Effects of tranexamic acid on intraoperative blood transfusion and postoperative thromboelastogram parameters in patients with partial hepatic resection of hydatid hepatica at high altitude / 中国输血杂志

【Objective】 To investigate the effects of tranexamic acid(TXA) on intraoperative blood transfusion(volume) and postoperative coagulation function in patients with partial hepatectomy for hepatic hydatid disease in high altitude area(altitude ≥2 500 m). 【Methods】 Forty-four patients [(39.09±14.70) years old, 19 males and 25 females] underwent elective partial hepatectomy for hydatid after general anesthesia from October 2018 to December 2019 in the Department of Hydatid of Qinghai Provincial People's Hospital, with ASA gradeⅠ~Ⅲ, Child Pugh grade A~B, and normal preoperative coagulation function. They were randomly divided into TXA injection group, who received intravenous injection of TXA 10 mg/(kg·person)(30 min before surgery), and control group, given a placebo needed the equal amounts of injected 0.9% sodium chloride(30 min before surgery). 3 mL of arterial blood was extracted from each patient before intravenous injection and at the end of operation for TEG detection. The intraoperative blood loss and transfusion volume as well as Plt, Hb and TEG parameters before and after surgery were compared between the two groups, and statistical analysis was performed with SPSS22.0 statistical software. 【Results】 The volume of intraoperative blood loss(mL) in TXA group and control group was 300(200, 1 000) vs 1 400(1 000, 2 100), respectively; the units of plasma transfusion(mL) 0(0, 0) vs 380(0, 575); the units of RBC suspension transfusion(mL) 0(0, 400) vs 1 200(800, 600). Preoperative TEG parameters of two groups were similar to each other(P>0.05). The postoperative R, K and Angle(°) of two groups was 8.32±2.24 vs 10.78±2.67, 2.80(2.10, 3.30) vs 3.70(3.20, 4.80) and 54.76±9.48 vs 43.70±9.02, respectively(P<0.05). 【Conclusion】 TXA can significantly improve coagulation functions, as well as effectively reduce intraoperative blood loss and intraoperative blood transfusion in patients with partial hepatic resection of hydatid hepatica in high altitude area.

Left lung and liver hydatid cyst: managed in single surgery

A 35 years male presented with history of pain left chest wall associated with cough, fever and blood in sputum on and off, complaint of pain in abdomen which was dull aching gradually progressive in nature since, 2 months. Radiologically diagnosed to have huge hydatid cysts both in left lung and liver. It is unusual to find such large cysts at multiple sites and organs as in this case. There are reports in the literature of staged management as well as simultaneous management of lung and liver hydatid cysts. Though concomitant cysts in lung and liver may be treated comfortably by one stage surgery. Here both cysts were enucleated in the same sitting by a combined thoracic and abdominal approach (left thoracotomy followed by laparotomy through right subcoastal incision). The technique is safe and results were comparable to two stage surgery. Albendazole treatment in post-operative period helps to prevent recurrence. This report emphasizes that surgical intervention for hydatid cysts at multiple sites done in a single stage is safe, lessens the financial burden and hospital stay by avoiding multiple surgeries and anaesthesia.

Radical versus conservative surgical treatment of liver hydatid cysts: a meta-analysis / 医学前沿

To date, the efficacy of radical surgery (RS) versus conservative surgery (CS) for liver hydatid cysts (LHC) remains controversial. This meta-analysis was conducted to compare the two interventions. PubMed, Embase, and Web of Science were searched from their inceptions until June 2016. Meta-analysis was performed using STATA 12.0 software. We identified 19 eligible studies from 10 countries by retrieval. In total, 1853 LHC patients who received RS were compared with 2274 patients treated by CS. The risk of postoperative overall complication, biliary fistula, and recurrence was significantly lower, and operation time was significantly longer in the RS group. However, no statistically significant differences were found in terms of mortality risk and the duration of hospital stay between RS and CS. No significant publication biases were observed in all the above analyses. In conclusion, RS reduces the rates of postoperative complications and recurrence, whereas no trend toward such a reduction in mortality was observed in LHC patients.

