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.
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.
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 summarize the clinical features of an adult patient with occult cerebral alveolar echinococcosis with liver and lung infection. MethodsA Tibetan male patient in his middle age from the epidemic area of echinococcosis infection was diagnosed to have liver, lung and cerebral alveolar echinococcosis infection in Ganzi People's Hospital. He had the resection surgery, and the pathological result confirmed the primary diagnosis. We searched the literatures from January 1985 to December 2015 for occult cerebral alveolar echinococcosis and reviewed all the full texts in China Journal Full-text Database. Seventeen articles were qualified and 42 patients were reported. Combining with the relevant English literature using Medline, we analyzed the epidemic, pathophysiological and clinical manifestations of cerebral alveolar echinococcosis infection and explored the methods of prevention and treatment. ResultsAccording to the results of literature analysis, cerebral alveolar echinococcosis appeared often secondary to infection of other organs. Nervous system symptom concealed or progressed slowly; imaging and pathological tests were important for diagnosis. Resection surgery was the essential method of cure. ConclusionAlveolar echinococcosis can affect multiple organs. In patients without neurological symptoms, if other organs are found to be infected, it is important to screen patients with intracranial involvement. Because this kind of patients with intracranial lesions with hydatid are often secondary to other organ infection, active treatment in early phase is necessary in order to avoid further expansion of lesions and metastasis.
The high incidence of hydatid disease in seven northwestern provinces, is one of the reason of "Poverty due to illness, and return poverty due to illness" in China. The incidence of chest hydatid disease in China after hepatic hydatid disease ranks second. Department of thoracic surgery in the First Affiliated Hospital of Xinjiang Medical University is on the domestic leading position of the treatment of chest hydatid disease. Since 1956 the first case of pulmonary hydatid cyst were completed, we have successfully finished the surgical treatment of pediatric chest hydatid disease, chest hydatid disease complex, huge pulmonary hydatid cyst, mediastinal and pleural hydatid cyst, and rib hydatid in our department. To further standardize the treatment of chest hydatid disease, a special formulation of "technical specification for chest hydatid disease diagnosis expert consensus" by our department were produced, in order to help clinicians treat chest hydatid disease by more suitable strategies. This consensus was released in July 2015, for the original version. The definition, diagnosis, treatment principle, and prevention of chest hydatid disease were elaborated and clinical experiences of 60 years were combined with in this consensus, in order to help the clinicians for diagnosis, treatment, and prevention of hydatid disease.
ObjectiveTo summarize the effect of artificial blood vessel replacement in the treatment of complex hepatic alveolar hydatid disease involving retrohepatic inferior vena cava.MethodClinical data of 5 patients with hepatic alveolar hydatid disease involving retrohepatic inferior vena cava, who underwent vena cava replacement operation from June 2018 to August 2019 in our hospital were collected to analyzed.ResultsThe operation was successfully completed in all the 5 patients, and the hepatic hydatid space-occupying lesions were completely removed. Among them, 2 cases underwent extended right hemihepatectomy and caudate lobectomy, the operative time was 7 h and 8 h, the intraoperative blood loss was 600 mL and 400 mL, respectively, and the hospital stay were both 14 d. Three cases underwent autotransplantation surgery, with the operative time of 16 h, 12 h, and 12 h, the intraoperative blood loss was 1 500 mL, 1 500 mL, and 1 000 mL, and the hospital stay were 24, 20, and 19 d, respectively. There was no massive hemorrhage occurred, and 1 case suffered from liver failure (compensatory period), 2 cases suffered form bile leakage, all of which were cured by liver protection, anti infection, and drainage. During the follow-up period, the 5 cases were all in good condition, no relapse or recurrence occurred, and the quality of life was good.ConclusionThe replacement of the infected inferior vena cava by artificial blood vessel is an effective and feasible method for the treatment of hepatic alveolar hydatid disease involving retrohepatic inferior vena cava.