BACKGROUND The NOD-like receptor family pyrin domain-containing 3(NLRP3)inflammasome is a significant component of the innate immune system that plays a vital role in the development of various parasitic diseases.Howe...BACKGROUND The NOD-like receptor family pyrin domain-containing 3(NLRP3)inflammasome is a significant component of the innate immune system that plays a vital role in the development of various parasitic diseases.However,its role in hepatic alveolar echinococcosis(HAE)remains unclear.AIM To investigate the NLRP3 inflammasome and its mechanism of activation in HAE.METHODS We assessed the expression of NLRP3,caspase-1,interleukin(IL)-1β,and IL-18 in the marginal zone and corresponding normal liver of 60 patients with HAE.A rat model of HAE was employed to investigate the role of the NLRP3 inflammasome in the marginal zone of HAE.Transwell experiments were conducted to investigate the effect of Echinococcus multilocularis(E.multilocularis)in stimulating Kupffer cells and hepatocytes.Furthermore,immunohistochemistry,Western blotting,and enzyme-linked immunosorbent assay were used to evaluate NLRP3,caspase-1,IL-1β,and IL-18 expression;flow cytometry was used to detect apoptosis and reactive oxygen species(ROS).RESULTS NLRP3 inflammasome activation was significantly associated with ROS.Inhibition of ROS production decreased NLRP3-caspase-1-IL-1βpathway activation and mitigated hepatocyte damage and inflammation.CONCLUSION E.multilocularis induces hepatocyte damage and inflammation by activating the ROS-mediated NLRP3-caspase-1-IL-1βpathway in Kupffer cells,indicating that ROS may serve as a potential target for the treatment of HAE.展开更多
BACKGROUND Hepatic alveolar echinococcosis(HAE)is a serious zoonotic infection that affects humans.It may have a tumor-like appearance at times.Percutaneous treatment of HAE patients is extremely relaxing for them.HAE...BACKGROUND Hepatic alveolar echinococcosis(HAE)is a serious zoonotic infection that affects humans.It may have a tumor-like appearance at times.Percutaneous treatment of HAE patients is extremely relaxing for them.HAE is a significant human zoonotic infection caused by the fox tapeworm Echinococcus Multilocularis larvae.It possesses the characteristics of an invasive tumor-like lesion due to its infiltrative growth pattern and protracted incubation period.The disease is endemic over central Europe,Asia,and North America.AIM To characterize HAE patients who were treated percutaneously,their outcomes,and the major technical features of percutaneous treatment in HAE.METHODS Patients who were treated with percutaneous cyst drainage and/or percutaneous biliary drainage were included in the study.Uncorrected abnormal coagulation values and solid or non-infected HAE with minor necrotic change were excluded.RESULTS Thirty-two patients underwent percutaneous cyst drainage,two patients underwent percutaneous biliary drainage,and four patients underwent percutaneous biliary drainage alone.Interventional radiology is utilized to drain echinococcal necrosis and abscesses within/without the liver,as well as diseased and clogged bile ducts.CONCLUSION Percutaneous drainage of cyst contents and/or biliary channels using a minimally invasive technique is a very beneficial.Percutaneous cyst drainage with albendazole therapy improves quality of life in patients who are unable to undergo surgery,even when the mass resolves with long-term treatment.展开更多
AIM: To evaluate the reliability and accuracy of threedimensional(3D) reconstruction for liver resection in patients with hepatic alveolar echinococcosis(HAE).METHODS: One-hundred and six consecutive patients with HAE...AIM: To evaluate the reliability and accuracy of threedimensional(3D) reconstruction for liver resection in patients with hepatic alveolar echinococcosis(HAE).METHODS: One-hundred and six consecutive patients with HAE underwent hepatectomy at our hospital between May 2011 and January 2015. Fifty-nine patients underwent preoperative 3D reconstruction and "virtual" 3D liver resection before surgery(Group A). Another 47 patients used conventional imaging methods for preoperative assessment(Group B). Outcomes of hepatectomy were compared between the two groups.RESULTS: There was no significant difference in preoperative data between the two groups. Compared with patients in Group B, those in Group A had a significantly shorter operation time(227.1 ± 51.4 vs 304.6 ± 88.1 min; P < 0.05), less intraoperative blood loss(308.1 ± 135.4 vs 458.1 ± 175.4 m L; P < 0.05), and lower requirement for intraoperative blood transfusion(186.4 ± 169.6 vs 289.4 ± 199.2 m L; P < 0.05). Estimated resection liver volumes in bothgroups had good correlation with actual graft weight(Group A: r = 0.978; Group B: r = 0.960). There was a significant higher serum level of albumin in Group A(26.3 ± 5.9 vs 22.6 ± 4.3 g/L, P < 0.05). Other postoperative laboratory parameters(serum levels of aminotransferase and bilirubin; prothrombin time) and duration of postoperative hospital stay were similar. Sixteen complications occurred in Group A and 19 in Group B. All patients were followed for 3-46(mean, 17.3) mo. There was no recurrence of lesions in Group A, but two recurrences in Group B. There were three deaths: two from cerebrovascular accident, and one from car accident.CONCLUSION: 3D reconstruction provides comprehensive and precise anatomical information for the liver. It also improves the chance of success and reduces the risk of hepatectomy in HAE.展开更多
AIM: To establish a computed tomography(CT)-morphological classification for hepatic alveolar echinococcosis was the aim of the study. METHODS: The CT morphology of hepatic lesions in 228 patients with confirmed alveo...AIM: To establish a computed tomography(CT)-morphological classification for hepatic alveolar echinococcosis was the aim of the study. METHODS: The CT morphology of hepatic lesions in 228 patients with confirmed alveolar echinococcosis(AE) drawn from the Echinococcus Databank of the University Hospital of Ulm was reviewed retrospectively. For this reason, CT datasets of combined positron emission tomography(PET)-CT examinations were evaluated. The diagnosis of AE was made in patientswith unequivocal seropositivity; positive histological findings following diagnostic puncture or partial resection of the liver; and/or findings typical for AE at either ultrasonography, CT, magnetic resonance imaging or PET-CT. The CT-morphological findings were grouped into the new classification scheme.RESULTS: Within the classification a lesion was dedicated to one out of five "primary morphologies" as well as to one out of six "patterns of calcification". "primary morphology" and "pattern of calcification" are primarily focussed on separately from each other and combined, whereas the "primary morphology" V is not further characterized by a "pattern of calcification". Based on the five primary morphologies, further descriptive sub-criteria were appended to types Ⅰ-Ⅲ. An analysis of the calcification pattern in relation to the primary morphology revealed the exclusive association of the central calcification with type Ⅳ primary morphology. Similarly, certain calcification patterns exhibited a clear predominance for other primary morphologies, which underscores the delimitation of the individual primary morphological types from each other. These relationships in terms of calcification patterns extend into the primary morphological sub-criteria, demonstrating the clear subordination of those criteria.CONCLUSION: The proposed CT-morphological classification(EMUC-CT) is intended to facilitate the recognition and interpretation of lesions in hepatic alveolar echinococcosis. This could help to interpret different clinical courses better and shall assist in the context of scientific studies to improve the comparability of CT findings.展开更多
