 min (mean of 42 min). Five cases received venous reconstruction, and 1 case received hepatic vein reconstruction. After operation, ascites occurred in 6 cases, pleural effusion occurred in 6 cases, liver failure occurred in 2 cases, bile leakage occurred in 2 cases, pulmonary infection occurred in 3 cases, deep vein thrombosis occurred in 1 case. All of the 13 cases were followed-up for 1–39 months (median time was 14 months), during the followed-up period, 4 cases died, including 3 cases of intrahepatic cholangiocarcinoma and 1 case of liver metastasis induced by colon cancer.ConclusionIt is encouraging to apply the vascular reconstruction and skilled hepatic partition technique for resection lesions which involved the second and the third porta hepatis, through meticulous preoperative evaluation and preparation.
目的 对腹腔镜下治疗肝包虫病合并胆漏的方法进行探讨并总结治疗体会。方法 回顾性分析我院2006年3月至2012年9月期间收治的76例肝包虫病患者行腹腔镜内囊摘除中合并胆漏的24例患者的临床资料。结果 24例肝包虫病合并胆漏患者行内囊摘除外囊缝合引流术，在缝合外囊前在残腔内置入多孔胶管，持续负压吸引2～3d。24例肝包虫病合并胆漏患者除1例因电凝过程中有明显出血情况而不便于处理转为中转开腹外，其余23例患者采用腹腔镜下胆漏治疗均取得一次性成功。术中无一例患者出现过敏反应，也无一例手术死亡。1例患者术后出现双肩酸痛，3d后自行缓解并逐渐消失。1例患者术后出现少量（约20mL）胆汁漏，经1周引流后自愈。24例肝包虫病合并胆漏患者平均手术时间为1.8h，平均住院时间为6.2d。术后随访2～24个月（平均10个月），无一例复发，未见包虫囊肿手术残腔积液、感染等术后并发症。结论 肝包虫病合并胆漏患者可采用腹腔镜治疗，但要严格把握手术适应证，术中做好周围组织和脏器的保护，以免发生腹腔种植、过敏反应等严重并发症，同时应彻底将包虫子囊、头节等灭活，降低术后远期复发率，腹腔镜手术治疗肝包虫病是安全、有效、可行的。
ObjectiveTo explore the safety and effectiveness of high intensity focused ultrasound (HIFU) in treatment of hepatic echinococcosis. MethodsThe clinical data of 8 patients with hepatic echinococcosis from 2008 to 2010 in the HIFU treatment center of The Second Affiliated Hospital of Chongqing Medical University were analyzed retrospectively, the effect of HIFU treatment, postoperative liver area pain, fever, skin burn and other complications were evaluated, the prognosis and recurrence were followed-up. ResultsAll the clinical manifestations and imaging manifes-tations of these 8 patients were improved after HIFU treatment. The liver functions of all the patients were injuried, which all were returned to normal within 5 days. Three patients suffered from fever and recovered within 6 days. Six patients appeared pain of liver area and relieved within 7 days. Operation area skin was basically normal, except 3 cases of mild swelling, no special complications happened. ConclusionFrom the limited data initially shows that it is a safe and effec-tive method of HIFU in treatment of hepatic echinococcosis, which is little invasion and less postoperative complications.