Diagnosis and laparoscopic treatment of atypical hepatic cystic echinococcosis type CE1 / 中华肝胆外科杂志

ABSTRACT

Objective:To explore the effective diagnosis method and the clinical effect of laparoscopic technique for atypical CE1 hepatic cystic echinococcosis.Methods:The clinical data of 17 patients with atypical liver cystic echinococcosis from June 2018 to June 2019 in the People's Hospital of Xinjiang Uygur Autonomous Region were analyzed retrospectively, including 11 males and 6 females, (46.0±21.6) years old, all patients with a history of exposure in animal husbandry area. Preoperative hydatid immunity test, abdominal ultrasound and abdominal CT examination were completed, and laparoscopic surgery was performed. Postoperative follow-up was conducted by outpatient review and telephone, and the follow-up period was up to June 2020. The diagnosis, operation and recurrence of hydatid disease by different examination methods were analyzed.Results:Preoperative serum immunological examination of 17 patients showed that 11 were positive and 6 were negative for hepatic echinococcosis. The results of abdominal CT showed that 17 cases were hepatic cyst. Conventional color doppler ultrasound showed that 14 patients were hepatic cyst, 3 patients showed cystic space occupying, and cystic hydatidosis was not excluded; 9 patients observed double track sign or local thickening of cystic wall at the top of hepatic cystic lesions after replacement of high-frequency probe, which was diagnosed as hepatic cystic echinococcosis(CE1) , 8 patients as hepatic cyst. All 17 patients underwent laparoscopic operation, during which they were definitely diagnosed as hepatic cystic echinococcosis (CE1). During the operation, there was no conversion to laparotomy. The operation time was (125.0±54.5) min, the intraoperative blood loss was (150.0±84.5) ml without blood transfusion, and the postoperative hospital stay was (6.5±2.5) d. There were no serious complications or deaths in the perioperative period, 2 cases had microbile leakage, and recovered by themselves 5-10 days after the operation; the patients were followed up for 6-12 months, no loss of follow-up, no recurrence of liver and abdominal hydatid.Conclusions:In the process of diagnosis and treatment of liver single cystic lesions, we should pay attention to the differential diagnosis of atypical CE1 hepatic cystic echinococcosis and simple liver cyst. The effective differential rate of abdominal spiral CT, hydatid immune experiment and abdominal ultrasound is low, which is easy to be misdiagnosed and missed. The high frequency probe of abdominal ultrasound can effectively find atypical CE1 hepatic cystic echinococcosis. Laparoscopic technique is not only an effective diagnosis method but also a treatment method. It is necessary to choose a reasonable operation method according to the patient's hydatidosis. Laparoscopic operation is safe and feasible in the treatment of hepatic cystic echinococcosis.