The effectiveness of liver autotransplantation for patients with partial hepatic alveolar echinococcosis was analyzed.We retrospectively studied 6 patients with hepatic alveolar echinococcosis who underwent liver auto...The effectiveness of liver autotransplantation for patients with partial hepatic alveolar echinococcosis was analyzed.We retrospectively studied 6 patients with hepatic alveolar echinococcosis who underwent liver autotransplantation in our hospital from 2008 to 2010.We also summarized the surgical indications of liver autotransplantation for hepatic alveolar echinococcosis and our experience in the management of postoperative complications of liver autotransplantation.Of 6 patients,5 achieved good curative results,and one died of multiple organ failure caused by portal vein thrombosis.Main complications included postoperative bleeding,bile leak and small-for-size liver graft syndrome.Liver autotransplantation offers a new approach to cure hepatic alveolar echinococcosis with non-resectable lesions.It could be the most effective method to cure intractable hepatic alveolar echinococcosis if correct handling in operation and proper prevention of complications are performed.But the long-term outcomes are still needed to be confirmed in longer follow-up.展开更多
AIM: To establish an ultrasonographic classification based on a large sample of patients with confirmed hepatic alveolar echinococcosis(AE).METHODS: Clinical data and ultrasonography(US) findings of 185 patients(100 m...AIM: To establish an ultrasonographic classification based on a large sample of patients with confirmed hepatic alveolar echinococcosis(AE).METHODS: Clinical data and ultrasonography(US) findings of 185 patients(100 males; 85 females; mean age at diagnosis: 51.4 ± 17.6 years; mean age at time of US examination: 58.7 ± 18.2 years) were retrospectively reviewed with respect to the US morphology of hepatic AE lesions. The sonomorphological findings were grouped according to a five-part classification scheme.RESULTS: Application of the new classification resulted in the following distribution of sonomorphological patterns among the patients examined: hailstorm(54.1%); pseudocystic(13.5%); ossification(13.0%); hemangioma-like(8.1%); and metastasis-like(6.5%). Only 4.9% of lesions could not be assigned to a sonomorphological pattern.CONCLUSION: The sonomorphological classification proposed in the present study facilitates the diagnosis,interpretation and comparison of hepatic alveolar echinococcosis in routine practice and in the context of scientific studies.展开更多
Background: The University of Wisconsin (UW) and histidine-tryptophan-ketoglutarate (HTK) solutions are the two most frequently used liver graft preservation fluids. The present study aimed to compare their efficacy i...Background: The University of Wisconsin (UW) and histidine-tryptophan-ketoglutarate (HTK) solutions are the two most frequently used liver graft preservation fluids. The present study aimed to compare their efficacy in end-stage hepatic alveolar echinococcosis patients who underwent ex-situ liver resection and autotransplantation (ELRA). Methods: A total of 81 patients received ELRA from August 2010 to March 2018. They were allocated into UW ( n = 48) and HTK groups ( n = 33) based on the type of solutions used. Demographic and operational data were retrospectively analyzed. Primary outcomes included 90-day mortality, incidence of early graft loss, primary dysfunction, and postoperative complications. Results: Demographic and operational characteristics were similarly distributed in the two groups. No statistically significant differences were observed with regard to 90-day mortality (12.77% vs. 12.12%) and early graft loss rate (8.51% vs. 9.09%) between the two groups. Patients in the UW and HTK groups showed a primary dysfunction rate of 27.66% and 27.27%, respectively. The UW group exhibited a higher incidence tendency of biliary complications, albeit with no statistical significance. Conclusions: This is the largest cohort study comparing the efficacy of the UW and HTK organ-preserving solutions in end-stage hepatic alveolar echinococcosis patients in ELRA settings. UW and HTK solutions presented similar efficacy and safety. A randomized clinical trial with larger scale is needed for further investigation in future clinical applications.展开更多
BACKGROUND Hepatic alveolar echinococcosis(AE)is most commonly found in retrohepatic inferior vena cava(RHIVC).Ex vivo liver resection and autotransplantation(ELRA)can better realize the radical resection of end-stage...BACKGROUND Hepatic alveolar echinococcosis(AE)is most commonly found in retrohepatic inferior vena cava(RHIVC).Ex vivo liver resection and autotransplantation(ELRA)can better realize the radical resection of end-stage hepatic AE with severely compromised hepatocaval confluences,and reconstruction of the affected vessels.Currently,there is a scarcity of information regarding RHIVC reconstruction in ELRA.AIM To propose reasonable RHICV reconstruction strategies for ex vivo liver resection and autotransplantation.METHODS We retrospectively summarized the clinical data of 114 patients diagnosed with hepatic AE who treated by ELRA in our department.A total of 114 patients were divided into three groups according to the different reconstruction methods of RHIVC:Group A with original RHIVC being repaired and reconstructed(n=64),group B with RHIVC being replaced(n=43),and group C with RHIVC being resected without reconstruction(n=7).The clinical data of patients,including the operation time,anhepatic phase,intraoperative blood loss,complications and postoperative hospital stay,were analyzed and the patients were routinely followed up.The normally distributed continuous variables were expressed as means±SD,whereas the abnormally distributed ones were expressed as median and analyzed by analysis of variance.Survival curve was plotted by the Kaplan-Meier method.RESULTS All patients were routinely followed up for a median duration of 52(range,12-125)mo.The 30 d mortality rate was 7.0%(8/114)and 7 patients died within 90 d.Among all subjects,the inferior vena cava(IVC)-related complication rates were 17.5%(11/63)in group A and 16.3%(7/43)in group B.IVC stenosis was found in 12 patients(10.5%),whereas thrombus was formed in 6 patients(5.3%).Twenty-two patients had grade III or higher complications,with the complication rates being 17.2%,16.3%,and 57.1%in the three groups.The average postoperative hospital stay in the three groups was 32.3±19.8,26.7±18.2,and 51.3±29.4 d(P=0.03),respectively.CONCLUSION ELRA can be considered a safe and feasible option for end-stage hepatic AE patients with RHIVC infiltration.The RHIVC reconstruction methods should be selected appropriately depending on the defect degree of AE lesions in IVC lumen.The RHIVC resection without any reconstruction method should be considered with caution.展开更多
We read the article titled,“Long-term follow-up of liver alveolar echinococcosis using echinococcosis multilocularis ultrasound classification,”by Schuhbaur J with great interest.However,we found some worthwhile iss...We read the article titled,“Long-term follow-up of liver alveolar echinococcosis using echinococcosis multilocularis ultrasound classification,”by Schuhbaur J with great interest.However,we found some worthwhile issues that we believe should be discussed with the authors,and have provided our comments in this letter.It would be valuable if the authors could provide further information about the clinical stages,follow-up time,and clinical outcomes of the patients.展开更多
