Laparoscopic treatment of hydatid liver cysts

Laparoscopic hepatic hydatidectomy (LHE) was performed in 37 patients. Conversion to laparotomy in one case was caused by intrahepatic location of liver cyst. In 36 patients after LHE, the postoperative period was significantly easier than after standard operation. There were the following complications: bile efflux in abdominal cavity (1), bile efflux from residual cavity (2), suppuration of residual cavity (1). The complications were removed without laparotomy, all the patients recovered. The patients were discharged on day 5.6 on the average. LHE is a promising method of surgical treatment for uncomplicated liver echinococcosis.     

Enzymology of the liver in hydatidosis

A research has been conducted studying the enzyme system of the liver using biopsy material of the organ taken during the operation from patients with echinococcosis and an experiment with infantile white mice. It is proved reduction of the activity of the alkaline and acid phosphatase as well as of the glycogen along with their progressive reduction during the disease progression. Compared with the other researches--histological and by electronic microscope, etc.--there are proved great hepatic damages due to the echinococcosis that have caused change of the treatment tactics: large preoperative period, including reconstructions of the glycogenic depot in the organ, gentle to the liver anesthesia, exact postoperative reanimation. Very good results have been obtained concerning the postoperative complications and operative mortality: observing the developed acute liver insufficiency--in the past the mortality has been 27.60% throughout 2.49% of the operated patients; after those measures the acute liver insufficiency after this kind of operation is seen just once (0.40% of the patients) and the mortality is 0.     

A clinical dilemma: cardiac and pericardiac echinococcosis.

BACKGROUND: Cardiac and pericardial echinococcosis as a life-threatening disease may present with a clear picture most of the time, however it may also become a clinical puzzle. METHODS: In the period between 1977 and 1998, 14 patients were operated on with the diagnosis of cardiac and pericardial echinococcosis. Nine patients were operated on with standard cardiopulmonary bypass (CPB) techniques, and the remaining 5 patients were operated on without CPB. Transesophageal echocardiography (TEE) or intraoperative surface echocardiography were used to plan and perform the operation for the late cases. RESULTS: One patient died during the postoperative period due to the rupture of interventricular septum. All other patients survived the perioperative period, received mebendazole treatment, and exhibited no recurrence during the follow-up. CONCLUSIONS: The definitive treatment is the surgical extraction of the cyst. Because the clinical picture may vary according to the number, size, and location of cysts, as well as complications, cardiac echinococcosis should be remembered and included in the differential diagnosis to achieve the treatment. Intraoperative surface echocardiography is of paramount value for diagnosis and planning the management of a successful surgery.     

Treatment of hydatid echinococcosis of liver

Experience of surgical treatment of 373 patients with echinococcosis of liver is analyzed. Traditional surgeries were performed in 342 patients. Postoperative lethality was 1.46%, number of specific postoperative complications -- 12.5%. In long-term period recurrence was revealed in 18 (6.8%) of 264 examined patients. In 9 years after surgery residual cavities were diagnosed in 33 (9.64%) patients. Recovery was achieved in 93% patients. Experience of treatment of 31 patients with echinococcosis of liver with puncture methods (PAIR, PEVAC) was also analyzed. There were no lethal outcomes, severe complications and recurrences of disease during 2 years of follow-up. It is concluded that puncture method may be regarded as alternative for traditional surgical treatment, but it require further study.     

Video endoscopy of the residual cavity in hydatidectomy of the liver

Results of treatment of 162 patients with echinococcosis of the liver were analyzed. Traditional surgical treatment of these patients was followed by endovideoscopy of the residual cavity of the liver. During endovideoscopy of the residual cavities the remnants of the chitinous membranes and small daughter vesicles not noticed during the open stage of the operation were removed in 7.4% of the patients, in 25.9% of the patients cystobiliary fistulas were detected. The endovideoscopy considerably improves revision of the residual cavities of the liver and facilitates liquidation of cystobiliary fistulas which gives better results of the treatment of such patients.     

