BACKGROUND Alveolar and cystic echinococcoses are lethal zoonotic diseases caused by Echinococcus multilocularis and Echinococcus granulosus infections,leading to alveolar echinococcosis(AE)or cystic echinococcosis(CE...BACKGROUND Alveolar and cystic echinococcoses are lethal zoonotic diseases caused by Echinococcus multilocularis and Echinococcus granulosus infections,leading to alveolar echinococcosis(AE)or cystic echinococcosis(CE),respectively.No study has hitherto reported effective treatment approaches for AE or CE with concurrent hepatorenal involvement.AIM To investigate the feasibility and efficacy of simultaneous combined surgery(SCS)as a comprehensive treatment approach for patients with hepatorenal echinococcosis.METHODS Clinical datasets of hepatorenal AE(n=10)and CE(n=11)patients were retrospectively collected and systematically analyzed.The SCS approach was introduced,and surgical outcomes,complications,and prognoses were documented in detail.RESULTS The SCS approach incorporated hybridized techniques,including partial hepatectomy,partial or total nephrectomy,ex vivo liver resection and autotransplantation,and total or subtotal cystectomy with endocystectomy.Radical SCS was achieved in 100%of AE patients and 63.6%of CE patients.All surgeries were completed without intraoperative complications.The short-term complication rate was 28.6%(Clavien-Dindo classification:AE-1 IIIb,3 IIIa;CE-2 II),while the long-term complication rate was 4.8%(Clavien-Dindo classification:AE-1 IIIb).Patients were followed up for a median of 37 months(AE:6-81 months;CE:34-123 months),with no reported deaths or disease relapses.CONCLUSION CS appears to be a feasible and effective treatment method for patients with hepatorenal involvement of AE or CE.It fulfills the management criteria for advanced AE or CE cases,aiming to maximize patient benefits.展开更多
BACKGROUND Hepatic alveolar echinococcosis(HAE)is a chronic parasitic disease caused by the larval stage of Echinococcus multilocularis.Although significant research has been conducted on the pathogenesis and immunolo...BACKGROUND Hepatic alveolar echinococcosis(HAE)is a chronic parasitic disease caused by the larval stage of Echinococcus multilocularis.Although significant research has been conducted on the pathogenesis and immunological aspects of HAE,comprehensive bibliometric analyses in this area are still lacking.This study sought to fill this gap by systematically analyzing the immunological literature on HAE using bibliometric methods.AIM To identify research trends,key contributors,and emerging developments and offer insights to guide future research in this field.METHODS Research articles on HAE published between 1983 and 2023 were retrieved from the Web of Science Core Collection database.A total of 319 articles were selected for bibliometric analysis,which was conducted using the CiteSpace and VOSviewer software.The analysis focused on key variables such as publication volume,authors,journals,countries,references,and keywords.RESULTS The analysis revealed a significant increase in research on HAE over the past four decades,particularly after 1995.China and Switzerland emerged as the leading countries in terms of publication volume,with Bruno Gottstein and Vuitton DA identified as the most influential authors in this field.Key research areas include the interaction between the pathogen and the host immune system,as well as advances in disease diagnosis and treatment strategies.The keyword co-occurrence analysis highlighted the primary themes and identified emerging trends within the research landscape.CONCLUSION This study provides a comprehensive framework for understanding HAE immunology and highlights research hotspots,future directions,key contributors,and the importance of international cooperation.展开更多
Echinococcosis or hydatid disease is induced mainly by Echinococcus granulosus and occasionally by Echinococcus multilocularis(alveolaris)and affects the liver predominantly.Hepatic alveolar echinococcosis is similar ...Echinococcosis or hydatid disease is induced mainly by Echinococcus granulosus and occasionally by Echinococcus multilocularis(alveolaris)and affects the liver predominantly.Hepatic alveolar echinococcosis is similar to carcinoma in appearance,and without treatment,it can lead to death.Diagnosis is based on current imaging modalities.Surgical management is the cornerstone of treatment.Complete removal of the cyst(total pericystectomy or hepatectomy)ensures a permanent cure and should be the first-choice treatment for cystic disease.Cyst evacuation,partial cystectomy,and drainage or omentoplasty,may be alternative choices in difficult cases.Albendazole,mebendazole and praziquantel are options for treating small cysts and preventing recurrence after surgery.Despite the efforts,alveolar echinococcus is not usually amenable to surgical management,except in the early stage,which is less common,and management by albendazole is indicated.However,there are few recent reports of major operations(ex-vivo hepatectomy,autotransplantation and vascular reconstruction)in advanced stages.展开更多
