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 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 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.
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.
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.
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 understand the current situation in the treatment of hepatic echinococcosis. MethodThe literatures about operation treatment, drug treatment, and the clinical pathway of hepatic echinococcosis were reviewed. ResultsCurrently, with the continuous development of surgical techniques and the application of minimally invasive surgery, the operative treatments of hepatic echinococcosis had made a great progress, it was still the preferred treatment for the disease. Liver transplantation was made as the final choice. The use of aspiration, sclerotherapy or interventional technique brought a hope for patients intolerant to laparotomy. Moreover, chemotherapy drugs, Chinese herbal medicine, and drug combinations also achieved a very good effect in the treatment of hepatic echinococcosis. The clinical pathway provided a good direction for the treatment of hepatic echinococcosis. ConclusionFor the treatment of hepatic echinococcosis various, we should choice a reasonable treatment according to the specific circumstances of patients, to achieve the best therapeutic effect with minimal trauma.
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.
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.