ObjectiveTo analyze the efficacy and safety of complete excision of the external capsule in the treatment of hepatic echinococcosis.MethodsThe clinical data of 90 patients with hepatic cystic echinococcosis admitted to our hospital from January 2016 to March 2018 were retrospectively analyzed. According to the different surgical methods, this patients were divided into two groups: the partial hepatectomy group and complete excision of the external capsule group, 45 cases in each group. The patient's general condition and the situation during hospitalization were analyzed, and the intraoperative conditions, postoperative complications, recurrence and mortality after one year in different surgical methods were compared.ResultsThe operative time and intraoperative blood loss in the partial hepatectomy group was significantly longer or more than that in the complete excision of the external capsule group (P<0.05), respectively. There was no significant difference between the two groups in hospitalization time (P>0.05). The incidence of postoperative complications was 11.11% in the partial hepatectomy group and 8.88% in the complete excision of the external capsule group. There was no significant difference between the two groups (P>0.05). After 1 year of followed-up, the recurrence rate of the partial hepatectomy group was 4.44%, and there was no recurrence in the complete excision of the external capsule group, and there was no significant difference between the two groups (P>0.05). There was no death in both groups.ConclusionsIn the surgical treatment of hepatic cystic echinococcosis, the most appropriate surgical method should be selected according to the specific conditions of the patient, and the complete excision of the external capsule has higher therapeutic effect and safety in the treatment of hepatic echinococcosis. It is worthy of clinical promotion.
ObjectiveTo explore the influencing factors of textbook outcomes (TO) after radical resection for hepatic alveolar echinococcosis (HAE). MethodsClinical data from 427 patients diagnosed with HAE at the Ganzi Branch of West China Hospital, Sichuan University, between 2015 and 2022, were retrospectively collected. The least absolute shrinkage and selection operator regression (LASSO) was first used to screen potential influencing factors for achieving TO (predictive model A). Univariate and multivariate logistic regression analysis were then used to explore the influencing factors of TO (predictive model B). A Nomogram was further constructed and validated. ResultsA total of 427 patients who successfully underwent radical liver resection were included, of which 174 patients (40.7%) achieved TO. Compared to the non-TO group, patients in the TO group had higher proportions of WHO PNM stage of P 1+2 [62.6% (109/174) vs 42.3% (140/253)], N0 [77.0% (134/174) vs 63.6% (161/253)], lesion diameter≤10 cm [77.0% (134/174) vs 64.8% (164/253)], albumin-bilirubin index (ALBI) ≤–2.6 [70.1% (122/174) vs 59.3% (150/253)], and minor liver resection [71.8% (125/174) vs 50.2% (127/253)], higher prealbumin (181 mg/L vs 169 mg/L) and albumin (39 g/L vs 38 g/L) levels, shorter postoperative hospital stay (15 d vs 19 d), and lower hospitalization costs (51 727 RMB vs 62 715 RMB), P<0.05. LASSO regression analysis indicated that P stage, lesion diameter, ALBI, and liver resection method were potential influencing factors for achieving TO after HAE surgery (model A), P<0.05. The TO rate for P 1+2 stage was higher than that of P 3+4 stage, the TO rate for lesion diameter ≤ 10 cm was higher than that of lesion diameter >10 cm, the TO rate for ALBI ≤–2.6 was higher than that of ALBI >–2.6, and the TO rate for minor liver resection was higher than of major liver resection. Multivariate logistic regression analysis showed that P stage (OR=1.800, P=0.025) and liver resection method (OR=1.974, P<0.001) were influencing factors for achieving TO (model B). The TO rates for P1+2 stage and minor liver resection were higher. Predictive model A demonstrated higher accuracy and stability compared to predictive model B (AUC: 0.754 vs 0.712, C-index: 0.756 vs 0.707). ConclusionsAmong patients undergoing radical resection for HAE, less than half achieved TO. Striving to achieve TO can significantly shorten the length of hospital stay and effectively reduce medical costs. The TO predictive model based on P stage, lesion diameter, ALBI, and liver resection method is superior to the model based solely on P stage and liver resection method.
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 summarize short-term and long-term effects of ex vivo liver resection followed by autotransplantation (Abbreviation: autotransplantation) in treatment of advanced hepatic alveolar echinococcosis (HAE).MethodThe clinical data and follow-up data of 17 patients with advanced HAE who underwent autotransplantation from November 2016 to July 2019 in the Ganzi Tibetan Autonomous Prefecture People’s Hospital were retrospectively analyzed.ResultsThe autotransplantations were performed successfully in the 17 patients with advanced HAE. Ten patients underwent the inferior vena cava (IVC) reconstruction with autologous saphenous veins, 5 patients underwent the artificial revascularization, 1 patient underwent the direct anastomosis of the original IVC, and 1 patient didn’t reconstructed (the retroperitoneal collateral circulation was abundant). The mean liver graft mass was 681.3 g (365–1 350 g) and operation time was 11.5 h (9–16 h). The median anhepatic period was 312 min (175–450 min), blood loss was 2 000 mL(950–4 500 mL), red blood cell suspension transfusion was 6.4 U (1–20 U), and fresh frozen plasma was 1.1 L (0.8–2.0 L). The postoperative hospital stay was 5 to 45 d with an average of 25.6 d. There were 4 patients with the postoperative hepatic enveloping effusion, 1 patient with bile leakage, and 1 patient with bile duct stenosis. All of them were treated and cured, and no death occurred. The follow-up time of 17 patients was 3 to 35 months with an average of 9.5 months, no recurrence of HAE and distant metastasis were observed.ConclusionsIn highlands, autotransplantation in treatment of advanced HAE patients with different IVC reconstruction is satisfactory, but it has a higher risk and is difficult. Choice of intraoperative reconstruction materials, judgment of posterior peritoneal collateral circulation, presence or absence of tension in end-to-end anastomosis of the IVC require precise consideration. At the same time, anticoagulation therapy and complications management are difficult, and it is only suitable for plateau medical center with rich experience.
Objective To discuss the clinical application of two-stage hepatectomy for multiple and huge hepatic alveolar echinococcosis. Methods The clinical data of 7 patients with multiple hepatic alveolar echinococcosis treated with two-staged hepatectomy in West China Hospital of Sichuan University and The people's Hospital of Ganzi Tibetan Autonomous Prefecture of Sichuan Province from August, 2013 to June, 2016 were analyzed retrospectively. The preoperative diagnose was definite according to CT and (or) MRI, serological and life in the epidemic area. The patients, which the future liver remnant was less than 30% according to CT, received two-staged hepatectomy. Epigastric enhancement CT, liver function and blood routine examination were reviewed monthly after the first surgery, the second surgery was operated after 3 monthes, epigastric ultrasound, enhancement CT or MRI, liver function, blood routine examination and serological were adopted in 1, 6, and 12 months and each year after the second operation. Results The liver function was normal in 7 days after two operations and no complications after the first suegery, one patient developd with biliary fistula after the second surgery, no recurrence or death occurred during the followed-up period. Conclusion The two-stage hepatectomy can be operated in multiple and huge alveolar echinococcosis to reduce surgery risk and cost, shorten hospital stays and improve quality of life.