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The clinical data of a case of adrenal alveolar echinococcosis treated and misdiagnosed in our hospital were reported retrospectively. The pre-operative CT examination of this patient showed that the liver S7 segment-the right adrenal gland area showed irregular masses of mixed density lesions, the boundary was unclear, consider the possibility of liver hydatid. During the operation, hydatid was found to only invade the liver capsule, and the primary lesion was the adrenal gland. The right adrenal gland and lesion were resected by urological surgeons. The pathological diagnosis was adrenal alveolar echinococcosis. When the imaging examination considers hepatic alveolar echinococcosis, and the lesion is mainly in the right adrenal gland area, it should be considered that the primary lesion could be in the adrenal gland.
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Objective To investigate the postoperative complications of ex vivo liver resection combined with autologous liver transplantation in the treatment of end-stage hepatic alveolar echinococcosis at high altitude and related prevention and treatment strategies. Methods Surgical data and follow-up data were collected from 11 patients with end-stage hepatic alveolar echinococcosis who underwent autologous liver transplantation in Qinghai People's Hospital from January 2013 to March 2019, and intraoperative and postoperative conditions were analyzed. Results All 11 patients underwent autologous liver transplantation successfully, without intraoperative death, among whom 2(18.18%) underwent hemi-extracorporeal hepatectomy and 9 (81.82%) underwent total extracorporeal hepatectomy. For the reconstruction of the retrohepatic inferior vena cava, 2 patients (18.18%) underwent reconstruction with the autologous great saphenous vein, 4 patients (36.36%) underwent reconstruction with artificial vessels, and the autologous retrohepatic inferior vena cava was preserved in 5 patients (45.45%). For biliary reconstruction, 8 patients (72.73%) underwent choledochoenterostomy and 3 (27.27%) underwent choledochocholedochostomy. The main postoperative complications of the 11 patients included bleeding in 2 patients (18.18%), bile leakage and abdominal infection in 4 patients (36.36%), bilioenteric anastomotic stenosis in 1 patient (9.09%), thrombus in 2 patients (18.18%), pulmonary infection and pleural effusion in 2 patients (18.18%), and echinococcosis recurrence in 1 patient (9.09%). Of all 11 patients, 2 (18.18%) died during the perioperative period, and the other 9 patients (81.82%) were improved and discharged. Conclusion Bleeding, biliary complications, and infection are the main causes of death in patients undergoing autologous liver transplantation at high altitude. An accurate understanding of surgical indication, careful multidisciplinary evaluation before surgery, superb operation during surgery, standardized surgical procedures, and fine perioperative management are the key to reducing perioperative mortality, avoiding and reducing postoperative complications, and achieving good long-term survival in patients undergoing autologous liver transplantation.
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Objective:To compare the different methods of hepatic blood flow occlusion in hepatectomy for hepatic alveolar echinococcosis.Methods:A total of 49 patients with hepatic alveolar echinococcosis who underwent radical hepatectomy from January 2018 to January 2019 in Department of General Surgery, Qinghai Provincial People's Hospital were retrospectively studied. There were 22 males and 27 females, aged 10-62 years. The patients were divided into the Glisson group ( n=22) and the Pringle group ( n=27) according to the method used for hepatic blood flow occlusion during operation. For the Glisson group, intrahepatic blood flow was occluded at the Glisson pedicle. For the Pringle group, intrahepatic blood flow was occluded using the Pringle’s maneuvre. Intraoperative blood loss, operation time, postoperative liver function and postoperative complications were compared between the two groups. Results:There were no significant differences between the two groups in operation time, intraoperative blood loss and intraoperative blood transfusion (all P>0.05). The vascular occlusion time of blood flow in the Pringle group was 35 (30, 45) min, which was significantly longer than that of 20 (15, 26) min in the Glisson group ( P<0.05). The drainage tube in the Pringle group was removed after 8 (7, 12) d, which was significantly longer than that of 7 (6, 9) d in the Glisson group ( P<0.05). After operation, alanine aminotransferase, aspartate aminotransferase, total bilirubin and direct bilirubin in the Glisson group were significantly better than those in the Pringle group (all P<0.05). Postoperative complications occurred in 9 patients (40.9%, 9/22) in the Glisson group and 15 patients (55.6%, 15/27) in the Pringle group ( P>0.05). Conclusion:The liver function, and time of removal of abdominal drainage tube after Glisson pedicle hepatic blood flow occlusion in patients who underwent hepatectomy for hepatic alveolar echinococcosis were significantly better than the Pringle method.
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Hepatic alveolar echinococcosis is a zoonotic parasitic disease. The therapeutic options of advanced hepatic alveolar echinococcosis mainly include: operation combined with drug treatment, percutaneous transhepatic biliary drainage, focus puncture drainage, drug treatment, liver transplantation. The individualized and comprehensive treatment mainly based on surgery is an ideal treatment method for advanced hepatic alveolar echinococcosis. This paper summarized the related literature at home and abroad, combined with clinical practice, and summarized the current situation and progress of the treatment of advanced hepatic alveolar echinococcosis.
