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Objective:To provide reference for clinical diagnosis and treatment of hepatic cystic echinococcosis by analyzing the clinical characteristics of these patients.Methods:Clinical data of 15 patients with hepatic cystic echinococcosis hospitalized in the Second Hospital of Lanzhou University from April 22, 2019 to March 5, 2022 were collected. The general data, clinical manifestations, abdominal imaging results, treatment and outcome of the included patients were retrospectively analyzed.Results:The age of 15 patients with hepatic cystic echinococcosis ranged from 39 to 78 years, with a median age of 51 years. Among the 15 patients, 12 were farmers, two were freelance workers, and one was unknown. Eleven patients presented with abdominal pain and fatigue, one patient presented with obstructive jaundice, and three patients whom were found by physical examination did not complain of obvious discomfort. Echinococcoid cysts were located at the right lobe of the liver in eight patients, at the left lobe of the liver in five patients, and with multiple lesions in the left and right lobes of the liver in two patients. Two patients received conservative therapy. All the 13 patients who received surgical treatment recovered without complications, such as biliary fistula and subphrenic infection. The clinical symptoms including abdominal pain and fatigue were relieved significantly after surgery. The hospital stay were four to 23 days. All patients were administrated with albendazole (400 mg once daily).Conclusions:Hepatic cystic echinococcosis is more common in the right lobe of the liver, with atypical clinical symptoms. Preoperative imaging diagnosis and postoperative pathological examination are necessary for diagnosis. Surgery is the most effective treatment at present, and albendazole should be taken regularly in all patients.
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A primary liver cancer patient complicated by hepatic cystic echinococcosis was reported. The case was admitted to the hospital due to intermittent upper abdominal discomfort for more than half a month, and an auxiliary examination revealed primary liver cancer complicated by hepatic cystic echinococcosis. Then, hepatic artery infusion and chemoembolization was performed, and no treatment was given to cystic echinococcosis lesions. Following treatment, the patient had remarkable improvements in the liver functions.
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Objective To evaluate the accuracy of CT imaging of inferior vena cava and hepatic vein in patients with hepatic cystic echinococcosis. Methods A total of 100 patients with hepatic cystic echinococcosis were given triple-phase abdominal CT scan, and the reconstructed images of the inferior vena cava and hepatic vein were obtained and compared to the real situation during the surgical operation. The reliability of the CT evaluation of the echinococcus cyst lesion invading inferior vena cava and hepatic vein was analyzed. Results The compression displacement, half-globular, no clear demarcation between the lesion and blood vessel and narrowing of the vessel detected by CT evaluation were in accordance with the real situation under the surgical sight. However, four cases of clear demarcation between the lesion and blood vessel were affirmed wrong under the surgical sight. There were three cases of over diagnosis of vascular stenosis judgments. Conclusion The CT images of hepatic vein and inferior vena cava can clearly show the relationship between the hepatic echinococcus cyst and hepatic vein and inferior vena cava.
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Objective To observe the changes of inflammatory factors after the hepatic cystic echinococcosis surgery and explore the intervention effect of ulinastatin on postoperative inflammatory factors. Methods Sixty patients with hepatic cystic echinococcosis were selected and randomly divided into a control group and ulinastatin intervention group according to whether or not use ulinastatin. The peripheral venous blood was extracted in all the patients and the levels of IL-6, IL-8, IL-9, and IL-10 were detected by the ELISA method on the day before operation, 1 day, 3 days, 5 days and 7 days after operation, respectively. The data was statistical analyzed to detect the relationships between/among the inflammatory factors mentioned above and ulina-statin and time. Results The variation of the levels of IL-6, IL-8, IL-9, and IL-10 were changed by the intervention of ulina-statin at different time. The differences of the levels of IL-6, IL-8, IL-9, and IL-10 between the ulinastatin intervention group and the control group were not significant on the day before operation, 1 day and 3 days after operation (t = -1.15 to 1.82, all P > 0.05), but the levels of IL-6, IL-8, IL-9, and IL-10 of the ulinastatin intervention group were significantly lower than those of the control group and there were statistically significant differences 5 days and 7 days after the operation (t = 3.22 and 23.51, both P<0.05) . Conclusion Ulinastatin has a good effect in inhibiting the inflammatory factors and can protect and repair the postoperative hepatic injury as well in patients with hepatic cystic echinococcosis.
