Primary echinococcal disease of the kidney: The case for a more conservative approach

Purpose: To evaluate conservative management of renal echinococcosis in cases with normal renal function and active disease. Patients and methods: From a series of 12 consecutive patients with primary renal echinococcosis, nephrectomy was suggested to 4 patients because of kidney destruction. One patient who denied surgery and 5, in whom serological tests were positive, were given mebendazole for 30 days. 3 patients with no evidence of active disease were not given any medication. Results: The patient who denied nephrectomy and 1 out of 5 with positive serological tests did not respond to mebendazole treatment. The latter underwent a cyst excision. Thus, 4 responders to mebendazole and3 who were not given any medication, avoided surgery and continue to have negative serological tests for more than 3 years. Conclusion: Conservative management and long term follow up are proposed for the non-active or mebendazole-responsive patients. For the non-respondents or the cases with kidney destruction, surgery is the only hope for cure. This revised version was published online in June 2006 with corrections to the Cover Date.     

腹腔镜肝切除术6例报告

2002年4月～2004年6月腹腔镜下超声刀结合氩气刀完成肝切除6例,其中原发性肝癌2例,肝海绵状血管瘤4例.手术时间0.5～4.0 h,平均1.8 h.术中出血量80～320 ml,平均220 ml.术后住院5～7 d,平均5.7 d.超声刀结合氩气刀是腹腔镜肝切除术的理想手术工具.     

Primary hydatid cyst of the root of the thigh: a case report and review of the literature

Hydatid disease of bone is a rare event, and it is characterized by a high diagnostic and therapeutic complexity. We report a case of primary hydatidosis of the proximal thigh involving both the soft tissues and the proximal femur in a 59-year-old man. It has been possible to establish the diagnosis only 8 years after the appearance of the first symptoms (painful swelling over the root of the left thigh), when the patient came to our institution after several investigations.     

Clinical and radiographic features of simple and hydatid cysts of the liver

The advances of hydatid chemotherapy and the non-operative management of simple (epithelial) hepatic cysts make a correct diagnosis of increasing importance. Twenty-six patients with hepatic hydatid cysts and eleven with simple cysts were reviewed. In both groups clinical presentation was most frequently due to pain. Sex, age and size of the cysts were similar. Hydatid serology was negative in six of the hydatid patients (23 per cent). None of the simple cyst patients had positive serology but one had a borderline titre. Ultrasound and computerized tomography identified daughter cysts within the main cyst in only 17 hydatid cysts (65 per cent) and considerable intra-cyst debris was also present in five of the simple cysts. Seven of the simple cysts were deroofed surgically and the remainder underwent percutaneous aspiration. Sixteen of the hydatid cysts were found to have a biliary communication whereas this was not found with any simple cyst. The difficulties in making a precise diagnosis in some patients with a liver cyst should deter the interventional radiologist and restrain the hydatid chemotherapist.     

肝静脉阻断技术在肝切除术中的应用(附105例报道)

目的探讨肝静脉阻断技术在复杂肝脏肿瘤切除术中防止肝静脉破裂大出血及空气栓塞的作用。方法对105例肝脏肿瘤手术切除患者施行了1根以上主肝静脉阻断。所有肿瘤均位于第二肝门并侵犯或压迫1根以上主肝静脉。肝静脉阻断方法采用绕线结扎、血管带阻断或血管夹及心耳钳夹闭法。结果105例中无一例肝静脉分离破裂。施行半肝全血流阻断41例（右侧27例，左侧14例），交替半肝全血流阻断4例，第一肝门阻断加部分肝静脉阻断45例，第一肝门阻断加全部肝静脉阻断（不阻断下腔静脉的全肝血流阻断）15例。其中46例同时行第三肝门分离。105例肿瘤顺利切除。结论肝静脉阻断技术是一种安全、有效的血流阻断技术。不阻断下腔静脉的全肝血流阻断术既能控制术中出血，又能保证全身血流动力学稳定。     

Surgical treatment of hydatid disease of the liver: 25 years of experience

Background

The aim of this study was to evaluate the results of conservative and radical treatment of liver hydatid disease.

Methods

Records of patients who underwent surgery for liver hydatid disease between 1980 and 2005 were reviewed. Outcomes measured were operative morbidity and mortality, hospital stay, and recurrence.

Results

Two hundred fourteen patients underwent conservative treatment (external drainage, marsupialization, omentoplasty), and 240 had radical surgery (hepatic resection, cystopericystectomy). Operative morbidity was 79.9% and 16.2% for conservative and radical procedures, respectively (P < .001). Operative mortality was 6.5% for conservative procedures and 9.2% for radical procedures (P = .3). The recurrence rate was 30.4% in patients having conservative surgery and 1.2% in patients undergoing radical surgery (P < .001). No recurrences occurred in patients with clear cysts after conservative surgery.