Objective:To assess the role of debulking surgery in extensive hepatic alveolar echinococcosis(HAE).Methods:Five cases of extensive HAE undergoing debulking surgery with their long-term follow-ups were reported.Additi...Objective:To assess the role of debulking surgery in extensive hepatic alveolar echinococcosis(HAE).Methods:Five cases of extensive HAE undergoing debulking surgery with their long-term follow-ups were reported.Additionally,a systematic review was carried out.Results:The average age of patients in the study was(50.8±17.1)years(range 36 to 77 years).Three cases were female.The median follow-up period was 61 months(range 12 to 84 months).Left liver resections were performed in 2 cases and right hemihepatectomies were undertaken in 2 cases.Two patients(cases 2 and 4)developed early surgical complications,while one of them(case 4)who suffered from the recurrent sub-hepatic abscess died at 12 months postoperatively.Conclusions:This study highlights the importance of debulking surgery for the management of complex symptomatic HAE lesions in patients with no curative option available.展开更多
Alveolar echinococcosis(AE) of the liver is caused by the metacestode of the fox tapeworm Echinococcus multilocularis(E. multilocularis), which is endemic in many parts of the world. AE is a very aggressive and potent...Alveolar echinococcosis(AE) of the liver is caused by the metacestode of the fox tapeworm Echinococcus multilocularis(E. multilocularis), which is endemic in many parts of the world. AE is a very aggressive and potentially fatal infestation which always affects the liver primarily and metastasizes to any part of the body. Without timely diagnosis and therapy, the prognosis is dismal, with death the eventual outcome in most cases. Diagnosis is usually based on findings at radiological imaging and in serological analyses. The alveolar cysts grow by exogenous proliferation and behave like a malignant neoplasm. Since AE lesions can occur almost anywhere in the body, familiarity with the spectrum of cross-sectional imaging appearances is advantageous. Therefore, AE lesions can cause physicians to generate a long list of differential diagnoses, including malignant tumors. Disseminated parasitic lesions in unusual locations with atypical imaging appearances may make it difficult to narrow the differential diagnosis. For diagnosis, ultrasonography(US) remains the first line examination. For a more accurate disease evaluation, aiming to guide the surgical strategy, computed tomography(CT), magnetic resonance imaging(MRI), including magnetic resonance cholangiography(MRC) imaging, are of importance, providing useful complementary information. However, making the correct diagnosis is possible if imaging findings are correlated with appropriate clinical findings. We present an overview of the radiological patterns produced by E. multilocularis lesions as seen on US, CT and MRI and discuss the interventional procedures in hepatic AE lesions.展开更多
BACKGROUND Hepatic cystic and alveolar echinococcosis coinfections,particularly with concurrent abscesses and sinus tract formation,are extremely rare.This article presents a case of a patient diagnosed with this uniq...BACKGROUND Hepatic cystic and alveolar echinococcosis coinfections,particularly with concurrent abscesses and sinus tract formation,are extremely rare.This article presents a case of a patient diagnosed with this unique presentation,discussing the typical imaging manifestations of both echinococcosis types and detailing the diagnosis and surgical treatment experience thereof.CASE SUMMARY A 39-year-old Tibetan woman presented with concurrent hepatic cystic and alveolar echinococcosis,accompanied by abdominal wall abscesses and sinus tract formation.Initial conventional imaging examinations suggested only hepatic cystic echinococcosis,but intraoperative and postoperative pathological examination revealed the coinfection.Following radical resection of the lesions,the patient’s condition improved,and she was discharged soon thereafter.Subsequent outpatient follow-ups confirmed no recurrence of the hydatid lesion and normal surgical wound healing.Though mixed hepatic cystic and alveolar echinococcosis with abdominal wall abscesses and sinus tract formations are rare,the general treatment approach remains consistent with that of simpler infections of alveolar echinococcosis.CONCLUSION Lesions involving the abdominal wall and sinus tract formation,may require radical resection.Long-term prognosis includes albendazole and follow-up examinations.展开更多
BACKGROUND Some hydatid cysts of cystic echinococcosis type 1(CE1)lack well-defined cyst walls or distinctive endocysts,making them difficult to differentiate from simple hepatic cysts.AIM To investigate the diagnosti...BACKGROUND Some hydatid cysts of cystic echinococcosis type 1(CE1)lack well-defined cyst walls or distinctive endocysts,making them difficult to differentiate from simple hepatic cysts.AIM To investigate the diagnostic methods for atypical hepatic CE1 and the clinical efficacy of laparoscopic surgeries.METHODS The clinical data of 93 patients who had a history of visiting endemic areas of CE and were diagnosed with cystic liver lesions for the first time at the People's Hospital of Xinjiang Uygur Autonomous Region(China)from January 2018 to September 2023 were retrospectively analyzed.Clinical diagnoses were made based on findings from serum immunoglobulin tests for echinococcosis,routine abdominal ultrasound,high-frequency ultrasound,abdominal computed tomography(CT)scan,and laparoscopy.Subsequent to the treatments,these patients underwent reexaminations at the outpatient clinic until October 2023.The evaluations included the diagnostic precision of diverse examinations,the efficacy of surgical approaches,and the incidence of CE recurrence.RESULTS All 93 patients were diagnosed with simple hepatic cysts by conventional abdominal ultrasound and abdominal CT scan.Among them,16 patients were preoperatively diagnosed with atypical CE1,and 77 were diagnosed with simple hepatic cysts by high-frequency ultrasound.All the 16 patients preoperatively diagnosed with atypical CE1 underwent laparoscopy,of whom 14 patients were intraoperatively confirmed to have CE1,which was consistent with the postoperative pathological diagnosis,one patient was diagnosed with a mesothelial cyst of the liver,and the other was diagnosed with a hepatic cyst combined with local infection.Among the 77 patients who were preoperatively diagnosed with simple hepatic cysts,4 received aspiration sclerotherapy of hepatic cysts,and 19 received laparoscopic fenestration.These patients were intraoperatively diagnosed with simple hepatic cysts.During the followup period,none of the 14 patients with CE1 experienced recurrence or implantation of hydatid scolices.One of the 77 patients was finally confirmed to have CE complicated with implantation to the right intercostal space.CONCLUSION Abdominal high-frequency ultrasound can detect CE1 hydatid cysts.The laparoscopic technique serves as a more effective diagnostic and therapeutic tool for CE.展开更多