BACKGROUND Liver hydatid cysts(LHC)liver requires effective surgical treatment.Open closed total pericystectomy removes the entire echinococcus cyst while preserving healthy liver tissue.AIM To evaluate the outcomes o...BACKGROUND Liver hydatid cysts(LHC)liver requires effective surgical treatment.Open closed total pericystectomy removes the entire echinococcus cyst while preserving healthy liver tissue.AIM To evaluate the outcomes of pericystectomy and its efficacy as a treatment modality for cystic echinococcosis(CE).METHODS Thirty-eight patients were analyzed after open total pericystectomy at the University Hospital of Cologne between January 2006 and January 2024.Demographic,clinical,and laboratory parameters were collected retrospectively.Intraoperative data and postoperative complications were documented and classified using the Clavien-Dindo classification.Throughout the follow-up period,patients underwent regular clinical,serological,and sonographic evaluations both at the outpatient department and by their general physicians.RESULTS Fifty-four cysts were treated with open total pericystectomy.Multiple cysts were found in 42.2%of cases.Singular cysts occurred in 57.8%.The right hepatic lobe was affected in 66.7%.Ectopic cysts occurred in 4 patients in the lung(n=3)and spleen(n=1).Median cyst size was 6.78 cm×5.92 cm(range:1.4-20.0 cm).The median surgical time of pericystectomy was 189 minutes(range:78-455 minutes)with a median blood loss of 400 mL(range:100-1400 mL).The complication rate(Clavien-Dindo>III)was 21.1%.The average hospital stay was 12.5 days.No recurrent disease could be detected after a median follow-up time of 97 months(range:4-216 months).No recurrent cyst manifestation,postoperative liver failure or death was observed.CONCLUSION The presented surgical procedure known as open total pericystectomy is a safe surgical technique in treatment of cystic echinococcosis.展开更多
Echinococcosis or hydatid disease （HD） is a zoonosis caused by the larval stages of taeniid cestodes belong- ing to the genus Echinococcus. Hepatic echinococcosis is a life-threatening disease, mainly differentiated...Echinococcosis or hydatid disease （HD） is a zoonosis caused by the larval stages of taeniid cestodes belong- ing to the genus Echinococcus. Hepatic echinococcosis is a life-threatening disease, mainly differentiated into alveolar and cystic forms, associated with Echinoc- cus multilocularis （E. multi/ocular/s） and Echinococcus granulosus （E. granulosus） infection, respectively. Cys- tic echinococcosis （CE） has a worldwide distribution, while hepatic alveolar echinococcosis （AE） is endemic in the Northern hemisphere, including North America and several Asian and European countries, like France, Germany and Austria. E. granulosus young cysts are spherical, unilocular vesicles, consisting of an internal germinal layer and an outer acellular layer. Cyst expansion is associated with a host immune reaction and the subsequent development of a fibrous layer, called the per/cyst; old cysts typically present internal septa- tions and daughter cysts. E. multilocularis has a tumor-like, infiltrative behavior, which is responsible for tissue destruction and finally for liver failure. The liver is the main site of HD involvement, for both alveolar and cystic hydatidosis. HD is usually asymptomatic for a long period of time, because cyst growth is commonly slow; the most frequent symptoms are fatigue and abdominal pain. Patients may also present jaundice, hepatomegaly or anaphylaxis, due to cyst leakage or rupture. HD diagnosis is usually accomplished with the combined use of ultrasonography and immunodiagnosis; furthermore, the improvement of surgical techniques, the introduction of minimally invasive treatments [such as puncture, aspiration, injection, re-aspiration （PAIR）] and more effective drugs （such as benzoimidazoles） have deeply changed life expectancy and quality of life of patients with HD. The aim of this article is to provide an up-to-date review of biological, diagnostic, clinical and therapeutic aspects of hepatic echinococcosis.展开更多
This paper deals with all aspects of liver alveolar echinococcosis (AE) including epidemiology, pathology, clinical manifestations, imaging examinations, diagnosis and differential diagnosis, surgical treatment and ch...This paper deals with all aspects of liver alveolar echinococcosis (AE) including epidemiology, pathology, clinical manifestations, imaging examinations, diagnosis and differential diagnosis, surgical treatment and chemotherapy.The review is not only based on personal clinical experiences but also in combination with relative basic research such as proliferation and growth of alveococcus, preclinical studies of a novel compound extracted from TCM for treatment of liver AE, and molecular immunology used for specific AE diagnosis, etc.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 patients with 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
