ObjectiveTo describe the current situation of the prevalence of hepatic hydatidosis, analyze the clinical characteristics and treatment method of the disease, in order to provide scientific basis for personal treatment plans of hepatic hydatidosis. MethodThe clinical data of 121 patients with recurrent hepatic hydatidosis treated between July 2006 and December 2013 were analyzed retrospectively. The general information of hydatid disease of liver, mass of liver, clinical manifestations, laboratory test results, treatment method, effectiveness of the treatment during hospitalization, and follow-up results were collected and analyzed. ResultsMost of the patients were adults from Sichuan and Tibet, and the majority of them had no clear occupation or clear animal contact history and had not taken raw or fresh meat. Lesions in the right lobe occurred in 87 cases, accounting for 71.90%. Abdominal pain and distension were the main clinical manifestations. Twenty-five (20.66%) of these patients were associated with hepatic dysfunction, among whom 23 patients had mild hepatic dysfunction. Alpha-fetoprotein level was increased in one (0.83%) of these cases. A total of 119 of the 121 patients received surgical treatment (98.35%) and all the surgeries were successful. Follow-up results revealed that three of the patients had recurrence. ConclusionsHepatic hydatidosis is an epidemic mainly in the Tibetan district of the West of China. The disease mainly occurs in the right lobe of the liver, which mainly causes mile liver damage. Hepatocellular carcinoma has not been found in these cases. Surgery treatment is the main therapy for liver hydatidosis and may result in good effectiveness.
ObjectiveTo evaluate roles and advantages of magnetic resonance imaging (MRI) and compute.tomography (CT) in preoperative assessment for hepatic alveolar echinococcosis. MethodMRI and CT scan imaging data of 60 patients with hepatic alveolar echinococcosis underwent radical surgery were retrospectively analyzed. ResultsMRI scanning could accurately identify the peripheral zone and marginal zone of hepatic alveolar echinococcosis lesions, and CT could not accurately show the above structures. In assessment of anatomic relation between vascular and lesions, MRI findings of 52 cases were in full compliance with corresponding intraoperative findings, and 8 cases were partial compliant. However, CT findings of 35 cases were in full compliance with corresponding intraoperative findings, 13 cases were partial compliant, and 12 cases were not compliant at all. In assessment of anatomic relation between biliary and lesions, MRCP could clearly show the bile duct, bile duct stenosis location and degree; CT scanning could only show widened bile duct, but could not accurately judge bile duct dilatation. ConclusionsMRI exerts some obvious advantages in preoperative evaluation of hepatic alveolar echinococcosis, and could accurately find relation between lesions and vascular or biliary system. MRI should be used as routine examination for patients with hepatic alveolar echinococcosis.
ObjectiveTo explore potential value of three-dimensional reconstruction technique for preoperative evaluation of hepatic alveolar echinococcosis. MethodsTwenty-one cases of hepatic alveolar echinococcosis proved by postoperative pathological examination in Affiliated Hospital of Qinghai University from October 2013 to March 2014 were analyzed retrospectively. The three periods of patients’ liver dynamic thin layerCTscan images were collected and imported in three-dimensional reconstruction software by DICOM format. The volume of the virtual resected liver tissue was calculated by software, and then was compared with the actual resected liver tissue volume. ResultsThe resected liver volume was (761.94±505.77) mL and (756.19±501.78) mL in the virtual surgery and in the veritable surgery, respectively. The proportion of resected liver in the total liver was (39.27±18.75)% and (38.95±16.99)% in the virtual surgery and in the veritable surgery, respectively. The resected liver volume had no significant difference between the virtual surgery and veritable surgery (P>0.05), which a positive relation (r=0.989, P<0.001). ConclusionThe limited preliminary data in this study show that three-dimensional reconstruction technique and virtual planning system for surgery could accurately guide resection of lesion and provide preoperative guidance of accurate liver resection for hepatic alveolar echinococcosis.
ObjectiveTo summarize the surgical technique and indications for liver masses involving the second and the third porta hepatis.MethodsThirteen cases of liver mass involving the second and the third porta hepatis, who underwent surgery in West China Hospital of Sichuan University from June 2013 to September 2016 were collected retrospectively, then made a statistical analysis, including patients’ information, characteristics of liver masses, operation information, and result of followed-up.ResultsOf the 13 cases, there were 3 cases of hepatic alveolar echinococcosis, 4 cases of hepatocellular carcinoma, 4 cases of intrahepatic cholangiocarcinoma, and 2 cases of liver metastasis induced by colon cancer. The mean tumor diameter was 12.5 cm (7–21 cm). Preoperative imaging examinations showed that mass had involved the second and the third porta hepatis, and all masses were resected by surgery without perioperative death, including 7 cases of right three hepatectomy resection, 1 case of left three hepatectomy resection, 4 cases of right hepatectomy resection, and 1 case of left hemi hepatectomy resection; among them, 9 cases were performed caudal lobectomy resection. The mean of operative time was 313 min (210–450 min), the mean of intraoperative blood loss was 592 mL (300–1 100 mL). Four cases received blood transfusion with 300–450 mL (mean of 338 mL). The total hepatic blood inflow occlusion time was 25–55 min (mean of 42 min). Five cases received venous reconstruction, and 1 case received hepatic vein reconstruction. After operation, ascites occurred in 6 cases, pleural effusion occurred in 6 cases, liver failure occurred in 2 cases, bile leakage occurred in 2 cases, pulmonary infection occurred in 3 cases, deep vein thrombosis occurred in 1 case. All of the 13 cases were followed-up for 1–39 months (median time was 14 months), during the followed-up period, 4 cases died, including 3 cases of intrahepatic cholangiocarcinoma and 1 case of liver metastasis induced by colon cancer.ConclusionIt is encouraging to apply the vascular reconstruction and skilled hepatic partition technique for resection lesions which involved the second and the third porta hepatis, through meticulous preoperative evaluation and preparation.