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Objective To evaluate the accuracy of CT imaging of inferior vena cava and hepatic vein in patients with hepatic cystic echinococcosis. Methods A total of 100 patients with hepatic cystic echinococcosis were given triple-phase abdominal CT scan, and the reconstructed images of the inferior vena cava and hepatic vein were obtained and compared to the real situation during the surgical operation. The reliability of the CT evaluation of the echinococcus cyst lesion invading inferior vena cava and hepatic vein was analyzed. Results The compression displacement, half-globular, no clear demarcation between the lesion and blood vessel and narrowing of the vessel detected by CT evaluation were in accordance with the real situation under the surgical sight. However, four cases of clear demarcation between the lesion and blood vessel were affirmed wrong under the surgical sight. There were three cases of over diagnosis of vascular stenosis judgments. Conclusion The CT images of hepatic vein and inferior vena cava can clearly show the relationship between the hepatic echinococcus cyst and hepatic vein and inferior vena cava.
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Objective To observe the changes of inflammatory factors after the hepatic cystic echinococcosis surgery and explore the intervention effect of ulinastatin on postoperative inflammatory factors. Methods Sixty patients with hepatic cystic echinococcosis were selected and randomly divided into a control group and ulinastatin intervention group according to whether or not use ulinastatin. The peripheral venous blood was extracted in all the patients and the levels of IL-6, IL-8, IL-9, and IL-10 were detected by the ELISA method on the day before operation, 1 day, 3 days, 5 days and 7 days after operation, respectively. The data was statistical analyzed to detect the relationships between/among the inflammatory factors mentioned above and ulina-statin and time. Results The variation of the levels of IL-6, IL-8, IL-9, and IL-10 were changed by the intervention of ulina-statin at different time. The differences of the levels of IL-6, IL-8, IL-9, and IL-10 between the ulinastatin intervention group and the control group were not significant on the day before operation, 1 day and 3 days after operation (t = -1.15 to 1.82, all P > 0.05), but the levels of IL-6, IL-8, IL-9, and IL-10 of the ulinastatin intervention group were significantly lower than those of the control group and there were statistically significant differences 5 days and 7 days after the operation (t = 3.22 and 23.51, both P<0.05) . Conclusion Ulinastatin has a good effect in inhibiting the inflammatory factors and can protect and repair the postoperative hepatic injury as well in patients with hepatic cystic echinococcosis.
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Objective To investigate the clinical efficacy of three-dimensional (3D) laparoscopic surgery in treatment of hepatic cystic echinococcosis.Methods The retrospective cross-sectional study was conducted.The clinical data of 40 patients with hepatic cystic echinococcosis who underwent 3D laparoscopic surgery in the Qinghai Province People's Hospital from March 2016 to July 2017 were collected.All the 40 patients were treated using 100 mg hydrocortisone on preventing intraoperative anaphylaxis.The experienced surgeons with proficiency in the laparoscopic technology in the same team finished surgery.Patients underwent respectively 3D laparoscopic excision of internal capsule in hepatic echinococcosis + residual cavity treatment,external capsule resection in hepatic echinococcosis and partial hepatectomy based on their conditions.Observation indicators:(1) intraoperative situations:operation completion,surgical procedures,operation time,volume of intraoperative blood loss and blood transfusion;(2) postoperative recovery situations:time to initial anal exsufflation,time for initial fluid diet intake,time for out-of-bed activity,time of indwelling drainage-tube,wound healing,postoperative complications and duration of postoperative hospital stay;(3) follow-up:number of patients with follow-up,follow-up time,oral anti-echinococcosis medical therapy during follow-up,hepatic echinococcosis recurrence and abdominal cavity implantation metastasis.Follow-up using outpatient examination and telephone interview was performed to detect the abdominal symptoms,oral anti-echinococcosis medicine,hepatic echinococcosis recurrence and metastasis up to September 2017.Measurement data with normal distribution were represented as (x)± s.Measurement data with skewed distribution were described as M (range).Results (1) Intraoperative situations:all the 40 patients underwent successful laparoscopic surgery,including 17 undergoing excision of internal capsule in hepatic echinococcosis + residual cavity treatment,15 undergoing external capsule resection in hepatic echinococcosis and 8 undergoing partial hepatectomy.Two patients were combined with abdominal and pelvic hydatids and underwent 3D laparoscopic excision.Operation time and volume of intraoperative blood loss of 40 patients were respectively (100 ± 28) minutes and (86± 24) mL,without intraoperative blood transfusion.(2) Postoperative recovery situations:time to initial anal exsufflation and time for initial fluid diet intake in 40 patients were (2.4± 1.8)hours and (1.7±0.9)days.Forty patients had out-of-bed activity on the day of surgery.Of 40 patients,abdominal drainage-tubes of 39 were placed for 2-3 days;abdominal drainage-tube of 1 with postoperative residual cavity-induced bile leakage was indwelled for 2 months and then was removed.Wound healing and duration of postoperative hospital stay in 40 patients were Class-A healing and (10.5 ± 2.1) days.During hospitalization,39 patients didn't have bleeding,bile leakage,anaphylactic shock,intestinal adhesion and obstruction;1 patient with postoperative residual cavity-induced bile leakage had indwelling drainage-tube removal at 2 months postoperatively.(3) Follow-up:all patients were followed up for 2-15 months,with a median time of 9 months.During the follow-up,40 patients were not complicated with discomforts and received oral antiechinococcosis medical therapy,without hepatic echinococcosis recurrence and abdominal cavity implantation metastasis.Conclusion The 3D laparoscopic surgery is safe and feasible in the treatment of hepatic cystic echinococcosis,and has an obvious advantage in the treatment of irregular hepatic cystic echinococcosis,with good short-term outcomes.