Conclusions

Cystopericystectomy was a safe and effective procedure that achieved excellent immediate and long-term results. Hepatic resection should be considered only in exceptional cases, because it involves the unnecessary sacrifice of healthy hepatic parenchyma. Conservative surgery and alternative procedures should be restricted to the treatment of clear cysts and to patients who cannot undergo radical surgery.     

腹腔镜肝癌切除术15例报告

目的探讨腹腔镜肝癌切除的可行性与适应证. 方法 1998年8月～2004年9月采用多功能手术解剖器(Peng's multifunctional operative dissector,PMOD)刮吸法断肝技术对15例肝癌行腹腔镜肝癌切除术. 结果 14例腹腔镜肝癌切除术成功,1例因术中出血中转开腹肝癌切除术.腹腔镜肝癌切除术手术时间60～240 min,平均125 min.术中出血量50～2 000 ml,平均501 ml.切除肝脏最大体积10 cm×9 cm×7 cm.术后无并发症发生.术后24 h均能下床活动,术后1～3 d即能进食.术后住院5～10 d,平均6.5 d. 结论对位于肝脏边缘、右肝表面或左半肝的恶性肿瘤,采用PMOD行腹腔镜肝癌切除是可行和安全的.     

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目的 总结19例肝泡状球蚴病致梗阻性黄疸，行超高位胆肠吻合术的治疗经验。方法 肝泡状球蚴病根治性切除12例（右半肝6例，左半肝4例，右三叶2例）。空肠与右肝管Roux-Y吻合4例。空肠与左肝管Roux-Y吻合8例，中肝叶姑息性切除7例，行空肠间置胆肠吻合。结果 18例泡型黄疸病人痊愈出院，1例术后发生胆肠瘘，死于肝肾综合征。16例坚持口服吡喹和甲苯咪唑。结论 泡型黄疸经泡肝根治性或姑息性切除，超高位胆肠吻合可改善肝功能，延长病人生存期限。     

肝静脉钳夹阻断技术在第二肝门区肿瘤切除术中的应用

Hepatic vein hemorrhage and air embolism are easily caused during the resection of the tumor involving the second hepatic hilum.Hepatic vein occlusion has been proven to decrease this risk,while classic selective hepatic vein occlusion with tourniquet is technique demanding.We modified the classic method by using Satinsky clamp in hepatic vein dissection and occlusion.Based on the clinical data of 220 patients who received hepatic vein occlusion with tourniquet and 330 patients with Satinsky clamp,we proved that hepatic vein occlusion with Satinsky clamp is simpler,safer and with high success rate.     

Orbital hydatid cysts: Report of four cases

Hydatid cysts of central nervous system are rare and comprise only 2% to 3% of all hydatid cysts reported. Orbital localization is very uncommon and has been reported less than 1 % of all hydatid diseases. The primary treatment of hydatid disease is surgical. The most important complication of the surgical treatment is secondary hydatidosis due to spillage of the cyst contents. Because of the difficulties of the orbital localization, total extirpation of the cysts without rupture is almost impossible. Preventing spontaneous rupture of the cysts during surgery and postoperative antihelmintic treatment should be taken into consideration in these cases.This study includes four cases who underwent surgery for orbital hydatid cysts. Radiological characteristics, operative technique and postoperative medical therapy are discussed.     

Update on Spigelian Hernia: Diagnosis and Treatment by Means of Two Cases

The rarity of Spigelian hernias and the frequent subtle clinical findings can cause an important delay in diagnosis, especially in obese patients. Furthermore it has a high risk of incarceration. When this occurs, a fast recognition and adequate treatment are necessary. Treatment can be primary suture or mesh repair. More recently, the laparoscopic approach has become more popular. We present two cases of incarcerated Spigelian hernia and we give a review of the literature, with specific attention for the anatomical features and pathogenesis.     

