ObjectiveTo explore the possibility of intrahepatic biliary perfusion by contrast enhanced ultrasonography via bile duct. MethodsSixteen rabbits weighing 2 000-2 500 g were studied. A 22 gauge catheter was inserted in the common bile duct by surgery. The rabbits were divided into 4 groups according to the concentration of contrast agent, including group A:1/100 of standard concentration; group B:1/200 of standard concentration; group C:1/400 of standard concentration; and group D:1/800 of standard concentration. We observed the filling status, presence of outflow of contrast enhanced signal and satisfactory enhanced time after the injection of contrast agent via the catheter in common bile duct. ResultsFive milliliter of contrast agent was injected in each rabbit. The number of homogeneous filling in group A, B, C and D was 4, 4, 3 and 0 respectively. The number of presence of outflow of contrast enhanced signal in group A, B, C and D was 4, 1, 0 and 0 respectively. The satisfactory enhanced time in group A, B, C and D was (340±29) s, (284±37) s, (82±8) s and 0 s respectively. There was no statistical difference in the satisfactory enhanced time between group A and B (P=0.06) while significant difference in the satisfactory enhanced time between group A and C (P < 0.01), and between group B and C (P < 0.01) was found. ConclusionIt is possible to perfuse the intrahepatic biliary system by sonographic contrast agents via bile duct, and 1/200 of standard concentration is a proper concentration of contrast agent to achieve satisfactory imaging.
ObjectiveTo discuss various surgical methods for hepatic alveolar echinococcosis. MethodsThe clinical data of 98 patients with hepatic alveolar echinococcosis treated in West China Hospital of Sichuan University from 2004 to 2015 were analyzed retrospectively. Palliative surgeries were performed in 9 cases, radical hepatectomies were performed in 69 cases, liver transplantations were performed in 20 cases, in which 12 cases were performed by liver allotransplantation, and 8 cases were performed by liver autotransplantation. ResultsThere was no death case during perioperative period. The rate of postoperative complications of the radical hepatectomy (11.6%, 8/69) was significantly lower than that of the palliative surgery (44.4%, 4/9), which had statistically significant difference (P<0.05). The followup time was from 4 months to 6 years, the average time was 36 months. The postoperative recurrence rate in the radical hepatectomy (1.4%, 1/69) was significantly lower than that in the palliative surgery (55.6%, 5/9), which had statistically significant difference (P<0.05). During follow-up period, the mortality of the palliative surgery (33.33%, 3/9) was also significantly higher than that of the radical hepatectomy (0, 0/69), which had statistically significant difference (P<0.05). Four patients underwent liver transplantation were death within 3 months (20.0%). ConclusionsRadical hepatectomy should be the first choice for alveolar echinococcosis. In this research, although the rates of postoperative complications and recurrence in palliative surgery are higher than those in radical hepatectomy, palliative surgery, for the patients who had lose the opportunity to perform radical hepatectomy, could be used to alleviate symptoms and physical signs, improve quality of life, delay progression of this disease. Although risk of liver transplantation is high, this might be an alternative for advanced hepatic alveolar echinococcosis.