BACKGROUND Radical resection is an important treatment method for hepatic echinococcosis.The posterosuperior segments of the liver remain the most challenging region for laparoscopic or robotic hepatectomy.AIM To demo...BACKGROUND Radical resection is an important treatment method for hepatic echinococcosis.The posterosuperior segments of the liver remain the most challenging region for laparoscopic or robotic hepatectomy.AIM To demonstrate the safety and preliminary experience of robotic radical resection of cystic and alveolar echinococcosis in posterosuperior liver segments.METHODS A retrospective analysis was conducted on the clinical data of 5 patients with a median age of 37 years(21-56 years)with cystic and alveolar echinococcosis in difficult liver lesions admitted to two centers from September to December 2019.The surgical methods included total pericystectomy,segmental hepatectomy,or hemihepatectomy.RESULTS Among the 5 patients,4 presented with cystic echinococcosis and 1 presented with alveolar echinococcosis,all of whom underwent robotic radical operation successfully without conversion to laparotomy.Total caudate lobectomy was performed in 2 cases,hepatectomy of segment Ⅶ in 1 case,total pericystectomy of segment Ⅷ in 1 case,and right hemihepatectomy in 1 case.Operation time was 225 min(175-300 min);blood loss was 100 mL(50-600 mL);and postoperative hospital stay duration was 10 d(5-19 d).The Clavien-Dindo complication grade was Ⅰ in 4 cases and Ⅱ in 1 case.No recurrence of echinococcosis was found in any patient at the 3 mo of follow-up.CONCLUSION Robotic radical surgery for cystic and selected alveolar echinococcosis in posterosuperior liver segments is safe and feasible.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 Lymph node metastasis is a specific type of metastasis in hepatic alveolar echinococcosis(AE).Currently,there is a scarcity of describing the clinical characteristics and lymph node metastasis rules of pati...BACKGROUND Lymph node metastasis is a specific type of metastasis in hepatic alveolar echinococcosis(AE).Currently,there is a scarcity of describing the clinical characteristics and lymph node metastasis rules of patients with hepatic AE combined with lymph node metastasis and its mechanism and management are still controversial.Radical hepatectomy combined with regional lymph node dissection is a better treatment.AIM To analyse the clinical features of hepatic AE combined with lymph node metastasis to explore its treatment and efficacy.METHODS A total of 623 patients with hepatic AE admitted to the First Affiliated Hospital of Xinjiang Medical University from 1 January 2012 to 1 January 2022 were retrospectively analysed.Fifty-five patients with combined lymph node metastasis were analysed for their clinical data,diagnosis and treatment methods,follow-up efficacy,and characteristics of lymph node metastasis.Finally,we comparatively analysed the lymph node metastasis rates at different sites.Categorical variables are expressed as frequencies and percentages,and the analysis of difference was performed using theχ2 test.The Bonferroni method was used for pairwise comparisons when statistical differences existed between multiple categorical variables.RESULTS A lymph node metastasis rate of 8.8%(55/623)was reported in patients with hepatic AE,with a female predilection(69.1%)and a statistically significant sex difference(χ2=8.018,P=0.005).Of the 55 patients with lymph node metastasis,72.7%had a parasite lesion,neighbouring organ invasion,and metastasis stage of P3N1M0 and above,of which 67.3%,78.2%,and 34.5%of hepatic AE lesions invaded the bile ducts,blood vessels,and distant metastases,respectively.Detection rates of lymph node metastasis of 16.4%,21.7%,and 34.2%were reported for a preoperative abdominal ultrasound,magnetic resonance imaging,and computed tomography examinations.All patients were intraoperatively suspected with enlarged lymph nodes and underwent radical hepatectomy combined with regional lymph node dissection.After surgery,a routine pathological examination was conducted on the resected lymph nodes.A total of 106 positive lymph nodes were detected in six groups at various sites,including 51 single-group metastasis cases and four multi-group metastasis cases.When the metastasis rates at different sites were statistically analysed,we observed that the metastasis rate in the para-hepatoduodenal ligament lymph nodes was significantly higher than that of the other sites(χ^(2)=128.089,P=0.000<0.05).No statistical difference was observed in the metastasis rate between the five other groups.Clavien-Dindo grade IIIa complication occurred in 14 cases,which improved after administering symptomatic treatment.Additionally,lymph node dissection-related complications were not observed.Recurrence after 2 years was observed in one patient.CONCLUSION Lymph node metastasis is a rare form of metastasis in hepatic AE,which is more frequent in women.Parahepatoduodenal ligament lymph nodes are commonly observed.Radical hepatectomy combined with regional lymph node dissection is a safe,effective,and feasible treatment for liver AE combined with lymph node metastasis.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
