Hepatic alveolar echinococcosis (HAE) is a severe zoonotic disease caused by Echinococcus multilocularis, primarily affecting the liver. Due to its insidious nature, the patients are often diagnosed at advanced stage, posing significant treatment challenges. We comprehensively examines the progress in surgical techniques for HAE management, focusing on various strategies across different disease stages. For the patients with early-stage HAE, ablation therapy has emerged as an effective treatment option. In the moderate to advanced cases, numerous surgical techniques and innovative approaches have been introduced, including laparoscopic surgery and liver transplantation, with particular emphasis on ex vivo liver resection and autotransplantation. These advancements offer more effective treatment options for the patients with advanced HAE. However, significant challenges persist, notably the preservation of adequate liver function while achieving complete lesion removal. Future research should prioritize the exploration and optimization of existing surgical methods, especially for advanced HAE cases. This includes refining surgical techniques through precise preoperative evaluation and staging, as well as developing novel surgical approaches to enhance safety and efficacy. Furthermore, multicenter and long-term follow-up prospective studies are crucial for validating the effectiveness of new surgical techniques and strategies. Through these concerted efforts, it is anticipated that the survival rates and quality of life for HAE patients will significantly be improved, marking a new era in the management of this complex disease.
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 evaluate roles and advantages of magnetic resonance imaging (MRI) and compute.tomography (CT) in preoperative assessment for hepatic alveolar echinococcosis. MethodMRI and CT scan imaging data of 60 patients with hepatic alveolar echinococcosis underwent radical surgery were retrospectively analyzed. ResultsMRI scanning could accurately identify the peripheral zone and marginal zone of hepatic alveolar echinococcosis lesions, and CT could not accurately show the above structures. In assessment of anatomic relation between vascular and lesions, MRI findings of 52 cases were in full compliance with corresponding intraoperative findings, and 8 cases were partial compliant. However, CT findings of 35 cases were in full compliance with corresponding intraoperative findings, 13 cases were partial compliant, and 12 cases were not compliant at all. In assessment of anatomic relation between biliary and lesions, MRCP could clearly show the bile duct, bile duct stenosis location and degree; CT scanning could only show widened bile duct, but could not accurately judge bile duct dilatation. ConclusionsMRI exerts some obvious advantages in preoperative evaluation of hepatic alveolar echinococcosis, and could accurately find relation between lesions and vascular or biliary system. MRI should be used as routine examination for patients with hepatic alveolar echinococcosis.
Objective To evaluate effects of three-dimensional (3D) visualized reconstruction technology on short-term benefits of different extent of resection in treating hepatic alveolar echinococcosis (HAE) as well as some disadvantages. Methods One hundred and fifty-two patients with HAE from January 2014 to December 2016 in the Department Liver Surgery, West China Hospital of Sichuan University were collected, there were 80 patients with ≥4 segments and 72 patients with ≤3 segments of liver resection among these patients, which were designed to 3D reconstruction group and non-3D reconstruction group according to the preference of patients. The imaging data, intraoperative and postoperative indicators were recorded and compared. Results The 3D visualized reconstructions were performed in the 79 patients with HAE, the average time of 3D visualized reconstruction was 19 min, of which 13 cases took more than 30 min and the longest reached 150 min. The preoperative predicted liver resection volume of the 79 patients underwent the 3D visualized reconstruction was (583.6±374.7) mL, the volume of intraoperative actual liver resection was (573.8±406.3) mL, the comparison of preoperative and intraoperative data indicated that both agreed reasonably well (P=0.640). Forty-one cases and 38 cases in the 80 patients with ≥4 segments and 72 patients with ≤3 segments of liverresection respectively were selected for the 3D visualized reconstruction. For the patients with ≥4 segments of liver resection, the operative time was shorter (P=0.021) and the blood loss was less (P=0.047) in the 3D reconstruction group as compared with the non-3D reconstruction group, the status of intraoperative blood transfusion had no significant difference between the 3D reconstruction group and the non-3D reconstruction group (P=0.766). For the patients with ≤3 segments of liver resection, the operative time, the blood loss, and the status of intraoperative blood transfusion had no significant differences between the 3D reconstruction group and the non-3D reconstruction group (P>0.05). For the patients with ≥4 segments or ≤3 segments of liver resection, the laboratory examination results within postoperative 3 d, complications within postoperative 90 d, and the postoperative hospitalization time had no significant differences between the 3D reconstruction group and the non-3D reconstruction group (P>0.05). Conclusion 3D visualized reconstruction technology contributes to patients with HAE ≥4 segments of liver resection, it could reduce intraoperative blood loss and shorten operation time, but it displays no remarkable benefits for ≤3 segments of liver resection.
