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 discuss the clinical application of two-step hepatectomy for hepatic alveolar echinococcosis which invaded the second and the third porta hepatis.MethodsThe clinical data of 60 patients with hepatic alveolar echinococcosis invaded the second and the third porta hepatis who treated with two-step hepatectomy in West China Hospital of Sichuan University and The People’s Hospital of Ganzi Tibetan Autonomous Prefecture of Sichuan Province from Jan. 2013 to Jun. 2017 were analyzed retrospectively.ResultsSixty patients had underwent radical hepatectomy successfully and no death happened during perioperative period. The average operative time was 309.17 min (150–475 min) and intraoperative blood loss was 586.67 mL (100–3 000 mL). Forty-eight patients blocked the blood flowing into the liver, the average blocking time was 25.85 min (15–50 min); 24 patients suffered red blood cell suspension, the average amount was 3.79 U (2–8 U), and 9 patients were infused with fresh frozen plasma, the average amount was 527.78 mL (350–850 mL). The average of hospital stays was 17.5 days (7–39 days) and average of hospitalization cost was 49 323.43 yuan (28 045.32–61 243.15 yuan). The liver function indicators returned to normal within 7 days after operation. After operation, 3 patients suffered from biliary fistula, 3 patients suffered from pleural effusion, 3 patients suffered from peritoneal effusion, 10 patients suffered from effusion. According to the rank of complication: 10 patients were defined as grade Ⅰ, 3 patients were defined as grade Ⅱ, 6 patients were defined as grade Ⅲa. The average follow-up time of 60 patients was 14.47 months (1–31 months). No recurrence and death occurred during follow-up period.ConclusionThe two-step hepatectomy in treatment of hepatic alveolar echinococcosis invaded the second and the third porta hepatis can avoid the large flucyuations of intraoperative blood pressure and other vital signs, can increase the safety of surgery and reduce the difficulty and risk of surgery.
【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.
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.
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.
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.
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。
ObjectiveTo explore the safety and effectiveness of high intensity focused ultrasound (HIFU) in treatment of hepatic echinococcosis. MethodsThe clinical data of 8 patients with hepatic echinococcosis from 2008 to 2010 in the HIFU treatment center of The Second Affiliated Hospital of Chongqing Medical University were analyzed retrospectively, the effect of HIFU treatment, postoperative liver area pain, fever, skin burn and other complications were evaluated, the prognosis and recurrence were followed-up. ResultsAll the clinical manifestations and imaging manifes-tations of these 8 patients were improved after HIFU treatment. The liver functions of all the patients were injuried, which all were returned to normal within 5 days. Three patients suffered from fever and recovered within 6 days. Six patients appeared pain of liver area and relieved within 7 days. Operation area skin was basically normal, except 3 cases of mild swelling, no special complications happened. ConclusionFrom the limited data initially shows that it is a safe and effec-tive method of HIFU in treatment of hepatic echinococcosis, which is little invasion and less postoperative complications.
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.