This review represents an updated scenario on the transmission cycle,epidemiology,clinical features and pathogenicity,diagnosis and treatment,and prevention and control measures of a cestode parasite Echincoccus granu...This review represents an updated scenario on the transmission cycle,epidemiology,clinical features and pathogenicity,diagnosis and treatment,and prevention and control measures of a cestode parasite Echincoccus granulosus(E.granulosus) infection causing cystic echinococcosis (CE) in humans.Human CE is a serious life-threatening neglected zoonotic disease that occurs in both developing and developed countries,and is recognized as a major public health problem. The life cycle of E.granulosus involves a definitive host(dogs and other canids) for the adult E.granulosus that resides in the intestine,and an intermediate host(sheep and other herbivores) for the tissue-invading metacestode(larval) stage.Humans are only incidentally infected;since the completion of the life cycle of E.granulosus depends on carnivores feeding on herbivores bearing hydatid cysts with viable protoscoleces,humans represent usually the dead end for the parasite.On ingestion of E.granulosus eggs,hydatid cysts are formed mostly in liver and lungs, and occasionally in other organs of human body,which are considered as uncommon sites of localization of hydatid cysts.The diagnosis of extrahepatic echinococcal disease is more accurate today because of the availability of new imaging techniques,and the current treatments include surgery and percutaneous drainage,and chemotherapy(albendazole and mebendazole).But.the wild animals that involve in sylvatic cycle may overlap and interact with the domestic sheepdog cycle,and thus complicating the control efforts.The updated facts and phenomena regarding human and animal CE presented herein are due to the web search of SCI and non-SCI journals.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 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
Human alveolar echinococcosis (AE) is a potentially deadly disease; recent studies have shown that the endemic area of Echinococcus multilocularis , its causative agent, is larger than previously known. This disease h...Human alveolar echinococcosis (AE) is a potentially deadly disease; recent studies have shown that the endemic area of Echinococcus multilocularis , its causative agent, is larger than previously known. This disease has low prevalence and remains underreported in Europe. Emerging clinical data show that diagnostic difficulties are still common. We report on a 76-year old patient suffering from AE lesions restricted to the left lobe of the liver who underwent a curative extended left hemihepatectomy. Prior to the resection a liver biopsy under the suspicion of an atypical malignancy was performed. After the intervention he developed a pseudoaneurysm of the hepatic artery that was successfully coiled. Surprisingly, during surgery, the macroscopic appearance of the tumour revealed a growth pattern that was rather typical for cystic echinococcosis (CE), i.e. , a gross tumour composed of multiple large vesicles with several centimeters in diameter. In addition, there were neither extensive adhesions nor infiltrations of the neighboring pancreas and diaphragm as was expected from previous imaging results. The unexpected diagnosis of AE was confirmed by definite histopathology, specific polymerase chain reaction and serology results. This is a rare case of unusual macroscopic presentation of AE that posed immense diagnostic challenges and had an eventful course. To our knowledge this is the first case of an autochthonous infection in this particular geographic area of Germany, the federal state of Saxony. This report may provide new hints for an expanding area of risk for AE and emphasizes the risk of complications in the scope of diagnostic procedures and the limitations of modern radiological imaging.展开更多
Cystic echinococcosis(CE) is a complex, chronic and neglected disease with a worldwide distribution. The liver is the most frequent location of parasitic cysts. In humans, its clinical spectrum ranges from asymptom-at...Cystic echinococcosis(CE) is a complex, chronic and neglected disease with a worldwide distribution. The liver is the most frequent location of parasitic cysts. In humans, its clinical spectrum ranges from asymptom-atic infection to severe, potentially fatal disease. Four approaches exist in the clinical management of CE: surgery, percutaneous techniques and drug treatment for active cysts, and the "watch and wait" approach for inactive cysts. Allocation of patients to these treat-ments should be based on cyst stage, size and location, available clinical expertise, and comorbidities. However, clinical decision algorithms, efficacy, relapse rates, and costs have never been properly evaluated. This paper reviews recent advances in classification and diagnosisand the currently available evidence for clinical deci-sion-making in cystic echinococcosis of the liver.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
AIM:To determine the long-term hepatobiliary complications of alveolar echinococcosis(AE) and treatment options using interventional methods.METHODS:Included in the study were 35 patients with AE enrolled in the Echin...AIM:To determine the long-term hepatobiliary complications of alveolar echinococcosis(AE) and treatment options using interventional methods.METHODS:Included in the study were 35 patients with AE enrolled in the Echinococcus Multilocularis Data Bank of the University Hospital of Ulm.Patients underwent endoscopic intervention for treatment of hepatobiliary complications between 1979 and 2012.Patients' epidemiologic data, clinical symptoms, and indications for the intervention, the type of intervention and any additional procedures, hepatic laboratory parameters(pre- and post-intervention), medication and surgical treatment(pre- and post-intervention), as well as complications associated