Thisstudyisbasedonaretrospectivereviewof48patientswithechinococcosisofliverwithemphasisonthedifferentialdiagnosisandtheselectionofsurgery.Causesofmisdiagnosisandtheevaluationofavariousoperationsonthisdiseasewerediscussed.Results:Thecommonmisdiagnosiswasduetoobscurehistoryandsymptoms,errorsonimmunologicaltests,lackofspecificmanifestationonradiologicalexaminationandtheforemostsymptomsofcomplications.Theoperativewaysmustbechoseninaccordancewitheachindividualdisease.Theimprovementofoperativetechniquessuchas“tumorfree”operation,irrigationwithhypertonicsalinesolution,infillingwithgreateromentum,applicationofbiojellycanincreasethetherapeuticeffectofoperation.Conclusion:Thekeypointofdifferentialdiagnosisistorecognizetheatypicalcases.Rationalselectionofoperationsandimprovementofoperativetechniquesandmethodsarethecrucialtoincreasethetherapeuticeffectofthisdisease.
【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.
目的 对腹腔镜下治疗肝包虫病合并胆漏的方法进行探讨并总结治疗体会。方法 回顾性分析我院2006年3月至2012年9月期间收治的76例肝包虫病患者行腹腔镜内囊摘除中合并胆漏的24例患者的临床资料。结果 24例肝包虫病合并胆漏患者行内囊摘除外囊缝合引流术，在缝合外囊前在残腔内置入多孔胶管，持续负压吸引2～3d。24例肝包虫病合并胆漏患者除1例因电凝过程中有明显出血情况而不便于处理转为中转开腹外，其余23例患者采用腹腔镜下胆漏治疗均取得一次性成功。术中无一例患者出现过敏反应，也无一例手术死亡。1例患者术后出现双肩酸痛，3d后自行缓解并逐渐消失。1例患者术后出现少量（约20mL）胆汁漏，经1周引流后自愈。24例肝包虫病合并胆漏患者平均手术时间为1.8h，平均住院时间为6.2d。术后随访2～24个月（平均10个月），无一例复发，未见包虫囊肿手术残腔积液、感染等术后并发症。结论 肝包虫病合并胆漏患者可采用腹腔镜治疗，但要严格把握手术适应证，术中做好周围组织和脏器的保护，以免发生腹腔种植、过敏反应等严重并发症，同时应彻底将包虫子囊、头节等灭活，降低术后远期复发率，腹腔镜手术治疗肝包虫病是安全、有效、可行的。
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.
ObjectiveTo explore the effect of the surgery with laparoscope combined with choledochoscope on plateau hepatic hydatid biliary fistulas. MethodsA total of 100 patients with liver hydatid disease diagnosed between January 2012 and June 2013 were divided into two groups according to the admitting time:laparoscope combined with choledochoscope group (combined group) and laparoscope group, with 50 patients in each group. The therapeutic results of the two groups were compared. ResultsA total of 186 biliary fistulas were found in the combined group during the operation, and there were 5 patients with biliary fistulas after the surgery; while 87 biliary fistulas were found in laparoscope group during the operation and there were 16 patients with biliary fistulas after the surgery. The difference in the occurrence rate of biliary fistulas after surgery between the two groups was significant (χ2=7.294, P=0.007). No infection of incisional wound was found in combined group but 5 infection was found in laparoscope group. The postoperative extubation time in the combined group and laparoscope group was (10.35±3.87) and (27.16±4.58) days, respectively, with a significant difference (t=12.538, P<0.001). ConclusionThe laparoscope combined with choledochoscope is a minimally invasive and safe therapeutic option for plateau hepatic hydatid biliary fistulas.
ObjectiveTo explore the diagnosis and surgical treatment of hepatic hydatid. MethodsWe collected 51 cases of liver hydatid treated in our department from January 2008 to September 2012, and retrospectively analyzed its diagnosis and surgical treatment. ResultsCT and ultrasonography were both effective in diagnosing liver hydatid (P>0.05). Several surgical methods were all effective in the treatment of hepatic hydatid. ConclusionCT and ultrasonography are effective in the diagnosis of hepatic hydatid. Economic, convenient, and noninvasive ultrasound can be used as a routine examination. Combined with CT examination, the diagnosis of hepatic hydatid can be intensely enhanced. Treatment of hepatic hydatid should be individualized.
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 and discuss the various surgical methods for hepatic echinococcosis. MethodsFour hundred and two patients with hepatic echinococcosis were treated in West China Hospital of Sichuan University from 2009 to 2014 and 271 of them were undergone surgical treatment. The cystic echinococcosis was in 195 patients, including 80 cases performed classic endocystectomy or subtotal cystectomy, 109 performed total cystectomy or hepatectomy, 6 cases performed palliative surgery. The alveolar echinococcosis was in 76 patients, including 7 cases performed palliative surgery, 54 cases performed hepatectomy, 12 cases performed liver allotransplantation, and 3 cases performed liver autotransplantation. Results①The draining time, the rate of postoperative complications, and the recurrence was (18.6±2.7) d, 21.2% (17/80), and 15.0%(12/80) respectively in the cases of cystic echinococcosis underwent classic endocystectomy or subtotal cystectomy, which were significantly higher than those cases of cystic echinococcosis underwent total cystectomy or hepatectomy〔(5.4±0.6) d, 7.3% (8/109), and 0.9% (1/109), respectively, P < 0.05〕.②The draining time and the recurrence was (5.9±0.7) d and 1.8% (1/54) respectively in the cases of alveolar echinococcosis underwent hepatectomy, which were significantly lower than those in the cases of alveolar echinococcosis took palliative surgery〔(9.7±1.4) d and 57.1% (4/7), respectively, P < 0.01〕. The 12 patients underwent liver transplantation were complete rehabilitation, while the rest 3 were death. Conclusions①Total cystectomy or hepatectomy should be the first choice for cystic echinococcosis; Palliative treatment could improve the symptoms of unresectable patients with cystic echinococcosis.②Hepatectomy should be the first choice for alveolar echinococcosis, palliative surgery could only be used to alleviate symptoms and physical signs, delay the progression of this disease.③Liver transplantation might be an alternative for advanced hepatic echinococcosis.