目的 分析其他疾病误诊为急性阑尾炎的原因。方法 结合相关文献资料，对2004年2月至2008年12月期间本院21例其他疾病被误诊为急性阑尾炎的过程进行回顾性分析。结果 除了胆囊结石、胃穿孔、肠结核、异位妊娠等常见病可能被误诊为急性阑尾炎外，肝包虫、胆管癌、癔病、恶性淋巴瘤等也有可能被误诊为急性阑尾炎。误诊的主要原因是经治医生经验不足、思维局限、知识面狭窄，更重要的则是重视不足，检查不仔细、不全面。结论 系统和全面仔细地问诊、查体，努力提高辅助检查诊断水平等是减少误诊的关键。
目的 探讨超声刀在肝包虫全囊切除术中的应用。方法 回顾性分析11例接受超声刀肝包虫手术患者的治疗及效果。结果 9例患者行全囊切除，其中1例因包虫与胆管相通，在进行全囊切除后，缝扎胆管，同时行T管引流； 1例因包虫与膈肌粘连无法分离，给予外囊大部切除术； 1例因包虫与膈肌粘连无法分离，给予外囊大部切除术； 1例10岁患者为肝顶部包虫，手术行内囊切除及外囊大部切除后，出现残腔感染，经穿刺引流后，证实为漏胆，经引流后痊愈出院。9例全囊切除患者术中均未输血，术后未出现并发症。结论 在肝包虫全囊切除术中应用超声刀是安全、有效的。
ObjectiveTo investigate the clinical significances of intraoperative methylene blue diluent injection through the residual bile duct for bile leakage after hepatic hydatidosis surgery.MethodsThe patients with hepatic hydatidosis who received the surgical treatment in this hospital from December 2018 to November 2019 were randomly divided into a study group and control group. The patients in the study group received the treatment of anatomical or nonanatomical hepatic lobectomy. The first hepatic hilum was locked, then the methylene blue diluent was injected through the residual bile duct to find the bile leakage. The drainage tube was retained in the abdominal cavity after the surgery. The patients in the control group except the white gauze was used to compress the liver wound surface for 5 min to find the bile leakage, the other treatment process was the same as the study group. The operation time, intraoperative blood loss, liver function on day 3 after the surgery (total bilirubin, alanine aminotransferase, albumin), detection rate of bile leakage during operation, postoperative complications (pulmonary infection, ascites, incision infection, bile leakage, residual cavity infection, and electrolyte disturbance), postoperative hospitalization time, and total hospitalization cost were compared between two groups.ResultsAccording to the inclusion and exclusion criteria, 67 patients were included in this study, including 32 in the study group and 35 in the control group. There were no significant differences in the baseline data such as the age, gender, preoperative complications, preoperative liver function (total bilirubin, alanine aminotransferase, albumin), and liver hydatid classification between the two groups (P>0.05). The operations were successful in the 67 patients, no perioperative death occurred. The detection rate of bile leakage during operation in the study group was higher than that in the control group (53.1% versus 17.1%, P<0.05). The postoperative hospitalization time was shorter and the total hospitalization cost was lower in the study group as compared with the control group (P<0.05). There were no significant differences in the operation time, intraoperative blood loss, liver function on day 3 after the surgery between the two groups (P>0.05). There was no case of the incision infection, bile leakage, and residual cavity infection in the study group, but there were 1, 5 and 4 cases in the control group, respectively. The incidences of incision infection and bile leakage had statistical significances between the two groups (P<0.05), and there was no significant differences in the incidences of other complications between the two groups (P>0.05).ConclusionsDetection rate of bile leakage during operation is high by intraoperative methylene blue diluent injection through the residual bile duct for bile leakage after hepatic hydatidosis surgery. It could reduce bile leakage, shorten postoperative hospitalization time, and reduce total hospitalization cost.
Thisstudyisbasedonaretrospectivereviewof48patientswithechinococcosisofliverwithemphasisonthedifferentialdiagnosisandtheselectionofsurgery.Causesofmisdiagnosisandtheevaluationofavariousoperationsonthisdiseasewerediscussed.Results:Thecommonmisdiagnosiswasduetoobscurehistoryandsymptoms,errorsonimmunologicaltests,lackofspecificmanifestationonradiologicalexaminationandtheforemostsymptomsofcomplications.Theoperativewaysmustbechoseninaccordancewitheachindividualdisease.Theimprovementofoperativetechniquessuchas“tumorfree”operation,irrigationwithhypertonicsalinesolution,infillingwithgreateromentum,applicationofbiojellycanincreasethetherapeuticeffectofoperation.Conclusion:Thekeypointofdifferentialdiagnosisistorecognizetheatypicalcases.Rationalselectionofoperationsandimprovementofoperativetechniquesandmethodsarethecrucialtoincreasethetherapeuticeffectofthisdisease.