with the intervention and patients‘ subsequent clinical courses were analyzed.In order to compare patients with AE with and without history of intervention, data from an additional 322 patients with AE who had not experienced hepatobiliary complications and had not undergone endoscopic intervention were retrieved and analyzed.RESULTS:Included in the study were 22 male and 13 female patients whose average age at first diagnosis was 48.1 years and 52.7 years at the time of intervention.The average time elapsed between first diagnosis and onset of hepatobiliary complications was 3.7 years.The most common symptoms were jaundice, abdominal pains, and weight loss.Thenumber of interventions per patient ranged from one to ten.Endoscopic retrograde cholangiopancreatography(ERCP)was most frequently performed in combination with stent placement(82.9%),followed by percutaneous transhepatic cholangiodrainage(31.4%)and ERCP without stent placement(22.9%).In 14.3%of cases,magnetic resonance cholangiopancreatography was performed.A total of eight patients received a biliary stent.A comparison of biochemical hepatic function parameters at first diagnosis between patients who had or had not undergone intervention revealed that these were significantly elevated in six patients who had undergone intervention.Complications(cholangitis,pancreatitis)occurred in six patients during and in 12patients following the intervention.The average survival following onset of hepatobiliary complications was 8.8years.CONCLUSION:Hepatobiliary complications occur in about 10%of patients.A significant increase in hepatic transaminase concentrations facilitates the diagnosis.Interventional methods represent viable management options.展开更多
Alveolar echinococcosis(AE) is a zoonotic disease that is caused by Echinococcus multilocularis that affects liver and a variety of organs and tissues. It differs from other echinococcal disease because it shows tumor...Alveolar echinococcosis(AE) is a zoonotic disease that is caused by Echinococcus multilocularis that affects liver and a variety of organs and tissues. It differs from other echinococcal disease because it shows tumor like behavior in the affected organ and tissues. The treatment of choice is concomitant medical therapy and resection with negative margins. Nevertheless, resection with the intent of negative margins(R0) may lead to serious complications such as liver failure. In the present case report, we used Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy(ALPPS) procedure, which was defined in 2012 by Schnitzbauer et al, in a 28-year-old male patient to avoid complications of major liver resection in order to treat alveolar echinococcosis. Until now, we have not encountered any study using ALPPS procedure for the treatment of alveolar echinococcosis. In the present case report we aimed to show that ALPPS procedure can be safely performed for marginnegative resection of primary or recurrent AE that shows a tumor like behavior. It is our opinion that this procedure should be performed in centers that have expertise and sufficient technical capacity to perform liver transplantation and advanced liver surgery.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
基金Supported by the National Natural Science Foundation of China,No.82360111Xinjiang Science and Technology Department-Leading Talents in Technological Innovation-High-Level Leading Talents,No.2022TSYCLJ0034+1 种基金State Key Laboratory for The Cause and Control of High Incidence in Central Asia Jointly Constructed by The Ministry and The Province,No.SKL-HIDCA-2023-2 and No.SKLHIDCA-2024-22Xinjiang Uygur Autonomous Region Graduate Innovation Program,No.XJ2024G153.
文摘BACKGROUND Alveolar and cystic echinococcoses are lethal zoonotic diseases caused by Echinococcus multilocularis and Echinococcus granulosus infections,leading to alveolar echinococcosis(AE)or cystic echinococcosis(CE),respectively.No study has hitherto reported effective treatment approaches for AE or CE with concurrent hepatorenal involvement.AIM To investigate the feasibility and efficacy of simultaneous combined surgery(SCS)as a comprehensive treatment approach for patients with hepatorenal echinococcosis.METHODS Clinical datasets of hepatorenal AE(n=10)and CE(n=11)patients were retrospectively collected and systematically analyzed.The SCS approach was introduced,and surgical outcomes,complications,and prognoses were documented in detail.RESULTS The SCS approach incorporated hybridized techniques,including partial hepatectomy,partial or total nephrectomy,ex vivo liver resection and autotransplantation,and total or subtotal cystectomy with endocystectomy.Radical SCS was achieved in 100%of AE patients and 63.6%of CE patients.All surgeries were completed without intraoperative complications.The short-term complication rate was 28.6%(Clavien-Dindo classification:AE-1 IIIb,3 IIIa;CE-2 II),while the long-term complication rate was 4.8%(Clavien-Dindo classification:AE-1 IIIb).Patients were followed up for a median of 37 months(AE:6-81 months;CE:34-123 months),with no reported deaths or disease relapses.CONCLUSION CS appears to be a feasible and effective treatment method for patients with hepatorenal involvement of AE or CE.It fulfills the management criteria for advanced AE or CE cases,aiming to maximize patient benefits.