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Objective To evaluate the effectiveness and safety of radical versus conservative surgery for hydatid liver cysts.Methods The Pubmed, EMBASE, MEDLINE, Cochrane Library, Chinese Biomedicine Database, CNKI, Wan Fang Databases, VIP Databases, Chinese scientific and technical journals full-text database and Chinese Journal of full text database were searched for randomized clinical trials or none-randomized clinical trials from January 2000 to January 2015.A Meta-analysis was performed with RevMan5.1.Results 10 studies with 2 123 patients were included into the final analysis.Meta-analysis demonstrated that the radical group was significantly longer in operation time [weighted mean difference (WMD) =25.11;95％ CI: 16.18-34.05;P ＜ 0.05], was significantly shorter in the length of hospital stay (WMD =-3.94;95％CI:-7.57-0.32;P ＜0.05), was significantly lower in the incidence of bile leak (OR =0.19;95％ CI: 0.07-0.49;P ＜ 0.05), was significantly lower in the incidence of residual cavity infection (OR =0.08;95 ％ CI: 0.04-0.15;P ＜ 0.05), and in the incidence of local recurrence (OR =0.10;95 ％ CI: 0.05-0.18;P ＜ 0.05) when compared with the conservative surgery group.Conclusions For hydatid liver cysts, radical surgical procedures had significantly lower rates of complications and recurrence.Thus, they are better treatments for hepatic cystic echinococcosis.
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Objective To investigate the prevalence rate of ovine hepatic cystic echinococcosis (HCE) in sheep in Quaker Wusu area of Bayinbuluke of Xinjiang by ultrasonography and provide evidence for the prevention and control of HCE in sheep.Methods The prevalence screening of HCE in sheep was conducted based on ultrasound images in this area in July 2014.The sheep were divided into different groups by dental age to calculate the age specific prevalence rate of HCE and analyzed the correlation between the dental age and the prevalence rate.Results The total prevalence rate of HCE in sheep in this area was 36.9％.The prevalence rates of none-calcified HCE and calcified HCE were 7.3％ and 29.6％,respectively.The prevalence rates of none-calcified HCE in different age groups were 1.2％ (1-2 years old),1.4％ (2-3 years old),14.0％ (3-4 years old),10.0％ (4-5 years old),15.6％(5-6 years old) and 4.2％(＞6 years old) respectively.The prevalence rate of calcified HCE in different age groups were 9.9％(1-2 years old),16.2％ (2-3 years old),31.6％(3-4 years old),47.8％(4-5 years old),42.2％(5-6 years old) and 41.7％(＞6 years old) respectively.The prevalence rate of HCE in 1-2 years old group was lower than those in other groups,the prevalence rate of HCE in age groups ＞3 years increased significantly.There was positive correlation between the prevalence rate of HCE and dental age (r=0.372,R2=0.107,F=44.176,P=0.000).Conclusion HCE is highly endemic in Quaker Wusu area.The prevalence rate of HCE is low in sheep with young age and high in sheep aged 3-4 years.It is necessary to conduct early prevention of HCE in sheep in this area.
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Objective To evaluate the clinical pathway (CP) for treatment of hepatic cystic echinococcosis.Methods Data were retrospectively obtained from hospitalized patients with hepatic cystic echinococcosis (CE) who were treated surgically between April 2011 to December 2012.Patient treated with the clinical pathway (the CP group) were compared with patients who were treated with conventional treatment (the non-CP group).The following outcomes were compared:the average length of in-hospital stay,the hospital charges,patient's satisfaction,patient's knowledge about his/ her own health and postoperative complications.Results For the CP groups,the length of in-hospital stay,the hospital charges,the patient's satisfaction and the health knowledge for the patients were (10.25±1.26)d,(19600.25±1520.73) yuan,(46.4 5±2.14),(83.50±8.02),respectively.The corresponding figures for the non-CP group were (14.25 ± 1.50) d,(23931.25 ± 1629.17) yuan,(42.65 ± 1.93),(74.50 ± 12.60),respectively.There were significant differences between the 2 groups (t=-4.086,-4.074,8.351,3.811 ; P＜0.05).The postoperative complications,including bile leakage,bleeding,ascites and pleural effusion,were 2,0,2 cases in the CP group,and 0,4,5 cases in the non-CP group.There were no significant difference between the 2 groups (x2 =0.17,0,0.6; P＞0.05).Conclusion Our initial clinical experience showed that the clinical pathway decreased the length of in-hospital stay and hospital charges,and provided quality and efficient clinical services to patients with hepatic cystic echinococcosis.