肝包虫外囊完整剥除术在肝包虫病手术治疗中的价值

目的 探讨肝包虫外囊完整剥除术在肝包虫手术治疗中的价值。方法 对223例肝包虫病患者手术情况进行回顾性分析,分为囊肿切除组（98例）与保留外囊组（125例）;囊肿切除组又分外囊切除组（87例）与肝叶部分切除组（11例）。观察指标为术后平均住院日、术中出血量、残腔并发症发生率及原位复发率等。结果 囊肿切除组术后残腔并发症发生率及原位复发率均低于保留外囊组（P〈0．01）。外囊切除组的术中出血量及住院天数均低于肝叶部分切除组（P〈0．01）。结论 肝包虫外囊完整剥除术可有效降低术后残腔并发症的发生率及原位复发率,在治疗肝包虫病的手术中是一种首选的合理术式。     

Treatment of multiple and associated bilateral echinococcosis of the lungs and liver

The peculiarities of one-stage echinococcotomy in 7 patients with multiple and combined bilateral echinococcosis of the lungs and liver are discussed. The operation is carried out by two surgical teams who work simultaneously except for the interval of time from the moment that the pleural cavity is opened to the removal of the pneumothorax, in which period the surgeons work in turns.     

Diagnostics and surgical treatment of liver echinococcosis in Latvia

The results of treatment of 44 patients (during the period 1996 - 2010) with liver echinococcosis (LE) were analysed. Echinococcosis hydatid (EH) cyst was found in 15 patients, alveolar echinococcosis (AE)--in 29 patients, 11.3% of cases were asymptomatical, different clinical symptoms were found in 36.4% of patients and 52.3% of patients were admited due to severe complications. Surgical treatment was performed in 41 patients. Among 15 patients with hydatid liver cyst 3--underwent liver resection, 8--pericystechinococcectomy, 4--guided percutaneous treatment--PAIR. No complications or recurrences were noted. Radical operations were performed in 12 patients with AE (41.3%), 11 of them had asymptomatical or noncomplicated disease. Recurrence appeared in one patient (8.3%). Nonradical or palliative operations due to AE complications were performed in 15 patients (51.7%). Complication at the postoperative periods occurred in 17% of patients with AE and lethality rate came to 3.4%. The diagnosis made at the early asymptomatic state and the following selection of combination of surgical approach and medicamental treatment (albendazol) can improve the results of treatment of patients with liver echinococcosis.     

Surgical approach in bilateral and combined echinococcosis of the lung

One hundred and two patients aged from 4 to 65 years with echinococcosis were treated. Solitary cysts in both lungs were diagnosed in 69 patients, multiple cysts -- in 33 patients. In 10 cases small and middle cysts were in the upper parts of both lungs. These patients underwent one-stage operation consisting in lateral thoracotomy, removing of the cyst from one lung, incision of retrosternal mediastinal pleura, removing of the cyst from the second lung, drainage of pleural cavity. Fifteen patients with combined echinococcosis of the upper lobe of the right lung and liver were operated with another one-stage surgical method through thoracotomy in the third and sixth or seventh intercostal space. These methods are characterized by low traumaticity, decreased number of postoperative complications and hospital stay.     

Surgical tactics in associated echinococcosis of the liver and lung]

Over 10 years operations were conducted in 28 patients with hydatid disease with concurrent involvement of the liver and lungs, which accounted for 5.76% of all patients with hydatid disease of the thoracic and abdominal organs. The following variants were encountered: uncomplicated echinococcosis of the right lung and right hepatic lobe (13 patients); uncomplicated echinococcosis of the left lung and liver (3); suppurative hydatid cyst of the liver with rupture into the pleural cavity and the development of pyothorax (9); rupture of a hepatic hydatid cyst into the bronchial tree of the right lung with the development of a cysto-bronchial fistula (3 patients). In the group of 28 patients with concurrent involvement of the liver and lung 18 were operated on through a thoraco-phreno-laparotomic approach, 9 through a transpleural approach, and one patient underwent a two-stage operation. The success of the treatment is determined by early recognition of the concurrent echinococcosis and the choice of the optimal surgical tactics. One-stage echinococcotomy from the liver and lung is the operation of choice in concurrent affection of the liver and right lung.     