基金Supported by National Natural Science Foundation of China,No.82270632 and No.82260411.
文摘BACKGROUND Hepatic alveolar echinococcosis(HAE)is a chronic parasitic disease caused by the larval stage of Echinococcus multilocularis.Although significant research has been conducted on the pathogenesis and immunological aspects of HAE,comprehensive bibliometric analyses in this area are still lacking.This study sought to fill this gap by systematically analyzing the immunological literature on HAE using bibliometric methods.AIM To identify research trends,key contributors,and emerging developments and offer insights to guide future research in this field.METHODS Research articles on HAE published between 1983 and 2023 were retrieved from the Web of Science Core Collection database.A total of 319 articles were selected for bibliometric analysis,which was conducted using the CiteSpace and VOSviewer software.The analysis focused on key variables such as publication volume,authors,journals,countries,references,and keywords.RESULTS The analysis revealed a significant increase in research on HAE over the past four decades,particularly after 1995.China and Switzerland emerged as the leading countries in terms of publication volume,with Bruno Gottstein and Vuitton DA identified as the most influential authors in this field.Key research areas include the interaction between the pathogen and the host immune system,as well as advances in disease diagnosis and treatment strategies.The keyword co-occurrence analysis highlighted the primary themes and identified emerging trends within the research landscape.CONCLUSION This study provides a comprehensive framework for understanding HAE immunology and highlights research hotspots,future directions,key contributors,and the importance of international cooperation.
文摘Echinococcosis or hydatid disease is induced mainly by Echinococcus granulosus and occasionally by Echinococcus multilocularis(alveolaris)and affects the liver predominantly.Hepatic alveolar echinococcosis is similar to carcinoma in appearance,and without treatment,it can lead to death.Diagnosis is based on current imaging modalities.Surgical management is the cornerstone of treatment.Complete removal of the cyst(total pericystectomy or hepatectomy)ensures a permanent cure and should be the first-choice treatment for cystic disease.Cyst evacuation,partial cystectomy,and drainage or omentoplasty,may be alternative choices in difficult cases.Albendazole,mebendazole and praziquantel are options for treating small cysts and preventing recurrence after surgery.Despite the efforts,alveolar echinococcus is not usually amenable to surgical management,except in the early stage,which is less common,and management by albendazole is indicated.However,there are few recent reports of major operations(ex-vivo hepatectomy,autotransplantation and vascular reconstruction)in advanced stages.
文摘BACKGROUND Liver hydatid cysts(LHC)liver requires effective surgical treatment.Open closed total pericystectomy removes the entire echinococcus cyst while preserving healthy liver tissue.AIM To evaluate the outcomes of pericystectomy and its efficacy as a treatment modality for cystic echinococcosis(CE).METHODS Thirty-eight patients were analyzed after open total pericystectomy at the University Hospital of Cologne between January 2006 and January 2024.Demographic,clinical,and laboratory parameters were collected retrospectively.Intraoperative data and postoperative complications were documented and classified using the Clavien-Dindo classification.Throughout the follow-up period,patients underwent regular clinical,serological,and sonographic evaluations both at the outpatient department and by their general physicians.RESULTS Fifty-four cysts were treated with open total pericystectomy.Multiple cysts were found in 42.2%of cases.Singular cysts occurred in 57.8%.The right hepatic lobe was affected in 66.7%.Ectopic cysts occurred in 4 patients in the lung(n=3)and spleen(n=1).Median cyst size was 6.78 cm×5.92 cm(range:1.4-20.0 cm).The median surgical time of pericystectomy was 189 minutes(range:78-455 minutes)with a median blood loss of 400 mL(range:100-1400 mL).The complication rate(Clavien-Dindo>III)was 21.1%.The average hospital stay was 12.5 days.No recurrent disease could be detected after a median follow-up time of 97 months(range:4-216 months).No recurrent cyst manifestation,postoperative liver failure or death was observed.CONCLUSION The presented surgical procedure known as open total pericystectomy is a safe surgical technique in treatment of cystic echinococcosis.