Objective To determine the value of contrast-enhanced ultrasound (CEUS) in the differentiation of primary liver cancer (PLC) and hepatic alveolar echinococcosis (HAE). Methods The data of 56 patients with PLC or HAE were collected between January 2010 and May 2015. Grayscale and CEUS features of the patients were analyzed retrospectively. The frequency of each imaging finding, including calcification, arterial enhancement, and internal enhancement were evaluated and compared. Results Statistically significant difference of the proportion of gender and age were detected between the two groups (P=0.013, 0.002). Thirty-eight PLC lesions were detected in 32 patients. The diameters of PLC lesions were 3-10 cm with an average of (5.6±2.1) cm. Thirty-two HAE lesions were found in 24 patients. The diameters of HAE lesions were 4-12 cm with an average of (9.1±4.4) cm. Statistically significant difference of lesion size and the incidence rate of calcification (5.3% vs. 75.0%) were seen between PLC and HAE (P<0.001). Peripheral enhancement were seen in 100.0% (38/38) PLC lesions, including 84.2% (32/38) hyperenhancement and 15.8% (6/38) dendritic hyperenhancement. All PLC lesions demonstrated hypoenhancement in late phase. Irregular peripherally hyperenhancement both in arterial and late phase were detected in 43.8% (14/32) HAE lesions. The other 56.2% (18/32) HAE lesions showed no peripheral enhancement both in arterial and late phase. No internal enhancement were seen in HAE lesions. The presence of arterial enhancement (100.0% vs. 43.8%) and absence of internal enhancement (0 vs. 100.0%) were significantly different between PLC and HAE (P<0.001). Conclusions PLC is predicted by arterial phase hyperenhancement and late phase hypoenhancement on CEUS. HAE is predicted with calcification on baseline sonography and internal non-enhancement on CEUS. Arterial phase enhancement is less common and less intensive in HAE than in PLC which also contributes to the differentiation of these lesions.
ObjectiveTo explore potential value of three-dimensional reconstruction technique for preoperative evaluation of hepatic alveolar echinococcosis. MethodsTwenty-one cases of hepatic alveolar echinococcosis proved by postoperative pathological examination in Affiliated Hospital of Qinghai University from October 2013 to March 2014 were analyzed retrospectively. The three periods of patients’ liver dynamic thin layerCTscan images were collected and imported in three-dimensional reconstruction software by DICOM format. The volume of the virtual resected liver tissue was calculated by software, and then was compared with the actual resected liver tissue volume. ResultsThe resected liver volume was (761.94±505.77) mL and (756.19±501.78) mL in the virtual surgery and in the veritable surgery, respectively. The proportion of resected liver in the total liver was (39.27±18.75)% and (38.95±16.99)% in the virtual surgery and in the veritable surgery, respectively. The resected liver volume had no significant difference between the virtual surgery and veritable surgery (P>0.05), which a positive relation (r=0.989, P<0.001). ConclusionThe limited preliminary data in this study show that three-dimensional reconstruction technique and virtual planning system for surgery could accurately guide resection of lesion and provide preoperative guidance of accurate liver resection for hepatic alveolar echinococcosis.