肝囊型包虫破裂的外科治疗110例

目的 分析肝囊型包虫破裂外科手术治疗方式的演变及其对患者预后的影响.方法 回顾性分析1990年1月至2008年12月外科手术治疗的肝囊型包虫破裂110例,按不同手术综合处理方法分为3组;A组22例:内囊摘除+甲醛或双氧水局部杀虫+残腔锁边缝合或大网膜填塞或残腔内翻缝合引流;B组65例:内囊摘除+高渗盐水局部杀虫+外囊肝外部分切除+残腔胆漏缝合+残腔开放引流;C组23例:外囊全部或次全剥除+高渗盐水局部杀虫+术区引流.分析3种外科综合手术治疗方式的效果.结果术后A组、B组、C组残腔并发症发生率分别为40.9%、16.9%、0.0%(P<0.05),复发率分别为18.2%、4.6%、0.0%(P<0.05);带管引流时间A组>B组>C组;手术耗时及术中出血量,A组、B组均低于C组,B组与A组相比无明显差别;高渗盐水腹腔处理后包虫腹腔种植率低于单纯生理盐水处理组,差异无统计学意义.结论 外囊全部或次全剥除+高渗盐水局部杀虫+术区引流的处理方式是目前最佳的治疗肝囊型包虫破裂的外科方法.     

Surgical treatment of suppurative hydatid echinococcosis of the liver]

Among 140 patients with hydatid echinococcosis of the liver complications were noted in 58 cases: suppuration of the cyst - in 38 (27.1%), cyst rupture in the anterior abdominal wall and abdominal cavity - in 4 (2.8%), in bile ducts - in 10 (7.1%), its rupture into the right lung lower lobe, calcification of the cyst was noted in 4 patients (2.8%). It is concluded that open echinococcotomy with partial excision of the fibrous capsule and drainage of the residual cavity with a rubber tube seem to be the most effective operation for suppurative echinococcosis of the liver.     

根治性全囊肿切除术治疗肝包虫病

目的 探讨根治性全囊肿切除手术在临床上治疗肝囊性包虫病的体会及治疗价值.方法 回顾分析近6年来开展的根治性全囊肿切除手术治疗肝囊性包虫病的临床资料86例,并与随机抽样的90例传统内囊摘除手术病例加以比较,观察其术后住院天数、腹腔引流天数、残腔置管天数、残腔积液、残腔感染、胆汁漏,原位复发率等临床指标.结果 根治性全囊肿切除手术治疗肝囊性包虫病,其手术彻底、安全,平均住院天数及腹腔引流天数明显少于传统内囊摘除术组(分别t=7.9915,59.86,均P＜0.001),且术后无胆漏、残腔积液、残腔感染、原位复发率等并发症发生,疗效显著.结论 根治性全囊肿切除手术其术后无残腔并发症、原位复发率发生,术后住院天数明显减少.是目前治疗肝囊性包虫病的一种比较理想的新的根治方法.     

Associated lesions of the liver by amebiasis and echinococcosis

Diagnosis and treatment of combined damage to the liver by echinococcosis and amebiasis were analyzed in 36 patients. The clinical picture in this combination depends on the phase, localization and sizes of a focal lesion. The authors consider ultrasound to be a basic diagnostic method that clarifies the nature of the contents of cavities, which will aid in making a correct diagnosis. The examination of liver function and its correction are required in the preoperative period. The authors consider omentoplasty to be the operation of choice for uncomplicated echinococcosis. It is necessary to drain an abscess residual cavity it the umbilical vein is catheterized.     

Assessment of the surgical approaches in liver hydatid disease

Surgery has major role in liver echinococcosis. Different types of operation techniques are being analyzed in the complicated and uncomplicated forms of the disease. The less traumatic closed methods are preferred, as the best results have been the modified operation of Lagro and Coria by bonding the veil with BTG on fibrous plate. In the yeast echinococcosis with best result has been the half-closed method with permanent lavage of the residual cavity. Different complications and behavior have been interpreted. There are offers in the surgery of the uncomplicated echinococcosis to introduced resection of the convex dome with application through pulverization of tissue glue on the remaining fibrosis. Theoretical advantages proved this method.     