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Objective To study the results of emergency treatment of ruptured hepatic cystic echinococcosis (HCE).Methods A standardized management protocol for hepatic echinococcosis was introduced by the First Hospital of Xinjiang Medical University in 2002.This study included 185 patients who received emergency treatment for ruptured HCE between 1994 and 2009.The patients were divided into group A (from 1994 to 2001) and group B (from 2002 to 2009).The clinical characteristics and surgical treatment results were compared retrospectively.Results In patients with ruptured HCE into the abdomen,classical endocystectomy (Group A1 ) resulted in significantly more postoperative complications in residual hepatic cavity,time of drainage,postoperative hospital stay,recurrence and peritoneal seeding than improved endocystectomy (Group B1 ) (P＜0.05).The operation time and blood loss were not significantly different between group A1 and B1 (P＞0.05).For patients with ruptured HCE into the biliary tree,classical endocystectomy (Group A2 ) resulted in significantly higher postoperative complications in residual hepatic cavity,time of drainage,postoperative hospital stay and recurrence than improved endocystectomy (B2) (P＜0.05).Operation time,blood loss and peritoneal seeding were not significantly different between group A2 and B2 (P ＞ 0.05). Only one patient (0.54％) died from allergic shock in this series of patients.Conclusions Improved endocystectomy was an efficacious surgical treatment for ruptured HCE and it is recommended for emergency surgery.
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Objective To investigate the diagnosis and treatment of ruptured hepatic cystic echinococcosis (HCE).Methods The clinical data of 109 patients with HCE who were admitted to the First Affiliated Hospital of Xinjiang Medical University from January 1994 to December 2009 were retrospectively analyzed.The diagnosis was based on the results of serological examination,epidemiological history,clinical manifestation and imaging findings.Of the 108 patients who received surgical treatment,67 received classic endocystectomy(classic group)and 41 received improved endocystectomy(improved group).The operation time,operative blood loss,length of postoperative hospital stay,time of drainage,effusion and infection of residual cavity,biliary fistula,pleura]effusion,local recurrence,dissemination and implantation of HCE,and death of the 2 groups were compared.All data were analyzed using the t test and chi-square test.Results The diagnostic rates of ultrasound,computed tomography and magnetic resonance imaging were 93%(101/109),99%(70/71)and 7/7,respectively.The positive rate of serological examination was 100%(61/61).Of the 109 patients,1 died of anaphylactic shock.The operation time and operative blood loss were(3.2 ± 0.3)hours and(104.0 ± 11.5)ml in the classic group and(3.3 ±0.4)hours and(110.0 ±23.8)ml in the improved group,respectively.There were no significant differences in the operation time and operative blood loss between the 2 groups(t =-1.474,-1.758,P ＞0.05).The length of hospital stay and time of drainage were(15.3 ± 4.3)days and(28.0 ± 4.6)days in the classic group and(9.3 ± 1.2)days and(7.6 ± 0.8)days in the improved group,respectively.There were significant differences between the 2 groups in the length of hospital stay and time of drainage(t = 8.628,28.088,P ＜0.05).The incidence rates of effusion and infection of residual cavity,biliary leakage,local recurrence,dissemination and implantation of HCE of the classic group were significantly higher than those in the improved group(x2 =4.335,3.888,5.691,4.581,10.153,P ＜0.05).Twenty-one patients received reoperation because of HCE recurrence or severe complications.Conclusions Epidemiological history,clinical manifestation,imaging findings and serological examination are important for the diagnosis of ruptured HCE.Improved endocystectomy + peritoneal lavage with hypertonic saline + administration of anti-HCE drugs is the optimal treatment for ruptured HCE.
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Hepatic echinococcosis(HE)is a zoonosis seriously affecting the population in west China.Computed tomography(CT),magnetic resonance angiography,ultrasound angiography can be used for detection of HE with the advantages of multiple angles and high definition.CT perfusion imaging,magnetic resonance perfusion imaging,diffusion weighted imaging and magnetic resonance spectrum may provide molecular imaging to visualize HE in vitro.Total cystectomy is a radical method for the treatment of hepatic cystic echinococcosis (HCE),but has the drawbacks of HE recurrence and bile leakage;subradical cystectomy not only eliminate residual cavity of HAE,but also effectively avoids the risks which might be caused by total cystectomy.Radical hepatectomy is the first choice for the treatment of hepatic alveolar echinococcosis(HAE),while for patients with end-stage HCE,liver transplantation is the final choice of treatment.