Objective To explore the correlations between the time of tracheal extubation and the intraoperative basic factors of ex vivo liver resection followed by autotransplantation in patients with advanced hepatic alveolar echinococcosis (HAE), and analyze the change trend of blood gas analysis during operation. Methods The data of 24 patients with advanced HAE who underwent ex vivo liver resection followed by autotransplantation in West China Hospital of Sichuan University between February 2014 and August 2017 were retrospectively analyzed. Results There were significant correlations between the extubation time and the duration of anesthesia (r=0.472, P=0.031), the amount of bleeding (r=0.524, P=0.015), the amount of erythrocyte suspensions infusion (r=0.627, P=0.002), and the amount of plasma infusion (r=0.617, P=0.003). There was no statistical difference in extubation time between patients with and without pulmonary complications in 3 months postoperatively [(23.74±15.84), (15.52±19.40) h, P=0.327]. Compared with those arterial blood gas results before the interruption, the pH value, blood glucose, lactic acid and base excess were statistically significantly different (P<0.05) at each time point after the interruption. Blood potassium increased at the end of operation compared with that before interruption (P<0.05); and the free calcium after blocking and opening increased with a temporary decrease (P<0.05); the hemoglobin decreased significantly after interruption and clamping (P<0.05). Conclusions Anesthesia length and bleeding should be reduced in ex vivo liver resection followed by autotransplantation, thus the extubation time would be shortened and the prognosis of the patients might be improved. Because of the longer anhepatic phase, the blood gas analysis varies largely. During operation, blood gas analysis and monitoring should be strengthened, and the acid-base balance and electrolytes should be maintained in time.
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.
ObjectiveTo analyze the efficacy and safety of complete excision of the external capsule in the treatment of hepatic echinococcosis.MethodsThe clinical data of 90 patients with hepatic cystic echinococcosis admitted to our hospital from January 2016 to March 2018 were retrospectively analyzed. According to the different surgical methods, this patients were divided into two groups: the partial hepatectomy group and complete excision of the external capsule group, 45 cases in each group. The patient's general condition and the situation during hospitalization were analyzed, and the intraoperative conditions, postoperative complications, recurrence and mortality after one year in different surgical methods were compared.ResultsThe operative time and intraoperative blood loss in the partial hepatectomy group was significantly longer or more than that in the complete excision of the external capsule group (P<0.05), respectively. There was no significant difference between the two groups in hospitalization time (P>0.05). The incidence of postoperative complications was 11.11% in the partial hepatectomy group and 8.88% in the complete excision of the external capsule group. There was no significant difference between the two groups (P>0.05). After 1 year of followed-up, the recurrence rate of the partial hepatectomy group was 4.44%, and there was no recurrence in the complete excision of the external capsule group, and there was no significant difference between the two groups (P>0.05). There was no death in both groups.ConclusionsIn the surgical treatment of hepatic cystic echinococcosis, the most appropriate surgical method should be selected according to the specific conditions of the patient, and the complete excision of the external capsule has higher therapeutic effect and safety in the treatment of hepatic echinococcosis. It is worthy of clinical promotion.
ObjectiveTo assess the value of multi-slice spiral CT (MSCT) in the diagnosis and resectability judgement of hepatic alveolar echinococcosis (HAE). MethodsThe CT findings of 28 patients who were confirmed HAE by surgical pathological examination were retrospectively analyzed. Comparative analysis were made between the CT findings and surgical pathology. ResultsAltogether 45 lesions in hepatic were detected. Lesions mainly revealed an infiltrating tumor-like hepatic mass with irregular margins and heterogeneous contents with varied attenuation, including scattered hyper-attenuating calcifications and hypo-attenuating areas corresponding to necrosis, no substantial enhancement, however, the fibro-inflammatory component surrounding the parasitic tissue was enhanced faintly in the delayed phase, and clearly demarcated from surrounding parenchyma. MSCT angiography (CTA) depicted signs of infiltration of hepatic vessels such as pushed, compression, displacement, stenosis, encasement and interruption. Compared with findings of operation, the sensitivity and specificity value of MSCT for evaluating the hepatic artery system disorders were 67%, 97%; and for portal venous system were 83%, 93%; and for hepatic venous system were 84%, 91%; while for inferior vena cava were 85%, 100%. Twelve cases which were evaluated as resectable by MSCT were in accordance with surgical findings. In the rest 16 patients which were judged as non-resectable by MSCT, only 2 patients were radical treatment through partial excision, repair and reconstruction for the involvement of large vessels and bile ducts. ConclusionMSCT is accuracy in the diagnosis and assessment of vessels complication of HAE. It has an important value to evaluate the resectability of HAE and the planning of treatment.