ObjectiveTo explore the clinical application of in vivo hepatectomy with preservation of retrohepatic inferior vena cava (IVC) for hepatic alveolar echinococcosis (HAE) with the invasion of IVC. MethodsThe clinicopathologic data of a complicated HAE patient with large lesion (maximum cross-section 12.6 cm×9.6 cm), infiltrative growth, unclear boundary with surrounding tissues, and invasions of diaphragm and IVC (invasion length up to 4.6 cm) admitted to the Department of Liver Surgery in the West China Hospital of Sichuan University in December 2021 was retrospectively collected. The three-dimensional reconstruction of the liver model was performed by Mimics Medical 21.0 software before operation. The invading IVC of the right liver lesion was measured and the resection was simulated. During the operation, the HAE lesion and the affected IVC were gradually separated from IVC by the hemostatic forceps, and the residual lesions were gradually removed. ResultsIn this patient, the HAE lesion of right liver was resected, the IVC was entirely preserved, and the resection of liver was consistent with the preoperative three-dimensional reconstruction plan. The operation time was 275 min, the bleeding was approximately 500 mL. On the first day after the operation, the alanine aminotransferase and aspartate aminotransferase were increased, no obvious abnormalities were observed in the plasma albumin and bilirubin, the patient recovered and was discharged on the seventh day after the operation. No complications occurred after the operation, and no recurrence or metastasis of HAE was observed during follow-up period. ConclusionsHepatectomy with preservation of retrohepatic IVC for HAE with invasion of IVC is safe and effective. Taking albendazole regularly after surgery will help maintain disease-free survival.
【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 analyze findings of 3.0 T diffusion weighted magnetic resonance (MR) in hepatic alveolar echinococcosis and evaluate potential role of apparent diffusion coefficients (ADC) in hepatic alveolar echinococcosis. MethodsThe clinical data of 26 patients with hepatic alveolar echinococcosis from November 2013 to January 2015 in this hospital were analyzed retrospectively. Hepatic MR scannings with diffusion weighted imaging (DWI) sequences (b-value=0, 600, 1 000, and 1 200 s/mm2) were performed in 26 patients with hepatic alveolar echinococcosis. The data of all the patients were stored to the PACS. The lesion features including type, size, distribution, location, and calcification (on the CT) were assessed by two deputy radiologists. TheADCvalues of marginal area, centre area, surrounding area of liver parenchyma tissue were measured at different b values (0, 600, 1 000, and 1 200 s/mm2) and compared. Results①There were 26 patients with a total of 29 lesions, of which involved multiple liver segments, 21 (72%) lesions located in the right lobe, 4 lesions involved simultaneously the left and right lobes. Twenty-four lesions invaded the hepatic vein or portal vein, 20 lesions invaded the intrahepatic bile duct, 10 lesions invaded the right adrenal gland. Seven patients occurred hilar and retroperitoneal lymph nodes metastases, 5 patients occurred pulmonary metastasis, 3 patients occurred brain metastasis, while 3 patients occurred lung and brain metastases simultaneously. ②There were 20 liquefied necrotic lesions, of which 5 lesions marginal area had multiple small round cysts in T2WI, 15 were only solid and without small cyst; The DWI of the centre area in 12 lesions showed a high signal, 8 lesions showed a low signal. There were 9 solid lesions, of which 2 lesions marginal area had multiple small round cysts in T2WI, 7 lesions marginal area were only solid and without cyst in T2WI. The DWI of the solid lesions showed a low signal, there was a "ring" high signal in the edge of lesions. ③At the same b value, theADCvalue of the centre area in the liquefied necrosis lesions were significantly higher than that in the solid lesions (P<0.01). At different b values, theADCvalue of the surrounding liver parenchyma tissue was significantly lower than that of the marginal area (P<0.01) and the centre area (P<0.01) in the liquefied necrosis lesions; theADCvalue of the centre area was significantly higher than that of the marginal area or surrounding liver parenchyma tissue (P<0.05, P<0.01) in the solid lesions. ConclusionsDWI could clearly distinguish structure and composition of hepatic alveolar echinococcosis and has a higher value in distinguishing from other liver dieases. The averageADCvalue of centre area in liquefied necrotic lesions is higher than that in solid lesions.
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 investigate the clinical effect of transversus abdominis plane (TAP) block as part of multimodal analgesia in enhanced recovery after surgery (ERAS) program for patients with hepatic hydatidosis. MethodsThis study was a randomized controlled trial (The registration number was ChiCTR2100053689). According to the established inclusion and exclusion criteria, the patients diagnosed with hepatic hydatidosis treated in the People’s Hospital of Aba Tibetan and Qiang Autonomous Prefecture from October 2019 to August 2021 were prospectively included. The odd and even by obverse and reverse of coin was adopted to assign into the study group and the control group, respectively. The patients in the study group were treated with ERAS + TAP block + patient controlled intravenous analgesia (PCIA) + tramadol and the patients in the control group were treated with ERAS + PCIA + tramadol. The intraoperative and postoperative statuses of the two groups were compared. ResultsA total of 64 patients were enrolled in this study, including 32 patients in the study group and 32 patients in the control group. There were no statistical differences in the baseline data such as the age, gender, preoperative complications, preoperative liver function, and liver hydatid type between the two groups (P>0.05). The operations of 64 patients were performed successfully, and there was no perioperative death. There were no statistical differences in the operation time, intraoperative bleeding, and operation mode between the two groups (P>0.05). Compared with the control group, the points of visual analogue scale of postoperative pain on day 1 and 2 were lower (P<0.05), the dosage of tramadol within 2 d after operation and hospitalization expenses were less (P<0.05), and the getting out of bed time, eating liquid diet time, postoperative exhaust time, and total hospital stay were shorter (P<0.05) in the study group. The total complication rate of the study group was lower than that of the control group [28.1% (9/32) vs. 78.1% (25/32), χ2=16.063, P<0.001]. The comprehensive complication index was positively correlated with the total hospital stay (r=0.941, P<0.001) and hospitalization expenses (r=0.958, P<0.001). ConclusionPreliminary results of this study suggest that multimodal analgesia included TAP block is effective in ERAS, and could shorten hospital stay and reduce hospitalization expenses.
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.