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.
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.
ObjectiveTo summarize clinical treatments of hepatic alveolar echinococcosis in recent years and provide a new basis for guiding clinical practice. MethodsThe relevant literatures about treating hepatic alveolar echinococcosis at home and abroad were reviewed. The clinical curative effect and advantages or disadvantages among various treatments were analyzed. ResultsThe radical surgery was still the primary treatment of hepatic alveolar echinococcosis, liver transplantation was more used in the treatment of the late hepatic alveolar echinococcosis. surgery combined with chemical therapy had an obvously clinical curative effect. ConclusionsWith a high incidence and poor prognosis of hepatic alveolar echinococcosis, it is difficult to cure. Radical surgery, liver transplantation, chemotherapy and radiation therapy have been used in clinical treatment of hepatic alveolar echinococcosis. It is essential to fully acknowledge indications of various treatments. At the same time, if occurrence and development of this disease could be further researched, it might bring us a new hope of curing hepatic alveolar echinococcosis.
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 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.
ObjectiveTo detect expressions of interleukin-17 (IL-17) and interleukin-27 (IL-27) proteins in liver tissue of hepatic alveolar echinococcosis. MethodsThe edge liver tissues (from the lesion edge 0.5 cm) and the normal liver tissues (from the lesion edge 5 cm) of 20 patients with hepatic alveolar echinococcosis in the Affiliated Hospital of Qinghai University were collected and stored at-80℃ freezer. The immunohistochemical method was used to detect the expressions of IL-17 and IL-27 proteins in these two tissues. ResultThe positive rates of IL-17 and IL-27 protein expressions in the edge liver tissues were significantly higher than those in the normal liver tissues[IL-17:80.0% (16/20) versus 10.0% (2/20), χ2=12.36, P < 0.01; IL-27:85.0% (17/20) versus 20.0% (4/20), χ2=12.36, P < 0.01]. ConclusionHigh expressions of IL-17 and IL-27 protein in edge liver tissue might participate in progress of hepatic alveolar echinococcosis.
ObjectiveTo investigate the expressions of type Ⅰ and type Ⅲ collagen protein in hepatic alveolar echinococcosis tissues, and to explore its relationship with the biological behavior in progress of hepatic alveolar echinococcosis (HAE). MethodsTwenty samples of normal liver tissues and liver tissues at the edge of the lesion with HAE in our hospital from Jan. 2012 to Dec. 2014 were collected, and HE and Masson staining were performed. The pathological changes and the degree of fibrosis of liver tissues around HAE lesion were observed under light microscope. The expressions of type Ⅰ and type Ⅲ collagen protein in liver tissues were detected by immunohistochemical staining. ResultsThe degree of liver fibrosis of liver tissues at the edge of the lesion with HAE was grade Ⅱ, and the degree of fibrosis of normal liver tissues was grade 0, the difference between the two was statistically significant (P < 0.05). The color index of type Ⅰand type Ⅲ collagen protein in the liver tissues at the edge of the lesion with HAE was 7.45±1.85 and 8.00±1.62, respectively, which were higher than those of normal liver tissues (3.10±1.02 and 3.50±0.89), the difference were statistically significant (t=-9.21, P=0.001;t=-10.88, P=0.001). ConclusionsThere is liver fibrosis around the lesion in the patients with HAE. HAE may promote the expressions of type Ⅰ and type Ⅲ collagen and then induce the occurrence of liver fibrosis.
Objective To determine the value of contrast-enhanced ultrasound (CEUS) in the differentiation of primary liver cancer (PLC) and hepatic alveolar echinococcosis (HAE). Methods The data of 56 patients with PLC or HAE were collected between January 2010 and May 2015. Grayscale and CEUS features of the patients were analyzed retrospectively. The frequency of each imaging finding, including calcification, arterial enhancement, and internal enhancement were evaluated and compared. Results Statistically significant difference of the proportion of gender and age were detected between the two groups (P=0.013, 0.002). Thirty-eight PLC lesions were detected in 32 patients. The diameters of PLC lesions were 3-10 cm with an average of (5.6±2.1) cm. Thirty-two HAE lesions were found in 24 patients. The diameters of HAE lesions were 4-12 cm with an average of (9.1±4.4) cm. Statistically significant difference of lesion size and the incidence rate of calcification (5.3% vs. 75.0%) were seen between PLC and HAE (P<0.001). Peripheral enhancement were seen in 100.0% (38/38) PLC lesions, including 84.2% (32/38) hyperenhancement and 15.8% (6/38) dendritic hyperenhancement. All PLC lesions demonstrated hypoenhancement in late phase. Irregular peripherally hyperenhancement both in arterial and late phase were detected in 43.8% (14/32) HAE lesions. The other 56.2% (18/32) HAE lesions showed no peripheral enhancement both in arterial and late phase. No internal enhancement were seen in HAE lesions. The presence of arterial enhancement (100.0% vs. 43.8%) and absence of internal enhancement (0 vs. 100.0%) were significantly different between PLC and HAE (P<0.001). Conclusions PLC is predicted by arterial phase hyperenhancement and late phase hypoenhancement on CEUS. HAE is predicted with calcification on baseline sonography and internal non-enhancement on CEUS. Arterial phase enhancement is less common and less intensive in HAE than in PLC which also contributes to the differentiation of these lesions.
Objective To explore the correlations between the time of tracheal extubation and the intraoperative basic factors of ex vivo liver resection followed by autotransplantation in patients with advanced hepatic alveolar echinococcosis (HAE), and analyze the change trend of blood gas analysis during operation. Methods The data of 24 patients with advanced HAE who underwent ex vivo liver resection followed by autotransplantation in West China Hospital of Sichuan University between February 2014 and August 2017 were retrospectively analyzed. Results There were significant correlations between the extubation time and the duration of anesthesia (r=0.472, P=0.031), the amount of bleeding (r=0.524, P=0.015), the amount of erythrocyte suspensions infusion (r=0.627, P=0.002), and the amount of plasma infusion (r=0.617, P=0.003). There was no statistical difference in extubation time between patients with and without pulmonary complications in 3 months postoperatively [(23.74±15.84), (15.52±19.40) h, P=0.327]. Compared with those arterial blood gas results before the interruption, the pH value, blood glucose, lactic acid and base excess were statistically significantly different (P<0.05) at each time point after the interruption. Blood potassium increased at the end of operation compared with that before interruption (P<0.05); and the free calcium after blocking and opening increased with a temporary decrease (P<0.05); the hemoglobin decreased significantly after interruption and clamping (P<0.05). Conclusions Anesthesia length and bleeding should be reduced in ex vivo liver resection followed by autotransplantation, thus the extubation time would be shortened and the prognosis of the patients might be improved. Because of the longer anhepatic phase, the blood gas analysis varies largely. During operation, blood gas analysis and monitoring should be strengthened, and the acid-base balance and electrolytes should be maintained in time.