BACKGROUND The main endemic areas of alveolar echinococcosis(AE)are in Central Europe and Western China.Both the infiltration of intrahepatic vascular and bile duct structures as well as extrahepatic disease can lead ...BACKGROUND The main endemic areas of alveolar echinococcosis(AE)are in Central Europe and Western China.Both the infiltration of intrahepatic vascular and bile duct structures as well as extrahepatic disease can lead to further complications and may increase morbidity in patients with AE.AIM To evaluate vascular/biliary involvement in hepatic AE and its distant extrahepatic disease manifestations in an international collective was the aim.METHODS Consecutively,five experienced examiners evaluated contrast-enhanced abdominal computed tomography(CT)scans for 200 patients with hepatic AE of each of four locations(n=50)in Germany,France and China.Therefore,we retrospectively included the 50 most recent abdominal contrast-enhanced CT examinations at each center,performed because of hepatic AE from September 21,2007 to March 21,2018.AE liver lesions were classified according to the echinococcosis multilocularis Ulm classification for CT(EMUC-CT).Distant extrahepatic manifestations were documented either by whole body positron emission tomography–CT or with the addition of thoracic CT and cranial magnetic resonance imaging.Vascular/biliary involvement of the hepatic disease as well as the presence of distant extrahepatic manifestations were correlated with the EMUC-CT types of liver lesion.Statistical analysis was performed using SAS Version 9.4(SAS Institute Inc.,Cary,NC,United States).RESULTS Distant extrahepatic AE manifestations were significantly more frequent in China than in Europe(P=0.0091).A significant relationship was found between the presence of distant extrahepatic disease and AE liver lesion size(P=0.0075).Vascular/biliary structures were involved by the liver lesions significantly more frequently in China than in Europe(P<0.0001),and vascular/biliary involvement depended on lesion size.Different morphological types of AE liver lesions led to varying frequencies of vascular/biliary involvement and were associated with different frequencies of distant extrahepatic manifestations:Vascular/biliary involvement as a function of lesions primary morphology ranged from 5.88%of type IV liver lesions to 100%among type III lesions.Type IV differed significantly in these associations from types I,II,and III(P<0.0001).With respect to extrahepatic disease,the primary morphology types IV and V of liver lesions were not associated with any case of distant extrahepatic disease.In contrast,distant extrahepatic manifestations in types I–III were found to varying degrees,with a maximum of 22%for type III.CONCLUSION Different CT morphological patterns of hepatic AE lesions influence vascular/biliary involvement and the occurrence of distant extrahepatic manifestations.There are intercontinental differences regarding the characteristics of AE manifestation.展开更多
To the Editor:Alveolar echinococcosis(AE),caused by infection with Echinococcus multilocularis,is regarded as the most dangerous parasitic zoonosis in the temperate climate zones of the northern hemisphere,particularl...To the Editor:Alveolar echinococcosis(AE),caused by infection with Echinococcus multilocularis,is regarded as the most dangerous parasitic zoonosis in the temperate climate zones of the northern hemisphere,particularly across Central Europe and large parts of North-/Central Asia.Left untreated,AE has a very high mortality rate.The liver is the organ most commonly affected showing complex,often infiltrative lesions.When lesions cannot be resected in curative intention,long-term parasitostatic pharmacotherapy with benzimidazoles is indicated to inhibit further extension.[1]展开更多
To the Editor:Hepatic alveolar echinococcosis(AE)is a lethal infectious disease caused by the larval stage Echinococcus multilocularis(E.multilocularis)and exhibits low prevalence in endemic areas with high morbidity ...To the Editor:Hepatic alveolar echinococcosis(AE)is a lethal infectious disease caused by the larval stage Echinococcus multilocularis(E.multilocularis)and exhibits low prevalence in endemic areas with high morbidity and mortality.AE lesions invading the hepato-caval confluence,including main hepatic veins and retro-hepatic inferior vena cava(IVC),may result in Budd-Chiari Syndrome(BCS),which was a severe complication of AE presented with abdominal pain,ascites,and hepatomegaly.In this study,we reported a case of chronic BCS caused by hepatic AE and summarized the therapeutic method of left trisectionectomy and supra-hepatic IVC replacement with prosthetic grafts.展开更多
Echinococcosis is a zoonotic parasitic disease caused by Escherichia larvae.It frequently involves the liver(70%-75%),followed by the lungs(15%-20%),and occasionally the brain,heart,spleen,bone,and other organs.The ma...Echinococcosis is a zoonotic parasitic disease caused by Escherichia larvae.It frequently involves the liver(70%-75%),followed by the lungs(15%-20%),and occasionally the brain,heart,spleen,bone,and other organs.The main pathogenic forms of human echinococcosis currently include cystic echinococcosis(CE)and alveolar echinococcosis(AE).CE is globally distributed,while the distribution of AE is generally restricted to the northern hemisphere.In China,CE accounts for 75%of all echinococcosis cases.With rapid advances in surgical techniques in recent decades,the surgical strategy for CE has changed,especially with the continuous improvement of surgical methods and the expansion of surgical contraindications.To further understand the changes in surgical treatment strategies for hepatic CE,we interpreted and analyzed the existing literature addressing the surgical treatment of hepatic CE both domestically and abroad and briefly summarized them in chronological order.This review aims to provide a deeper understanding of the progress in the surgical treatment of hepatic CE to provide clearer avenues for its clinical diagnosis and treatment.展开更多
BACKGROUND Mixed infection of hepatic cystic and alveolar echinococcosis is extremely rare.This article reveals the typical imaging manifestations of cystic and alveolar echinococcosis and investigates the diagnosis a...BACKGROUND Mixed infection of hepatic cystic and alveolar echinococcosis is extremely rare.This article reveals the typical imaging manifestations of cystic and alveolar echinococcosis and investigates the diagnosis and surgical experience of mixed infection of hepatic cystic and alveolar echinococcosis.CASE SUMMARY From January 2017 to May 2019,4 cases with rare mixed infection of hepatic cystic and alveolar echinococcosis were admitted and treated by the Division of General Surgery of Qinghai Provincial People’s Hospital.Three of the patients occasionally had upper abdominal discomfort,but it did not affect their daily lives.However,hepatic echinococcosis was found in one patient by physical examination,and the patient had no discomfort.All 4 cases were Tibetans who had lived in pastoral areas of southern Qinghai for a long time.Enzyme-linked immunosorbent assay for echinococcosis was positive for all patients.Moreover,abdominal computed tomography showed typical imaging manifestations of cystic and alveolar echinococcosis including coexisting"honeycomb sign,"and"spotted calcification."Three of the patients underwent radical resection,and 1 case underwent palliative resection.All 4 patients developed different types of surgical complications after the operation,but all of them recovered and were discharged after symptomatic treatment.CONCLUSION There are no problems diagnosing mixed infection of hepatic cystic and alveolar echinococcosis.The difficulties involve preoperative evaluation and treatment of surgical complications.展开更多
基金Supported by the National Major Research and Development Project of“Precision Medicine Research”,No.2017YFC0909900Qinghai Province Science and Technology Department Programme,No.2019-SF-131the Qinghai Province Health and Family Planning Commission Programme,No.2016-wjzd-04.
