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Objective:To evaluate the efficacy and safety of video-assisted thoracoscopic surgery (VATS) and thoracotomy in the treatment of pulmonary echinococcosis.Methods:Pubmed, ScienceDirect, Medline, Wanfang Data Knowledge Service Platform, China National Knowledge Infrastructure (CNKI) and VIP Chinese Journal Service Platform were searched by computer from the earliest publication time of the documents included in the database to August 2020. Comparative studies on VATS and thoracotomy in the treatment of pulmonary echinococcosis were included and the quality was evaluated. The data were combined and analyzed by RevMan 5.3 software.Results:Eleven articles were finally included, including two randomized controlled trials (RCT) articles, and the rest were case-control studies. A total of 878 patients were included, including 447 in VATS group and 431 in thoracotomy group. The results of meta analysis showed that compared with thoracotomy group, VATS operation time [ MD (95% CI): - 28.59 (- 41.79, - 15.39)], intraoperative blood loss [ MD (95% CI): - 35.83 (- 49.65, - 22.01)], postoperative drainage volume [ MD (95% CI): - 94.83 (- 150.55, - 39.01)], postoperative catheterization time [ MD (95% CI): - 2.26 ( - 2.94, - 1.59)], hospital stay [ MD (95% CI): - 4.59 (- 6.51, - 2.67)], and postoperative complications [ MD (95% CI): 0.48 (0.32, 0.73)] in VATS group were significantly lower ( P < 0.05). There was no significant difference in postoperative recurrence between VATS group and thoracotomy group [ MD (95% CI): 0.75 (0.26, 2.16), P > 0.05]. Conclusions:Compared with thoracotomy, VATS in the treatment of pulmonary echinococcosis has the advantages of shorter operation time, less intraoperative blood loss, less postoperative drainage volume, shorter postoperative catheterization time and fewer postoperative complications. VATS is a safe and effective surgical method for the treatment of pulmonary echinococcosis.
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Objective:To investigate the risk factors related to choledocholithiasis in gallstone patients.Methods:The clinical data of 140 patients with gallstones or gallstones complicated with choledocholithiasis treated at our hospital from Jan 2017 to Dec 2019 were analyzed retrospectively.Results:The results showed gallstones≥ 10 mm (χ 2=7.896, P=0.019), parapapillary diverticulum (χ 2=10.849, P=0.013), the number of gallstones (single vs. multiple) (χ 2=9.760, P=0.080), age ( t=2.767, P=0.006), diameter of common bile duct ( t=8.068, P=0.000), total bilirubin level ( t=2.372, P=0.019), alkaline phosphatase ( t=2.448, P=0.016), significantly related to the formation of common bile duct stones. Logistic regression analysis showed that gallstone ≥ 10 mm, common bile duct dilatation, parapapillary diverticulum and multiple gallstones were all independent risk factors for choledocholithiasis in gallstone patients. Conclusion:A variety of risk factors were responsible for the formation of choledocholithiasis in gallstone patients.
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Objective:To analyze the treatment and the impact of brain metastases on patients with hepatic alveolar hydatid disease.Methods:The data of 11 patients with hepatic alveolar hydatidosis with brain metastases treated at the First Affiliated Hospital of Xinjiang Medical University from January 2014 to December 2019 were retrospectively analyzed. There were 7 males and 4 females. The age range was 19~49 years, with an average of 34 years. Of 11 patients, 7 were treated with surgery combined with drugs and 4 with drugs only. Analyze the treatment and results of patients.Results:Of the 7 patients who were treated with surgery and drugs, 2 patients underwent hepatectomy. They were treated with regular postoperative oral medication and were well on follow-up. Three patients underwent only brain surgery. On follow-up from 1 to 3 years, one patient developed pneumonia with atelectasis, another patient developed ascites and jaundice with physical decline. The third patient was stable and had an independent life. Two patients underwent partial hepatectomy and hydatidectomy, with one patient requiring repeated hydatidectomies. On follow-up for one of these 2 patients for 5 years, the patient was home bound and could not take care of himself. The other patient was followed up for 3 years and was stable, alive and able of self-care. Four patients were treated with albendazole liposome, including one patient who developed ascites, a second one with weight loss, physical decline, limb edema and a third one with pleural effusion, pelvic effusion and pneumonia. These patients were still alive with improvement of symptoms on supportive treatment.Conclusion:The treatment of hepatic alveolar hydatidosis with brain metastases is still mainly surgery and anti-hydatid drugs. The prognosis of most patients was poor. The surgical principle is neurosurgery first, followed by surgery on liver, lung, spleen and other organs involved by hydatid disease.
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Objective:To study the impact of selective occlusion of hepatic arterial blood flow in external capsule excision for hepatic cystic echinococcosis.Methods:A retrospective analysis was conducted on the data of 80 patients with hepatic cystic echinococcosis who underwent surgical treatment from January 2017 to January 2019 in the First Affiliated Hospital of Xinjiang Medical University. There were 36 males and 44 females, with an average age of 47 years. All patients underwent external capsule excision of hepatic cystic echinococcosis. According to the type of intraoperative blood flow occlusion, the patients were divided into: group A ( n=42), selective occlusion of hepatic artery; group B ( n=38), Pringle’s maneuvre. The hospitalization stay, intraoperative blood loss, postoperative ventilation time and complications were compared between the two groups. The postoperative alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin, and total bilirubin were compared between the two groups. Results:The intraoperative blood loss (215.7±29.6) ml, postoperative ventilation time (2.3±0.1)d, and hospital stay (11.6±1.0) d in group A were better than those in group B (254.8±20.6) ml, (3.2±0.2) d, (12.7±0.7) d, the differences were significant (all P<0.05). There were 4 patients (9.5%) who developed postoperative complications in group A and 5 patients (13.2%) in group B. There was no significant difference between the two groups ( P>0.05). Group A had better ALT, AST, albumin, and total bilirubin on day 3 after operation, and the differences were significant (all P<0.05). The ALT (62.8±5.2) U/L, AST (32.7±2.6) U/L, albumin (39.1±0.3) g/L, total bilirubin (12.1±0.5) μmol/L in Group A were better than group B (121.9±5.6) U/L, (53.9±8.0) U/L, (32.2±0.6) g/L, (19.3±0.9) μmol/L on day 5 after operation, the differences were significant (all P<0.05). Conclusion:Selective occlusion of the hepatic artery in external capsule excision for hepatic cystic echinococcosis was superior to the traditional Pringle’s maneuver in controlling intraoperative bleeding and postoperative liver function recovery.
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Objective@#To invastigate how to differentiate the single cystic hepatic hydatidosis from single hepatic cysts.@*Methods@#From Apr 2014 to Aug 2018 at the First Affiliated Hospital of Xinjiang Medical University, 30 cases of liver single cystic diseases were misdiagnosed·Relevant clinical data were compared including medical history, imaging features, immunological examination etc.@*Results@#18 cases of echinococcosis were misdiagnosed as hepatic cysts before operation, and 12 patients with hepatic cysts were misdiagnosed as hepatic cystic echinococcosis before operation.There were no significant differences between the two groups in eosinophil count (Eo#)(t=1.35, P>0.05), albumin (t=0.38, P>0.05), aspartate aminotransferase (t=0.99, P>0.05), and CT values(t=0.85, P>0.05). The results suggest that anti-EgCF antibody(χ2=4.26, P<0.05) and EgB antibody (χ2=7.26, P<0.05) are of significantly differential value in the identification of the two diseases.@*Conclusion@#Levels of anti-EgB and anti-EgCF antibodies to hepatic cystic echinococcosis are higher than that to single hepatic cysts.