High intensity focused ultrasound treatment in hepatic echinococcosis / 国际外科学杂志

Hepatic echinococcosis is a worldwide parasitic disease caused by Echinococcus.It divided into two parts,cystic echinococcosis and alveolar echinococcosis.Surgical operation is the main treatment method and with huge trauma and risk.The treatment methods for hepatic echinococcosis became diverse with the development of minimally invasive treatment.High intensity focused ultrasound is an effective and safety treatment method for hepatic echinococosis.This paper introduced high intensity focused ultrasound treatment therapy in hepatic hydatid disease systematically.Introduced the principle,safety and efficacy,indications and therapeutic advantages,complications and shortcomings,through these aspects we could know about high intensity focused ultrasound treat for hepatic echinococcosis clearly.This paper introduced the prospect of high intensity focused ultrasound treatment in hepatic echinococcosis and affirmed the therapeutic value about it.This paper introduced a new method of minimally hvasive treatment,which is helpful for clinical treatment.

Primary Giant Splenic and Hepatic Echinococcal Cysts Treated by Laparoscopy

Cystic echinococcosis is a zoonosis caused by the larval stage of Echinococcus granulosus. Liver and lungs are the most commonly affected organs whereas splenic infection is rare and its primary involvement occurs in less than 2% of cases. We report a case of primary giant splenic and hepatic hydatid cyst in a 28-year-old woman who was admitted for upper right quadrant pain. The abdominal ultrasonography and computed tomography showed two cystic tumors with hydatid features in liver and spleen. Total splenectomy was performed for the splenic cyst and partial pericystectomy with drainage for the liver cyst using a laparoscopic approach. One drain was kept in place for two months due to a biliary leak of about 20 ml/day and removed afterward. The patient was discharged on postoperative day 7. Laparoscopic approach for patients with concomitant splenic and hepatic hydatidosis is a safe and effective option.

Evaluation and comparison of the outcomes of open and laparoscopic surgery of liver hydatid cyst

Background: Hydatid disease is the parasitic infestation which is endemic in many sheep and cattle raising area of India. Previously open surgical treatment with albendazole remains the mainstay for treatment. But in the recent era of minimal invasive surgery and its advantages give privilege to laparoscopic surgery to become one of better option for the treatment of the liver hydatid disease. Objectives: The purpose of this study was to compare the difference of incidence of post-operative complications, operative duration, length of hospital stay, duration of return to work, and recurrence in patients undergoing laparoscopic or open surgery for the liver hydatid disease. Materials and methods: The present study was a multicenter study which had been carried out at the tertiary care centre. Total numbers of 36 cases were studied and were followed up for the period of 6 months to 30 months (mean 15 months). All the patients were operated either by laparoscopy or open surgery by the same surgical team depending on below mentioned criteria. Inclusion criteria for laparoscopy surgery were cyst in the segments 1, 2, 3, 4, 5, 6 of liver, cyst over the anterior surface of liver, cyst more than 6 cm. Inclusion criteria for open surgery were cyst in communication with the biliary tree, intra parenchymal and posterior cyst, cyst in the segment 7, 8 of liver, cyst lying in relation to the vital structure, infected cyst, cyst with thick or calcified wall. Results: Out of total 36 patients, 20 (55.55%) were male and the 16 (44.45%) were females. The predominant chief complain of presentation was abdominal pain in 14 (38.89%) patients followed by abdominal lump in the 13 (36.11%) patients followed by other complains. The right lobe of the liver Patel NJ, Khandra HP, Chhabra SR, Singh CBP. Evaluation and comparison of the outcomes of open and laparoscopic surgery of liver hydatid cyst. IAIM, 2016; 3(4): 118-124. Page 119 was involved in the 20 (55.55%) patients, left lobe in 14 (38.89%) patients and both lobes involved in the 2 (5.56%) patients. The single cyst were seen in 33 (91.66%) patients and the more than one in 3 (8.34%) patients. 16 patient underwent laparoscopic surgery while 20 patient underwent open surgery. The mean operating time for the laparoscopy group was 110.0 min compare to 137.5 min for the open group ( p value <0.0001 ,which was statistically significant). The post-operative analgesic requirement was much less in the laparoscopy group (mean 2.37 days) than in the open group (mean 6.85 days; p value <0.0001, which is statistically significant). The drain was removed in the laparoscopy on an average of 4.56 days compared to the average 4.75 days for the open group; (p value = 0.36, which was >0.05; was statistically insignificant). The mean hospital stay in the laparoscopy group was 5.87 days compared to 10.85 days in the open group (p value <0.0001, which was statistically significant). Patients in the laparoscopy group resumed routine activities earlier (11.56 days) than those in the open group (27.8 days; p value=0.0006, which was statistically significant). We found no statistical significant difference in post-operative complications in the two groups except perhaps slightly higher rate in the open group than the laparoscopy group. Conclusion: Laparoscopy management of liver hydatid cyst is feasible, safe and effective provided that surgeon has good knowledge of basic laparoscopic surgery and proper selection of the patient is done.