文摘BACKGROUND The NOD-like receptor family pyrin domain-containing 3(NLRP3)inflammasome is a significant component of the innate immune system that plays a vital role in the development of various parasitic diseases.However,its role in hepatic alveolar echinococcosis(HAE)remains unclear.AIM To investigate the NLRP3 inflammasome and its mechanism of activation in HAE.METHODS We assessed the expression of NLRP3,caspase-1,interleukin(IL)-1β,and IL-18 in the marginal zone and corresponding normal liver of 60 patients with HAE.A rat model of HAE was employed to investigate the role of the NLRP3 inflammasome in the marginal zone of HAE.Transwell experiments were conducted to investigate the effect of Echinococcus multilocularis(E.multilocularis)in stimulating Kupffer cells and hepatocytes.Furthermore,immunohistochemistry,Western blotting,and enzyme-linked immunosorbent assay were used to evaluate NLRP3,caspase-1,IL-1β,and IL-18 expression;flow cytometry was used to detect apoptosis and reactive oxygen species(ROS).RESULTS NLRP3 inflammasome activation was significantly associated with ROS.Inhibition of ROS production decreased NLRP3-caspase-1-IL-1βpathway activation and mitigated hepatocyte damage and inflammation.CONCLUSION E.multilocularis induces hepatocyte damage and inflammation by activating the ROS-mediated NLRP3-caspase-1-IL-1βpathway in Kupffer cells,indicating that ROS may serve as a potential target for the treatment of HAE.
文摘BACKGROUND Hepatic alveolar echinococcosis(HAE)is a serious zoonotic infection that affects humans.It may have a tumor-like appearance at times.Percutaneous treatment of HAE patients is extremely relaxing for them.HAE is a significant human zoonotic infection caused by the fox tapeworm Echinococcus Multilocularis larvae.It possesses the characteristics of an invasive tumor-like lesion due to its infiltrative growth pattern and protracted incubation period.The disease is endemic over central Europe,Asia,and North America.AIM To characterize HAE patients who were treated percutaneously,their outcomes,and the major technical features of percutaneous treatment in HAE.METHODS Patients who were treated with percutaneous cyst drainage and/or percutaneous biliary drainage were included in the study.Uncorrected abnormal coagulation values and solid or non-infected HAE with minor necrotic change were excluded.RESULTS Thirty-two patients underwent percutaneous cyst drainage,two patients underwent percutaneous biliary drainage,and four patients underwent percutaneous biliary drainage alone.Interventional radiology is utilized to drain echinococcal necrosis and abscesses within/without the liver,as well as diseased and clogged bile ducts.CONCLUSION Percutaneous drainage of cyst contents and/or biliary channels using a minimally invasive technique is a very beneficial.Percutaneous cyst drainage with albendazole therapy improves quality of life in patients who are unable to undergo surgery,even when the mass resolves with long-term treatment.
基金Supported by National Natural Science Foundation of China,No.81160201 and No.U1303222
文摘AIM: To evaluate the reliability and accuracy of threedimensional(3D) reconstruction for liver resection in patients with hepatic alveolar echinococcosis(HAE).METHODS: One-hundred and six consecutive patients with HAE underwent hepatectomy at our hospital between May 2011 and January 2015. Fifty-nine patients underwent preoperative 3D reconstruction and "virtual" 3D liver resection before surgery(Group A). Another 47 patients used conventional imaging methods for preoperative assessment(Group B). Outcomes of hepatectomy were compared between the two groups.RESULTS: There was no significant difference in preoperative data between the two groups. Compared with patients in Group B, those in Group A had a significantly shorter operation time(227.1 ± 51.4 vs 304.6 ± 88.1 min; P < 0.05), less intraoperative blood loss(308.1 ± 135.4 vs 458.1 ± 175.4 m L; P < 0.05), and lower requirement for intraoperative blood transfusion(186.4 ± 169.6 vs 289.4 ± 199.2 m L; P < 0.05). Estimated resection liver volumes in bothgroups had good correlation with actual graft weight(Group A: r = 0.978; Group B: r = 0.960). There was a significant higher serum level of albumin in Group A(26.3 ± 5.9 vs 22.6 ± 4.3 g/L, P < 0.05). Other postoperative laboratory parameters(serum levels of aminotransferase and bilirubin; prothrombin time) and duration of postoperative hospital stay were similar. Sixteen complications occurred in Group A and 19 in Group B. All patients were followed for 3-46(mean, 17.3) mo. There was no recurrence of lesions in Group A, but two recurrences in Group B. There were three deaths: two from cerebrovascular accident, and one from car accident.CONCLUSION: 3D reconstruction provides comprehensive and precise anatomical information for the liver. It also improves the chance of success and reduces the risk of hepatectomy in HAE.