腹腔镜治疗肝包虫病术中关键技术探讨

目的探讨腹腔镜肝包虫内囊摘除术关键技术要点.方法对56例肝包虫病患者行腹腔镜肝包虫内囊摘除术,术中常规采用3%过氧化氢溶液纱条保护、特制套管穿刺吸引器冲洗吸引、20%高渗盐水二次灭活和残腔探查.结果56例均获成功,无一例中转开腹,手术时间45～150 min,平均60 min,术中出血量10～120 ml,平均70 ml.无并发症.56例随访1～12年,平均2年6个月,无肝包虫复发.结论3%过氧化氢溶液纱条保护、特制套管穿刺吸引器冲洗吸引、20%高渗盐水二次灭活和残腔探查处理技术的应用是手术成功的关键.     

The diagnosis and surgical treatment of hydatid disease of the liver in children

An experience with the diagnosis and surgical treatment of hydatid disease of the liver included 191 patients aged from 2 through 15 years, 26 of them had a combined involvement of the liver and lung, in 7 patients there were combined lesions with other organs. Complicated echinococcosis was noted in 25 children. Ultrasonography was given the main role in the diagnosis. Videolaparoscopic hydatidectomy of the liver was performed in 62 patients. Solitary cysts of small and medium sizes located superficially were considered as indications to operation. In patients with large and gigantic cysts of special significance was capitonnage of the residual cavity. Use of albendazole as an antiparasitic agent for the recurrent disease and a prophylactic agent after operation for multiple and combined hydatid disease of the liver was found to be sufficiently effective.     

Surgical treatment of multiple pulmonary echinoccocosis]

Clinical observations concerning the surgical treatment of multiple pulmonary echinococcosis in 54 patients are set forth in the paper. Various surgical interventions were carried out upon 46 patients: 16--for unilateral multiple echinicoccosis, 30--for bilateral multiple echinococcosis; in 8 patients pulmonary echinococcosis was combined with liver injury. From the authors' experience the surgical treatment of multiple pulmonary echinococcosis is an effective method. Good clinico-roentgenologic results were found in 44 out of 46 patients operated upon. 2 patients died from cardio-pulmonary insufficiency in the early postoperative period.     

非典型CE1型肝囊型包虫病的诊断及腹腔镜治疗体会

目的:探讨非典型CE1型肝囊型包虫病的有效诊断方法及腹腔镜手术的临床疗效。方法:回顾性分析2018年6月至2019年6月新疆维吾尔自治区人民医院收治的17例非典型CE1型肝囊型包虫患者临床资料,其中男性11例,女性6例,年龄(46.0±21.6)岁,均有畜牧区接触史。术前完善包虫免疫实验、腹部超声、腹部CT检查,行腹腔...     

“减体积式病灶肝切除”治疗晚期肝巨大泡型包虫病的临床应用

目的:探讨"减体积式病灶肝切除"治疗晚期巨大肝泡型包虫病的有效性及临床应用价值。方法:分析2010年8月—2011年2月4例难以常规根治性切除的巨大肝泡型包虫病行"减体积式病灶肝切除"患者的临床资料。手术前对病人全面评估,严格掌握手术适应证和手术时机,术中精细操作,术后均给予口服阿苯达唑(ABZ)抗包虫治疗。结果:4例患者手术顺利进行,手术历时中位时间267.5 min(210~320 min),术中出血量中位数737.5 mL(600~950 mL),术中输注红细胞悬液中位数4.0 U(2~6 U)。术后随访中位时间10.0个月(8~14个月),仅1例患者出现残腔胆瘘,1例患者出现残腔积液。患者梗阻性黄疸、下肢水肿均消失,未发生患者病灶肝内转移或死亡。结论:"减体积式病灶肝切除"为难以根治性治疗的晚期巨大肝泡型包虫病患者提供了可行性技术路径。术前严格掌握手术适应证和手术时机,术后规律服用抗包虫药物是防治HAE复发和转移的有效方法。