文摘Echinococcosis or hydatid disease （HD） is a zoonosis caused by the larval stages of taeniid cestodes belong- ing to the genus Echinococcus. Hepatic echinococcosis is a life-threatening disease, mainly differentiated into alveolar and cystic forms, associated with Echinoc- cus multilocularis （E. multi/ocular/s） and Echinococcus granulosus （E. granulosus） infection, respectively. Cys- tic echinococcosis （CE） has a worldwide distribution, while hepatic alveolar echinococcosis （AE） is endemic in the Northern hemisphere, including North America and several Asian and European countries, like France, Germany and Austria. E. granulosus young cysts are spherical, unilocular vesicles, consisting of an internal germinal layer and an outer acellular layer. Cyst expansion is associated with a host immune reaction and the subsequent development of a fibrous layer, called the per/cyst; old cysts typically present internal septa- tions and daughter cysts. E. multilocularis has a tumor-like, infiltrative behavior, which is responsible for tissue destruction and finally for liver failure. The liver is the main site of HD involvement, for both alveolar and cystic hydatidosis. HD is usually asymptomatic for a long period of time, because cyst growth is commonly slow; the most frequent symptoms are fatigue and abdominal pain. Patients may also present jaundice, hepatomegaly or anaphylaxis, due to cyst leakage or rupture. HD diagnosis is usually accomplished with the combined use of ultrasonography and immunodiagnosis; furthermore, the improvement of surgical techniques, the introduction of minimally invasive treatments [such as puncture, aspiration, injection, re-aspiration （PAIR）] and more effective drugs （such as benzoimidazoles） have deeply changed life expectancy and quality of life of patients with HD. The aim of this article is to provide an up-to-date review of biological, diagnostic, clinical and therapeutic aspects of hepatic echinococcosis.
文摘This paper deals with all aspects of liver alveolar echinococcosis (AE) including epidemiology, pathology, clinical manifestations, imaging examinations, diagnosis and differential diagnosis, surgical treatment and chemotherapy.The review is not only based on personal clinical experiences but also in combination with relative basic research such as proliferation and growth of alveococcus, preclinical studies of a novel compound extracted from TCM for treatment of liver AE, and molecular immunology used for specific AE diagnosis, etc.
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 patients with 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BACKGROUND Radical resection is an important treatment method for hepatic echinococcosis.The posterosuperior segments of the liver remain the most challenging region for laparoscopic or robotic hepatectomy.AIM To demonstrate the safety and preliminary experience of robotic radical resection of cystic and alveolar echinococcosis in posterosuperior liver segments.METHODS A retrospective analysis was conducted on the clinical data of 5 patients with a median age of 37 years(21-56 years)with cystic and alveolar echinococcosis in difficult liver lesions admitted to two centers from September to December 2019.The surgical methods included total pericystectomy,segmental hepatectomy,or hemihepatectomy.RESULTS Among the 5 patients,4 presented with cystic echinococcosis and 1 presented with alveolar echinococcosis,all of whom underwent robotic radical operation successfully without conversion to laparotomy.Total caudate lobectomy was performed in 2 cases,hepatectomy of segment Ⅶ in 1 case,total pericystectomy of segment Ⅷ in 1 case,and right hemihepatectomy in 1 case.Operation time was 225 min(175-300 min);blood loss was 100 mL(50-600 mL);and postoperative hospital stay duration was 10 d(5-19 d).The Clavien-Dindo complication grade was Ⅰ in 4 cases and Ⅱ in 1 case.No recurrence of echinococcosis was found in any patient at the 3 mo of follow-up.CONCLUSION Robotic radical surgery for cystic and selected alveolar echinococcosis in posterosuperior liver segments is safe and feasible.
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 Natural Science Foundation of Xinjiang Uygur Autonomous Region,China,No.2022D01D17.