文摘AIM: To establish a computed tomography(CT)-morphological classification for hepatic alveolar echinococcosis was the aim of the study. METHODS: The CT morphology of hepatic lesions in 228 patients with confirmed alveolar echinococcosis(AE) drawn from the Echinococcus Databank of the University Hospital of Ulm was reviewed retrospectively. For this reason, CT datasets of combined positron emission tomography(PET)-CT examinations were evaluated. The diagnosis of AE was made in patientswith unequivocal seropositivity; positive histological findings following diagnostic puncture or partial resection of the liver; and/or findings typical for AE at either ultrasonography, CT, magnetic resonance imaging or PET-CT. The CT-morphological findings were grouped into the new classification scheme.RESULTS: Within the classification a lesion was dedicated to one out of five "primary morphologies" as well as to one out of six "patterns of calcification". "primary morphology" and "pattern of calcification" are primarily focussed on separately from each other and combined, whereas the "primary morphology" V is not further characterized by a "pattern of calcification". Based on the five primary morphologies, further descriptive sub-criteria were appended to types Ⅰ-Ⅲ. An analysis of the calcification pattern in relation to the primary morphology revealed the exclusive association of the central calcification with type Ⅳ primary morphology. Similarly, certain calcification patterns exhibited a clear predominance for other primary morphologies, which underscores the delimitation of the individual primary morphological types from each other. These relationships in terms of calcification patterns extend into the primary morphological sub-criteria, demonstrating the clear subordination of those criteria.CONCLUSION: The proposed CT-morphological classification(EMUC-CT) is intended to facilitate the recognition and interpretation of lesions in hepatic alveolar echinococcosis. This could help to interpret different clinical courses better and shall assist in the context of scientific studies to improve the comparability of CT findings.
文摘The effectiveness of liver autotransplantation for patients with partial hepatic alveolar echinococcosis was analyzed.We retrospectively studied 6 patients with hepatic alveolar echinococcosis who underwent liver autotransplantation in our hospital from 2008 to 2010.We also summarized the surgical indications of liver autotransplantation for hepatic alveolar echinococcosis and our experience in the management of postoperative complications of liver autotransplantation.Of 6 patients,5 achieved good curative results,and one died of multiple organ failure caused by portal vein thrombosis.Main complications included postoperative bleeding,bile leak and small-for-size liver graft syndrome.Liver autotransplantation offers a new approach to cure hepatic alveolar echinococcosis with non-resectable lesions.It could be the most effective method to cure intractable hepatic alveolar echinococcosis if correct handling in operation and proper prevention of complications are performed.But the long-term outcomes are still needed to be confirmed in longer follow-up.
文摘AIM: To establish an ultrasonographic classification based on a large sample of patients with confirmed hepatic alveolar echinococcosis(AE).METHODS: Clinical data and ultrasonography(US) findings of 185 patients(100 males; 85 females; mean age at diagnosis: 51.4 ± 17.6 years; mean age at time of US examination: 58.7 ± 18.2 years) were retrospectively reviewed with respect to the US morphology of hepatic AE lesions. The sonomorphological findings were grouped according to a five-part classification scheme.RESULTS: Application of the new classification resulted in the following distribution of sonomorphological patterns among the patients examined: hailstorm(54.1%); pseudocystic(13.5%); ossification(13.0%); hemangioma-like(8.1%); and metastasis-like(6.5%). Only 4.9% of lesions could not be assigned to a sonomorphological pattern.CONCLUSION: The sonomorphological classification proposed in the present study facilitates the diagnosis,interpretation and comparison of hepatic alveolar echinococcosis in routine practice and in the context of scientific studies.
基金supported by grants from Xinjiang Uyghur Autonomous Region Key Laboratory Open Research Program(No.2018D03002)the National Natural Science Foundation of China(No.81560329)+1 种基金Xinjiang Uyghur Autonomous Region Key Scientific Research Program(No.201430123–2)State Key Laboratory of Pathogenesis,Prevention,Treatment of High Incidence Diseases in Central Asia Fund(No.SKL-HIDCA-2017-Y2)
文摘Background: The University of Wisconsin (UW) and histidine-tryptophan-ketoglutarate (HTK) solutions are the two most frequently used liver graft preservation fluids. The present study aimed to compare their efficacy in end-stage hepatic alveolar echinococcosis patients who underwent ex-situ liver resection and autotransplantation (ELRA). Methods: A total of 81 patients received ELRA from August 2010 to March 2018. They were allocated into UW ( n = 48) and HTK groups ( n = 33) based on the type of solutions used. Demographic and operational data were retrospectively analyzed. Primary outcomes included 90-day mortality, incidence of early graft loss, primary dysfunction, and postoperative complications. Results: Demographic and operational characteristics were similarly distributed in the two groups. No statistically significant differences were observed with regard to 90-day mortality (12.77% vs. 12.12%) and early graft loss rate (8.51% vs. 9.09%) between the two groups. Patients in the UW and HTK groups showed a primary dysfunction rate of 27.66% and 27.27%, respectively. The UW group exhibited a higher incidence tendency of biliary complications, albeit with no statistical significance. Conclusions: This is the largest cohort study comparing the efficacy of the UW and HTK organ-preserving solutions in end-stage hepatic alveolar echinococcosis patients in ELRA settings. UW and HTK solutions presented similar efficacy and safety. A randomized clinical trial with larger scale is needed for further investigation in future clinical applications.
文摘BACKGROUND Hepatic alveolar echinococcosis(AE)is most commonly found in retrohepatic inferior vena cava(RHIVC).Ex vivo liver resection and autotransplantation(ELRA)can better realize the radical resection of end-stage hepatic AE with severely compromised hepatocaval confluences,and reconstruction of the affected vessels.Currently,there is a scarcity of information regarding RHIVC reconstruction in ELRA.AIM To propose reasonable RHICV reconstruction strategies for ex vivo liver resection and autotransplantation.METHODS We retrospectively summarized the clinical data of 114 patients diagnosed with hepatic AE who treated by ELRA in our department.A total of 114 patients were divided into three groups according to the different reconstruction methods of RHIVC:Group A with original RHIVC being repaired and reconstructed(n=64),group B with RHIVC being replaced(n=43),and group C with RHIVC being resected without reconstruction(n=7).The clinical data of patients,including the operation time,anhepatic phase,intraoperative blood loss,complications and postoperative hospital stay,were analyzed and the patients were routinely followed up.The normally distributed continuous variables were expressed as means±SD,whereas the abnormally distributed ones were expressed as median and analyzed by analysis of variance.Survival curve was plotted by the Kaplan-Meier method.RESULTS All patients were routinely followed up for a median duration of 52(range,12-125)mo.The 30 d mortality rate was 7.0%(8/114)and 7 patients died within 90 d.Among all subjects,the inferior vena cava(IVC)-related complication rates were 17.5%(11/63)in group A and 16.3%(7/43)in group B.IVC stenosis was found in 12 patients(10.5%),whereas thrombus was formed in 6 patients(5.3%).Twenty-two patients had grade III or higher complications,with the complication rates being 17.2%,16.3%,and 57.1%in the three groups.The average postoperative hospital stay in the three groups was 32.3±19.8,26.7±18.2,and 51.3±29.4 d(P=0.03),respectively.CONCLUSION ELRA can be considered a safe and feasible option for end-stage hepatic AE patients with RHIVC infiltration.The RHIVC reconstruction methods should be selected appropriately depending on the defect degree of AE lesions in IVC lumen.The RHIVC resection without any reconstruction method should be considered with caution.