小肝癌切除术后并发肝功能衰竭20例

目的 探讨小肝癌术后肝功能衰竭的原因和防治。方法 回顾性分析近3年我院小肝癌切除的临床资料。结果 近3年我院共行直径＜3cm小肝癌409例，术后发生肝功能衰竭者20例(4．89％)，其中行肿瘤切除附加门奇断流术者占85％。与无肝功能衰竭者相比，术后出现肝功能衰竭的病人术中出血量明显多于后者(P＜0．01)。结论 小肝癌术后肝功能衰竭的发生并不少见。小肝癌术后肝功能衰竭的原因除了本身有较重的肝硬化外，术中出血量多、附加其他手术致手术创伤大也是重要因素。因此，对小肝癌，尤其是合并门脉高压症者，不可盲目追求行根治性肿瘤切除术以及随意附加门脉高压症手术。     

腹腔镜肝切除术12例临床分析

目的探讨腹腔镜肝切除术（LH）的可行性与适应证。方法回顾分析12例行LH患者（LH组）与20例同期行开腹肝切除术（OH）患者（OH组）的临床资料,比较两组手术时间、术中出血量、切口长度、肛门排气时间等指标。结果所有手术均获成功。LH组切口长度、术后肛门排气时间、术后禁食时间、留置引流时间、术后住院时间等与OH组比较具有明显的优势,差异有统计学意义（P〈0.01）。在手术时间、术中出血量、总住院时间及住院总费用上两组间差异无统计学意义（P〉0.05）。结论对位于肝脏边缘、右肝表面或左半肝的恶性肿瘤,行LH是可行和安全的。     

Echinococcal cyst of the seminal vesicles: A case-report and literature review

Solitary echinococcal cysts of the seminalvesicles are very uncommon. The use ofultrasonography, computed tomography andmagnetic resonance imaging aids considerably inthe differential diagnosis. Surgical removal ofpelvic echinococcal cysts should be performedwith great caution to avoid accidental punctureand parasite spillage in the retroperitonealspace. We report on a case of a male patientpresenting with urinary retention owing to alarge hydatid cyst of the seminal vesicles. Theliterature regarding this rare clinical entityis also reviewed.     

剩余肝体积不足的晚期肝泡型包虫外科治疗进展

剩余肝体积(RLV)不足是肝切除术后肝功能衰竭和患者死亡的主要原因.肝泡型包虫(HAE)常侵及肝内外重要血管,致使功能肝段的保留极为困难,根治性切除率低.尽管离体肝切除联合自体肝移植术(ERAT)极大拓宽了晚期HAE手术指征,但RLV不足仍是限制HAE根治性切除的主要因素.近年来,包括分期肝切除、肝静脉支架置入序贯ER...     

Primary hydatid cyst of the breast: A case report

We describe herein the rare case of a hydatid cyst found in the breast of a 26-year-old woman. Clinically, the mass was at first suspected of being a fibroadenoma, but fine needle aspiration cytology (FNAC) yielded clear fluid only. Histopathologic examination of the resected speciman confirmed that it was a hydatid cyst.     

腹腔镜肝癌切除术61例疗效分析

目的 探讨腹腔镜肝癌切除术的可行性及疗效.方法 对2002年11月至2007年6月行完全腹腔镜下肝癌切除术的61例患者进行可行性及疗效分析,其中男性49例,女性12例,年龄14～71岁,平均46.7岁.所有病例均经B超、CT或磁共振成像及甲胎蛋白(AFP)等诊断为原发性肝癌.结果 其中有56例患者腹腔镜肝癌切除术获得成功,5例因术中出血中转开腹肝癌切除术.腹腔镜肝癌切除术手术时间30～150 min,平均60 min,术中出血量100～2000 ml,平均450 ml.术中阻断肝门15～30 min,平均20 min,术后无并发症发生.术后24 h均能下床活动,术后1～3 d即能进食.术后住院5～10 d,平均6.6 d.结论 对位于肝脏边缘、右肝表面或左半肝的恶性肿瘤,采用肝门阻断器阻断肝门后行腹腔镜肝癌切除是可行和安全的.     

肝泡型包虫病根治性切除163例回顾性分析

目的:探讨肝泡型包虫病根治性切除的治疗效果。方法:回顾性分析2013年1月—至2015年6月163例行根治性切除肝泡型包虫病患者的临床资料。结果:根治性手术平均时间(3.1±1.2)h,术中出血量(763±498)m L。术后携带腹腔引流管中位时间6 d,11例携带T管,术后1个月拔除。术后平均肛门排气时间(2.1±0.8)d、经口进食时间(2.7±1.1)d、住院时间(7.9±3.4)d。8例出现术后并发症,其中5例术后胆瘘,1例术区感染,2例术后腹水。术后电话或门诊随访1~6个月无死亡及包虫复发情况。结论:根治性切除是当前肝泡型包虫病患者的首选治疗方案。术前充分评估手术可行性,术中充分掌握肝脏血流控制、肝脏外科解剖、门静脉重建、胆管重建等技术,通过根治性手术切除可明显改善泡型包虫病患者的生存质量,延长患者的生存时间。