ObjectiveTo investigate and analysis the data of patients with hepatic echinococcosis in Ganzi County in 2018, and to understand the epidemiological characteristics of hepatic echinococcosis in Ganzi County, Sichuan Province.MethodsA total of 811 patients were enrolled. The basic information of sex, age, weight, occupation, nation, educational level, family address and so on were recorded. The location, number, classification, transverse diameter and longitudinal diameter of hepatic echinococcosis masses were recorded by abdominal color Doppler ultrasonography.ResultsIn 2018, 811 new cases of hepatic echinococcosis were reported in Ganzi County, with a prevalence rate of 4.6% (811/17 650), and 17.81% (572/3 212) in the Datongma area. Patients ranged in age from 6 to 92, the average age was (44.8±16.6) years old. The majority of patients were Tibetans (98.5%), herdsmen (71.8%) and illiterates (83.5%). The most common lesions were in right liver (84.2%) and single (91.4%).ConclusionsThere is serious transmission of hepatic echinococcosis in Ganzi County, especially in pure pastoral areas, and HAE is more prevalent than HCE. Most of the infected people are Tibetan herdsmen with illiterate educational background and more females than males. The peak incidence of hepatic echinococcosis is 30-55 years old. Close monitoring should be carried out for these people.
ObjectiveTo summarize the therapeutic effect and clinical significance of reduced volume lesion resection combined with drug therapy for end-stage alveolar hepatic echinococcosis.MethodClinical data of 46 patients with end-stage alveolar hepatic echinococcosis who received treatment of reduced volume lesion resection combined with drug therapy at Department of General Surgery of Qinghai Provincial People’s Hospital from March 2013 to October 2019 were retrospectively analyzed.ResultsAmong the 46 patients, 3 patients were lost to follow-up and 43 patients received follow-up. The follow-up time ranged from 3 to 79 months, with the median of 40 months. Fifteen patients died during the follow-up period, of which 5 patients with cerebral hydatid disease died during 16–36 months due to acute seizures and cerebral edema, 4 patients with multiple systemic metastases died during 9–36 months due to multiple organ failure, 2 patients with pulmonary echinococcosis died due to acute pulmonary embolism, 4 patients died in 2 years after operation due to recurrent biliary tract infection, other patients survived during follow-up period without distant organ metastasis.ConclusionReduced volume lesion resection combined with drug therapy in treatment of end-stage alveolar hepatic echinococcosis can improve the patient’s quality of life, reduce the hospital cost, reduce the occurrence of postoperative complications, and shorten the length of hospital stay.
We comprehensively outlined the application of imaging, immunology, and molecular biology techniques in the detection of hepatic echinococcosis (HE). Imaging techniques, represented by ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography, not only provided some critical information about the morphology, location, and characteristics of HE lesions, but also could be combined with artificial intelligence technologies to enhance the diagnostic capabilities and expand the application scenarios. These techniques were essential tools for the diagnosis, screening, and prevention of HE. Immunological techniques, such as the indirect hemagglutination assay, enzyme-linked immunosorbent assay, immunoblotting, and chemiluminescence immunoassay, aided in diagnosis and differential diagnosis by detecting the specific antibodies. Molecular biology techniques, such as polymerase chain reaction and high-throughput sequencing, provided a strong support for the diagnosis and pathogen identification of HE due to their high sensitivity and specificity. Based on these three major technologies, more sensitive, specific, convenient, and cost-effective detection techniques had emerged, offering more options for the detection and control of HE. Additionally, constructing comprehensive diagnostic models by combining the advantages of different detection technologies will aid to improve the diagnostic efficiency of HE.
We reviewed the research progress of anesthesia management in hepatic echinococcosis surgery in recent years, including the key technologies, practical experience, and research progress of anesthesia management in hepatic echinococcosis surgery, so as to guide clinical practice. Firstly, in the selection of anesthesia, the general anesthesia combined with epidural block or regional nerve block is recommended to improve surgical safety and patients’ comfort. At the same time, the importance of intraoperative continuous monitoring, including key indicators such as hemodynamics and respiratory function, is emphasized, and transesophageal echocardiography and brain function monitoring techniques are introduced to optimize anesthesia management. Finally, the concept of enhanced recovery after surgery is promoted, and measures such as preoperative optimization, intraoperative heat preservation, refined fluid management, and postoperative analgesic management are implemented to promote the rapid recovery of patients. At the same time, some challenges and unsolved problems in the current research also are pointed out, such as complex case evaluation, complications prevention, and teamwork, etc., which need to be further studied in the future to optimize the anesthesia strategy.
Objective To summarize the research status of percutaneous ultrasound interventional therapy for the patients with hepatic echinococcosis, and to provide some experience and reference for the treatment of disease in clinical medical personnel. Method The relevant literature on percutaneous ultrasound intervention therapy for hepatic echinococcosis both domestically and internationally was summarized and analyzed. Results For the patients with hepatic cystic echinococcosis (HCE), ultrasound-guided percutaneous transhepatic drainage is safe and effective for the World Health Organization Informal Working Group classification CE1 and CE3a cysts. For the patients with hepatic alveolar chinococcosis (HAE), although radical resection is still the gold standard, ultrasound-guided microwave ablation had better postoperative recovery and less trauma for patients with lesion diameter ＜5 cm; Due to limited research on the efficacy and safety of ultrasound-guided radiofrequency ablation for patients with HAE, further exploration is needed; Ultrasound guided percutaneous cyst puncture drainage is used for external drainage of necrotic material in the cyst cavity, which can effectively control infection and remove necrotic tissue; percutaneous transhepatic cholangial drainage (PTCD) could effectively relieve biliary obstruction, improve liver function, and enhance the quality of life of patients with advanced HAE complicated with obstructive jaundice. Conclusions Ultrasound-guided percutaneous interventional techniques have their own advantages and disadvantages in treatment of hepatic echinococcosis. For patients with HCE, strict indications and contraindications should be followed when performing percutaneous ultrasound interventions. For patients with HAE, early-stage small lesions should be prioritized for microwave ablation, and patients in the middle and late stages with larger lesions or those with intra-cyst infection or jaundice should be treated with percutaneous cyst puncture drainage and PTCD to alleviate symptoms, following the second stage operation.
ObjectiveTo comprehend the current diagnosis status and new progress of hepatic echinococcosis (HE). MethodThe literature from domestic and foreign researchers relevant diagnosis of HE in recent years was searched and summarized. ResultsThe HE was widely distributed worldwide, with extremely high mortality and disability rates, posing a serious threat to local economic development and public health. At present, in addition to the traditional and widely recognized diagnostic methods based on epidemiological histories, clinical manifestations, routine imaging, and experimental examinations, many innovative technologies based on these traditional diagnostic methods had emerged in the field of HE diagnosis, such as diagnostic prediction models constructed based on ultrasound and other imaging data, artificial intelligence, three-dimensional visual reconstruction, and circulating free DNA testing, which significantly improved the diagnosis rate of the HE. ConclusionsIn recent years, with the continuous improvement of medical level, the in-depth and perfect exploration of HE has made remarkable progress, which not only provides a new possibility for the early diagnosis of the HE, but also provides an important basis for research in related fields and the formulation of prevention and control measures. Therefore, the further promotion and application of these new techniques will aid to promote the diagnosis progress of HE and reduce its impact on population health.
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.