文摘We read the article titled,“Long-term follow-up of liver alveolar echinococcosis using echinococcosis multilocularis ultrasound classification,”by Schuhbaur J with great interest.However,we found some worthwhile issues that we believe should be discussed with the authors,and have provided our comments in this letter.It would be valuable if the authors could provide further information about the clinical stages,follow-up time,and clinical outcomes of the patients.
文摘Objective:To assess the role of debulking surgery in extensive hepatic alveolar echinococcosis(HAE).Methods:Five cases of extensive HAE undergoing debulking surgery with their long-term follow-ups were reported.Additionally,a systematic review was carried out.Results:The average age of patients in the study was(50.8±17.1)years(range 36 to 77 years).Three cases were female.The median follow-up period was 61 months(range 12 to 84 months).Left liver resections were performed in 2 cases and right hemihepatectomies were undertaken in 2 cases.Two patients(cases 2 and 4)developed early surgical complications,while one of them(case 4)who suffered from the recurrent sub-hepatic abscess died at 12 months postoperatively.Conclusions:This study highlights the importance of debulking surgery for the management of complex symptomatic HAE lesions in patients with no curative option available.
文摘Alveolar echinococcosis(AE) of the liver is caused by the metacestode of the fox tapeworm Echinococcus multilocularis(E. multilocularis), which is endemic in many parts of the world. AE is a very aggressive and potentially fatal infestation which always affects the liver primarily and metastasizes to any part of the body. Without timely diagnosis and therapy, the prognosis is dismal, with death the eventual outcome in most cases. Diagnosis is usually based on findings at radiological imaging and in serological analyses. The alveolar cysts grow by exogenous proliferation and behave like a malignant neoplasm. Since AE lesions can occur almost anywhere in the body, familiarity with the spectrum of cross-sectional imaging appearances is advantageous. Therefore, AE lesions can cause physicians to generate a long list of differential diagnoses, including malignant tumors. Disseminated parasitic lesions in unusual locations with atypical imaging appearances may make it difficult to narrow the differential diagnosis. For diagnosis, ultrasonography(US) remains the first line examination. For a more accurate disease evaluation, aiming to guide the surgical strategy, computed tomography(CT), magnetic resonance imaging(MRI), including magnetic resonance cholangiography(MRC) imaging, are of importance, providing useful complementary information. However, making the correct diagnosis is possible if imaging findings are correlated with appropriate clinical findings. We present an overview of the radiological patterns produced by E. multilocularis lesions as seen on US, CT and MRI and discuss the interventional procedures in hepatic AE lesions.
基金Supported by National Natural Science Foundation of China,No.82260412.
文摘BACKGROUND Hepatic cystic and alveolar echinococcosis coinfections,particularly with concurrent abscesses and sinus tract formation,are extremely rare.This article presents a case of a patient diagnosed with this unique presentation,discussing the typical imaging manifestations of both echinococcosis types and detailing the diagnosis and surgical treatment experience thereof.CASE SUMMARY A 39-year-old Tibetan woman presented with concurrent hepatic cystic and alveolar echinococcosis,accompanied by abdominal wall abscesses and sinus tract formation.Initial conventional imaging examinations suggested only hepatic cystic echinococcosis,but intraoperative and postoperative pathological examination revealed the coinfection.Following radical resection of the lesions,the patient’s condition improved,and she was discharged soon thereafter.Subsequent outpatient follow-ups confirmed no recurrence of the hydatid lesion and normal surgical wound healing.Though mixed hepatic cystic and alveolar echinococcosis with abdominal wall abscesses and sinus tract formations are rare,the general treatment approach remains consistent with that of simpler infections of alveolar echinococcosis.CONCLUSION Lesions involving the abdominal wall and sinus tract formation,may require radical resection.Long-term prognosis includes albendazole and follow-up examinations.
文摘BACKGROUND Some hydatid cysts of cystic echinococcosis type 1(CE1)lack well-defined cyst walls or distinctive endocysts,making them difficult to differentiate from simple hepatic cysts.AIM To investigate the diagnostic methods for atypical hepatic CE1 and the clinical efficacy of laparoscopic surgeries.METHODS The clinical data of 93 patients who had a history of visiting endemic areas of CE and were diagnosed with cystic liver lesions for the first time at the People's Hospital of Xinjiang Uygur Autonomous Region(China)from January 2018 to September 2023 were retrospectively analyzed.Clinical diagnoses were made based on findings from serum immunoglobulin tests for echinococcosis,routine abdominal ultrasound,high-frequency ultrasound,abdominal computed tomography(CT)scan,and laparoscopy.Subsequent to the treatments,these patients underwent reexaminations at the outpatient clinic until October 2023.The evaluations included the diagnostic precision of diverse examinations,the efficacy of surgical approaches,and the incidence of CE recurrence.RESULTS All 93 patients were diagnosed with simple hepatic cysts by conventional abdominal ultrasound and abdominal CT scan.Among them,16 patients were preoperatively diagnosed with atypical CE1,and 77 were diagnosed with simple hepatic cysts by high-frequency ultrasound.All the 16 patients preoperatively diagnosed with atypical CE1 underwent laparoscopy,of whom 14 patients were intraoperatively confirmed to have CE1,which was consistent with the postoperative pathological diagnosis,one patient was diagnosed with a mesothelial cyst of the liver,and the other was diagnosed with a hepatic cyst combined with local infection.Among the 77 patients who were preoperatively diagnosed with simple hepatic cysts,4 received aspiration sclerotherapy of hepatic cysts,and 19 received laparoscopic fenestration.These patients were intraoperatively diagnosed with simple hepatic cysts.During the followup period,none of the 14 patients with CE1 experienced recurrence or implantation of hydatid scolices.One of the 77 patients was finally confirmed to have CE complicated with implantation to the right intercostal space.CONCLUSION Abdominal high-frequency ultrasound can detect CE1 hydatid cysts.The laparoscopic technique serves as a more effective diagnostic and therapeutic tool for CE.
基金Supported by a German Research Foundation funded project called“Establishment of a national database for alveolar echinococcosis”,No.KA 4356/3-1“Implementation of interfaces for the standardization of nationaldatabase systems for alveolar echinococcosis and its transformation processes”,No.KR 5204/1-2+1 种基金Multiple imaging study of the Hepatic Alveolar Echinococcosis after albendazole treatment,the Qinghai Science and Technology Department,No.2017-SF-158and the Müller Holding Ltd.and Co.KG Ulm.