Objective To investigate the diagnosis and treatment of the liver hydatidosis in nonpastureland. Methods Clinical features of 16 patients with liver hydatidosis were analyzed retrospectively. Results Only 8 of 16 patients possessed the clinical symptoms and 8 patients had had history of inhabitancy in epidemic area. Casoni test and indirect hemagglutination showed a sensitivity of 90% and the correct diagnostic rate of CT was higher than that of B-ultrasound examination. The main effective treatment of the liver hydatidosis was surgical, 15 out of 16 patients received surgical treatment. In this series, the curative effect was good without any death, allergic reaction and implantation. Conclusion The cystic lesion of liver should be considered as liver hydatidosis and Casoni test, indirect hemagglutination, together with CT and B-us examination can be used to comfirm the diagnosis though no clinical symptoms and history of inhabitancy in epidemic area presented. Surgical operation is the main effective treatment for liver hydatidosis.
【摘要】 目的 观察肝包虫病的螺旋CT表现，以便作出正确的CT诊断。 方法 2003年1月-2010年1月，临床证实的35例肝包虫病患者行螺旋CT平扫及增强扫描，对其CT表现进行分析。 结果 多发病变30例，单发病变5例。囊性病变32例，其中囊壁钙化29例，囊壁内囊分离2例，囊内见子囊11例；实质性肿块3例，均见斑点状钙化。 结论 肝包虫病的螺旋CT表现有其特殊性，螺旋CT基本能作出正确的诊断。但有时需与肝脏其它疾病鉴别。【Abstract】 Objective To improve the understanding of liver echinococcosis and make correct diagnosis of the disease by analyzing its spiral CT characteristics. Methods From January 2003 to January 2010, 35 patients with clinically confirmed liver echinococcosis underwent spiral CT simple scan and enhanced scan. The results of CT scan were analyzed. Results There were 30 cases of multiple lesions and five cases of single lesion. Cystic lesion occurred in 32 cases, including 29 cases of cystic wall calcification, two cases of separated endocyst from the cystic wall. Daughter cysts could be seen in 11 cases of cystic lesion. Substantial mass could be seen in therr cases with spotty calcification. Conclusion The spiral CT manifestation of liver echinococcosis has its particularity. Basically, it can make the correct diagnosis. However, the diagnostic results sometimes need to be distinguished from other liver diseases.
ObjectiveTo explore the safety and efficacy of preoperative liver regeneration and then two-stage liver resection for advanced hepatic alveolar echinococcosis (HAE) patients pre-evaluating insufficient future liver remnant (FLR) after resection. MethodThe clinical data of the advanced HAE patients who were expected to have insufficient FLR after liver resection and underwent two-step liver resection in the Sichuan Provincial People’s Hospital from December 2016 to December 2022 were retrospectively collected and summarized. ResultsA total of 11 patients with advanced HAE pathologically confirmed were collected. Among them, 2 cases underwent portal vein embolization (PVE), 2 cases underwent liver vein deprivation (LVD), and 7 cases underwent associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) to promote residual liver regeneration in the first stage. The FLR/standard liver volume (SLV) exceeded the surgical requirement standard of 40%. Then the ex-vivo liver resection and autotransplantation, or directly radical liver resection was performed in the second stage. Only one patient underwent surgery to remove packed gauze on day 3 postoperatively due to massive intraoperative bleeding (approximately 4 000 mL). The median (P25, P75) follow-up time after surgery was 36 (15, 75) months, only one case was found to relapse at the third year after surgery and underwent surgical resection again, and the rest patients had no recurrence, long-term complications, or death. ConclusionsBased on the results from these cases, applying PVE, LVD, or ALPPS in the patients with advanced HAE who were expected to have insufficient FLR after resection aids to residual liver regeneration, creating conditions for the second stage radical resection. The second stage treatment including ex-vivo liver resection and autotransplantation or directly radical liver resection could achieve good results and is feasible and safe, which brings a hope of survival for the advanced HAE patients who could not previously undergo curative resection. However, this treatment strategy still incurs high costs and requires further optimization in the future.