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Objective@#To evaluate the efficacy and safety of reduced volume hepatectomy in treatment of advanced hepatic alveolar echinococcosis.@*Methods@#The clinical data of 90 patients with advanced hepatic alveolar echinococcosis treated at the Qinghai Provincial People's Hospital from January 2017 to January 2019 were retrospectively analyzed. There were 41 males and 49 females, with an average age of 32 (range 11 to 58) years. The locations of the lesions, operations, complications and follow-up were analyzed.@*Results@#90 patients were treated with reduced volume focal hepatectomy, 38 with radical resection and 52 with quasi radical resection. The operation time was (361±22) min. The hospital stay was (22±2) day, and the blood loss was (781±37) ml. Red blood cells were transfused in 19 patients and plasma in 39 patients. Pringle’s maneuver was used in 12 patients, regional hepatic blood flow occlusion in 42 patients, and Glisson sheath occlusion in 26 patients. The total bilirubin, alanine aminotransferase and aspartate aminotransferase returned to normal in 3 to 14 days after operation. There were 12 patients who developed bile leakage, 41 pleural effusion and 26 effusion in the operation sites. A total of ninety patients were followed up for 2 to 24 months. There was no recurrence of echinococcosis after radical resection and no enlargement of residual lesions after quasi-radical resection.@*Conclusion@#Reduced-volume hepatectomy reduced the risk and difficulty of operation. The follow-up results were good. This approach provides a feasible scheme for treatment of advanced hepatic alveolar echinococcosis.
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Objective@#To compare the changes in liver function in patients with different types of hepatic alveolar echinococcosis after radiofrequency ablation.@*Methods@#The data of 32 patients with hepatic alveolar echinococcosis treated by radiofrequency ablation from December 2016 to December 2018 at the Qinghai Provincial People's Hospital were retrospectively analyzed. There were 12 males and 20 females. The patients were divided into the single lesion group (n=17) and the multiple lesions group (n=15) according to the number of hydatid lesions. The lesions were further divided into the small lesion group (n=12) and the large or medium lesion group (n=20). The operation time, changes in AST and ALT were compared among these groups.@*Results@#The operation time of the single lesion group was 1.5 (1.0, 1.8) hour, and that of the multiple lesions group was 3.0 (1.5, 3.5) hour. The difference was statistically significant (P<0.05). On the 1st and 3rd day after treatment, ALT in the multiple lesions group was significantly higher than that in the single lesion group (P<0.05). Compared with the 1st day after operation, ALT of the two groups decreased on the 5th day after treatment, and the difference was statistically significant (P<0.05). The changes in AST in the two groups were basically the same as that of ALT. The operation time of the small lesion group was 1.0 (1.0, 1.9) hour, and of the large and medium lesion group was 2.5 (1.5, 3.0) hour. The difference was statistically significant (P<0.05). On the 1st, 3rd and 5th day after treatment, ALT in the small lesion group was significantly lower than the large or medium lesion group (P<0.05). Compared with the 1st day after treatment, ALT of the two groups decreased on the 5th day after treatment, and the difference was statistically significant (P<0.05). There was a significant difference in AST between the small lesion group and the large or medium lesion group only on the 1st day after operation (P<0.05).@*Conclusion@#Radiofrequency ablation for hepatic alveolar echinococcosis with a single lesion and a small lesion had shorter operation time with less changes in liver function after treatment.
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Objective To compare the changes in liver function in patients with different types of hepatic alveolar echinococcosis after radiofrequency ablation.Methods The data of 32 patients with hepatic alveolar echinococcosis treated by radiofrequency ablation from December 2016 to December 2018 at the Qinghai Provincial People's Hospital were retrospectively analyzed.There were 12 males and 20 females.The patients were divided into the single lesion group (n =17) and the multiple lesions group (n =15)according to the number of hydatid lesions.The lesions were further divided into the small lesion group (n =12) and the large or medium lesion group (n =20).The operation time,changes in AST and ALT were compared among these groups.Results The operation time of the single lesion group was 1.5 (1.0,1.8)hour,and that of the multiple lesions group was 3.0 (1.5,3.5) hour.The difference was statistically significant (P ＜ 0.05).On the 1st and 3rd day after treatment,ALT in the multiple lesions group was significantly higher than that in the single lesion group (P ＜ 0.05).Compared with the 1 st day after operation,ALT of the two groups decreased on the 5th day after treatment,and the difference was statistically significant (P ＜ 0.05).The changes in AST in the two groups were basically the same as that of ALT.The operation time of the small lesion group was 1.0 (1.0,1.9) hour,and of the large and medium lesion group was 2.5 (1.5,3.0) hour.The difference was statistically significant (P ＜0.05).On the 1st,3rd and 5th day after treatment,ALT in the small lesion group was significantly lower than the large or medium lesion group (P ＜ 0.05).Compared with the 1 st day after treatment,ALT of the two groups decreased on the 5thday after treatment,and the difference was statistically significant (P ＜ 0.05).There was a significant difference in AST between the small lesion group and the large or medium lesion group only on the 1 st day after operation (P ＜ 0.05).Conclusion Radiofrequency ablation for hepatic alveolar echinococcosis with a single lesion and a small lesion had shorter operation time with less changes in liver function after treatment.