文摘BACKGROUND The main endemic areas of alveolar echinococcosis(AE)are in Central Europe and Western China.Both the infiltration of intrahepatic vascular and bile duct structures as well as extrahepatic disease can lead to further complications and may increase morbidity in patients with AE.AIM To evaluate vascular/biliary involvement in hepatic AE and its distant extrahepatic disease manifestations in an international collective was the aim.METHODS Consecutively,five experienced examiners evaluated contrast-enhanced abdominal computed tomography(CT)scans for 200 patients with hepatic AE of each of four locations(n=50)in Germany,France and China.Therefore,we retrospectively included the 50 most recent abdominal contrast-enhanced CT examinations at each center,performed because of hepatic AE from September 21,2007 to March 21,2018.AE liver lesions were classified according to the echinococcosis multilocularis Ulm classification for CT(EMUC-CT).Distant extrahepatic manifestations were documented either by whole body positron emission tomography–CT or with the addition of thoracic CT and cranial magnetic resonance imaging.Vascular/biliary involvement of the hepatic disease as well as the presence of distant extrahepatic manifestations were correlated with the EMUC-CT types of liver lesion.Statistical analysis was performed using SAS Version 9.4(SAS Institute Inc.,Cary,NC,United States).RESULTS Distant extrahepatic AE manifestations were significantly more frequent in China than in Europe(P=0.0091).A significant relationship was found between the presence of distant extrahepatic disease and AE liver lesion size(P=0.0075).Vascular/biliary structures were involved by the liver lesions significantly more frequently in China than in Europe(P<0.0001),and vascular/biliary involvement depended on lesion size.Different morphological types of AE liver lesions led to varying frequencies of vascular/biliary involvement and were associated with different frequencies of distant extrahepatic manifestations:Vascular/biliary involvement as a function of lesions primary morphology ranged from 5.88%of type IV liver lesions to 100%among type III lesions.Type IV differed significantly in these associations from types I,II,and III(P<0.0001).With respect to extrahepatic disease,the primary morphology types IV and V of liver lesions were not associated with any case of distant extrahepatic disease.In contrast,distant extrahepatic manifestations in types I–III were found to varying degrees,with a maximum of 22%for type III.CONCLUSION Different CT morphological patterns of hepatic AE lesions influence vascular/biliary involvement and the occurrence of distant extrahepatic manifestations.There are intercontinental differences regarding the characteristics of AE manifestation.
基金The results included data from a German Research Foundation(DFG)funded project called“Establishment of a national database for alveolar echinococcosis”(Ref.No.KA 4356/3-1)“Implementation of interfaces to unify national database systems for alveolar echinococcosis and its transformation processes”(Ref.No.KR 5204/1-2).
文摘To the Editor:Alveolar echinococcosis(AE),caused by infection with Echinococcus multilocularis,is regarded as the most dangerous parasitic zoonosis in the temperate climate zones of the northern hemisphere,particularly across Central Europe and large parts of North-/Central Asia.Left untreated,AE has a very high mortality rate.The liver is the organ most commonly affected showing complex,often infiltrative lesions.When lesions cannot be resected in curative intention,long-term parasitostatic pharmacotherapy with benzimidazoles is indicated to inhibit further extension.[1]
文摘To the Editor:Hepatic alveolar echinococcosis(AE)is a lethal infectious disease caused by the larval stage Echinococcus multilocularis(E.multilocularis)and exhibits low prevalence in endemic areas with high morbidity and mortality.AE lesions invading the hepato-caval confluence,including main hepatic veins and retro-hepatic inferior vena cava(IVC),may result in Budd-Chiari Syndrome(BCS),which was a severe complication of AE presented with abdominal pain,ascites,and hepatomegaly.In this study,we reported a case of chronic BCS caused by hepatic AE and summarized the therapeutic method of left trisectionectomy and supra-hepatic IVC replacement with prosthetic grafts.
基金the Qinghai Province Talent Action Plan of KunlunNational Natural Science Foundation of China,No.82260412+2 种基金Basic Research Project of Qinghai Province,No.2020-wjzdx-27Qinghai Province 2022 Innovation Platform Construction Special Project,No.2022-ZJ-T01High-end Innovative Talent Project of Kunlun Talents of Qinghai Province in 2021.
文摘Echinococcosis is a zoonotic parasitic disease caused by Escherichia larvae.It frequently involves the liver(70%-75%),followed by the lungs(15%-20%),and occasionally the brain,heart,spleen,bone,and other organs.The main pathogenic forms of human echinococcosis currently include cystic echinococcosis(CE)and alveolar echinococcosis(AE).CE is globally distributed,while the distribution of AE is generally restricted to the northern hemisphere.In China,CE accounts for 75%of all echinococcosis cases.With rapid advances in surgical techniques in recent decades,the surgical strategy for CE has changed,especially with the continuous improvement of surgical methods and the expansion of surgical contraindications.To further understand the changes in surgical treatment strategies for hepatic CE,we interpreted and analyzed the existing literature addressing the surgical treatment of hepatic CE both domestically and abroad and briefly summarized them in chronological order.This review aims to provide a deeper understanding of the progress in the surgical treatment of hepatic CE to provide clearer avenues for its clinical diagnosis and treatment.
文摘BACKGROUND Mixed infection of hepatic cystic and alveolar echinococcosis is extremely rare.This article reveals the typical imaging manifestations of cystic and alveolar echinococcosis and investigates the diagnosis and surgical experience of mixed infection of hepatic cystic and alveolar echinococcosis.CASE SUMMARY From January 2017 to May 2019,4 cases with rare mixed infection of hepatic cystic and alveolar echinococcosis were admitted and treated by the Division of General Surgery of Qinghai Provincial People’s Hospital.Three of the patients occasionally had upper abdominal discomfort,but it did not affect their daily lives.However,hepatic echinococcosis was found in one patient by physical examination,and the patient had no discomfort.All 4 cases were Tibetans who had lived in pastoral areas of southern Qinghai for a long time.Enzyme-linked immunosorbent assay for echinococcosis was positive for all patients.Moreover,abdominal computed tomography showed typical imaging manifestations of cystic and alveolar echinococcosis including coexisting"honeycomb sign,"and"spotted calcification."Three of the patients underwent radical resection,and 1 case underwent palliative resection.All 4 patients developed different types of surgical complications after the operation,but all of them recovered and were discharged after symptomatic treatment.CONCLUSION There are no problems diagnosing mixed infection of hepatic cystic and alveolar echinococcosis.The difficulties involve preoperative evaluation and treatment of surgical complications.