Comparative study of laparoscopic versus open surgery in 42 cases of liver hydatid cyst.

Background: Hydatid disease is endemic mainly in the Mediterranean countries, the Middle East, South America, India, Northern china and other sheep rearing areas. Liver is the commonest site of affection (55-70 %) followed by lung (18-35%). In the last decade, laparoscopic treatment of hepatic hydatid disease has been increasingly popular and has undergone a revolution parallel to the progress in laparoscopic surgery. This study presented our experience with 42 cases of liver hydatid cyst comparing laparoscopic approach and open approach for surgery during a period of one and a half years at our institute. Objectives: The main objective of the present study was to study retrospectively, the merits of laparoscopy over that of open approach for surgery during a period of one and a half years at our institute. Objectives: The main objective of the present study was to study retrospectively, the merits of laparoscopy over that of open surgery in treatment of hydatid cyst of liver. Material and methods: This study comprised of 42 patients who diagnosed to have liver hydatid cyst treated during the period of January 2013 to June 2014 at our Hospitals. They were treated either by laparoscopic approach or by open method for liver hydatid cyst. Patients not fitting into inclusion criteria were excluded from study. Predefined proforma was filled up and results were analyzed. Results: Conversion to open surgery occurred in two cases (4.84 %). The mean cyst diameter was 6.62 cm (range, 2–15 cm) in group 1 and 7.23 cm (range, 2-18 cm)in group 2 (p = 0.699). The mean operative time was 90 min (range, 70-110 min) in group 1 and 110 min (range,90-130 min) in group 2 (p\0.001). The general complication rate and abdominal wound complication rate were respectively 0 % and 0 % in group 1 (p = 0.023) compared with 5.23 and 8.72 % in group 2 (p =0.015). The mean hospital stay was 6.42 days (range, 1-21 days) in group 1 and 11.7 days (range, 4–80 days) in group 2 (p = 0.001). The mean follow-up period was 24.2 months (range,6-32 months) in group 1 and 28.4 months (range, 6-40 months) in group 2. No recurrences were observed in either group during this period. Conclusions: Laparoscopic surgery provides a safe and efficacious approach for almost all types of hepatic hydatid cysts. Large, prospective, randomized trials are needed to confirm its superiority.

The influence of whole nursing model on health-related knowledge awareness and satisfaction rate of patients with liver hydatidosis receiving pericystectomy / 中国实用护理杂志

Objective To observe the influence of whole nursing model on health-related knowledge awareness and satisfaction rate of patients with liver hydatidosis receiving pericystectomy.Methods 180 patients in hospital receiving resection of liver hepatic cyst were randomly divided into the observation group and the control group with 90 patients in each group.The control group was given usual care,while the observation group received whole treatment model.The patients' health-related knowledge awareness and satisfaction rate were compared between two groups.Results The rate of health-related knowledge awareness and satisfaction about nursing work in the observation group preceded the control group.Conclusions This whole treatment model can boost the awareness rate of health-related knowledge and nursing satisfaction,which not only provides the care with full,comfortable and efficient services,but also advances the self-care capacity and cognition of disease of patients.

Ultrasound-guided percutaneous puncture aspiration and sclerotherapy of liver hydatid cysts / 中国介入影像与治疗学

Objective To investigate the clinical application of ultrasound-guided percutaneous puncture aspiration and sclerotherapy of liver hydatid cysts.Methods Thirty-eight patients of hepatic hydatid cysts underwent ultrasound-guided percutaneous puncture aspiration and sclerotherapy;then 20%-25%septic hypertonic saline or 95%absolute alcohol were injected into the cysts (the volume was about 25%-50%of the aspirated fluid) ;and the fluid was reaspirated after 5-15 min.At last,5-10 ml sclerosing agent was injected again.Oral albendazole 30-50 mg/kg was administrated to all patients before and after the above procedures.Ultrasonic follow-up was performed at 3-month interval in the first year and once a year afterwards.Results The successful rate of once puncture was 100%.Aher 6 months,cysts volume reduced 50% in 16 patients,reduced 30% in 22 patients.One year later,34 patients were cured,3 were effectively treated and 1 was improved.All hydatid cysts volume gradually decreased and calcification occurred.The total cure rate was 100%. Conclusion Ultrasound-guided percutaneous puncture aspiration and sclerotherapy is a safe,effective and reliable treatment of liver hydatid cysts.