文摘BACKGROUND Lymph node metastasis is a specific type of metastasis in hepatic alveolar echinococcosis(AE).Currently,there is a scarcity of describing the clinical characteristics and lymph node metastasis rules of patients with hepatic AE combined with lymph node metastasis and its mechanism and management are still controversial.Radical hepatectomy combined with regional lymph node dissection is a better treatment.AIM To analyse the clinical features of hepatic AE combined with lymph node metastasis to explore its treatment and efficacy.METHODS A total of 623 patients with hepatic AE admitted to the First Affiliated Hospital of Xinjiang Medical University from 1 January 2012 to 1 January 2022 were retrospectively analysed.Fifty-five patients with combined lymph node metastasis were analysed for their clinical data,diagnosis and treatment methods,follow-up efficacy,and characteristics of lymph node metastasis.Finally,we comparatively analysed the lymph node metastasis rates at different sites.Categorical variables are expressed as frequencies and percentages,and the analysis of difference was performed using theχ2 test.The Bonferroni method was used for pairwise comparisons when statistical differences existed between multiple categorical variables.RESULTS A lymph node metastasis rate of 8.8%(55/623)was reported in patients with hepatic AE,with a female predilection(69.1%)and a statistically significant sex difference(χ2=8.018,P=0.005).Of the 55 patients with lymph node metastasis,72.7%had a parasite lesion,neighbouring organ invasion,and metastasis stage of P3N1M0 and above,of which 67.3%,78.2%,and 34.5%of hepatic AE lesions invaded the bile ducts,blood vessels,and distant metastases,respectively.Detection rates of lymph node metastasis of 16.4%,21.7%,and 34.2%were reported for a preoperative abdominal ultrasound,magnetic resonance imaging,and computed tomography examinations.All patients were intraoperatively suspected with enlarged lymph nodes and underwent radical hepatectomy combined with regional lymph node dissection.After surgery,a routine pathological examination was conducted on the resected lymph nodes.A total of 106 positive lymph nodes were detected in six groups at various sites,including 51 single-group metastasis cases and four multi-group metastasis cases.When the metastasis rates at different sites were statistically analysed,we observed that the metastasis rate in the para-hepatoduodenal ligament lymph nodes was significantly higher than that of the other sites(χ^(2)=128.089,P=0.000<0.05).No statistical difference was observed in the metastasis rate between the five other groups.Clavien-Dindo grade IIIa complication occurred in 14 cases,which improved after administering symptomatic treatment.Additionally,lymph node dissection-related complications were not observed.Recurrence after 2 years was observed in one patient.CONCLUSION Lymph node metastasis is a rare form of metastasis in hepatic AE,which is more frequent in women.Parahepatoduodenal ligament lymph nodes are commonly observed.Radical hepatectomy combined with regional lymph node dissection is a safe,effective,and feasible treatment for liver AE combined with lymph node metastasis.
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This review represents an updated scenario on the transmission cycle,epidemiology,clinical features and pathogenicity,diagnosis and treatment,and prevention and control measures of a cestode parasite Echincoccus granulosus(E.granulosus) infection causing cystic echinococcosis (CE) in humans.Human CE is a serious life-threatening neglected zoonotic disease that occurs in both developing and developed countries,and is recognized as a major public health problem. The life cycle of E.granulosus involves a definitive host(dogs and other canids) for the adult E.granulosus that resides in the intestine,and an intermediate host(sheep and other herbivores) for the tissue-invading metacestode(larval) stage.Humans are only incidentally infected;since the completion of the life cycle of E.granulosus depends on carnivores feeding on herbivores bearing hydatid cysts with viable protoscoleces,humans represent usually the dead end for the parasite.On ingestion of E.granulosus eggs,hydatid cysts are formed mostly in liver and lungs, and occasionally in other organs of human body,which are considered as uncommon sites of localization of hydatid cysts.The diagnosis of extrahepatic echinococcal disease is more accurate today because of the availability of new imaging techniques,and the current treatments include surgery and percutaneous drainage,and chemotherapy(albendazole and mebendazole).But.the wild animals that involve in sylvatic cycle may overlap and interact with the domestic sheepdog cycle,and thus complicating the control efforts.The updated facts and phenomena regarding human and animal CE presented herein are due to the web search of SCI and non-SCI journals.
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 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.
文摘Human alveolar echinococcosis (AE) is a potentially deadly disease; recent studies have shown that the endemic area of Echinococcus multilocularis , its causative agent, is larger than previously known. This disease has low prevalence and remains underreported in Europe. Emerging clinical data show that diagnostic difficulties are still common. We report on a 76-year old patient suffering from AE lesions restricted to the left lobe of the liver who underwent a curative extended left hemihepatectomy. Prior to the resection a liver biopsy under the suspicion of an atypical malignancy was performed. After the intervention he developed a pseudoaneurysm of the hepatic artery that was successfully coiled. Surprisingly, during surgery, the macroscopic appearance of the tumour revealed a growth pattern that was rather typical for cystic echinococcosis (CE), i.e. , a gross tumour composed of multiple large vesicles with several centimeters in diameter. In addition, there were neither extensive adhesions nor infiltrations of the neighboring pancreas and diaphragm as was expected from previous imaging results. The unexpected diagnosis of AE was confirmed by definite histopathology, specific polymerase chain reaction and serology results. This is a rare case of unusual macroscopic presentation of AE that posed immense diagnostic challenges and had an eventful course. To our knowledge this is the first case of an autochthonous infection in this particular geographic area of Germany, the federal state of Saxony. This report may provide new hints for an expanding area of risk for AE and emphasizes the risk of complications in the scope of diagnostic procedures and the limitations of modern radiological imaging.
基金Supported by The EU grant FP7/2007-2013,No.602051-HERACLES(to Brunetti E)
文摘Cystic echinococcosis(CE) is a complex, chronic and neglected disease with a worldwide distribution. The liver is the most frequent location of parasitic cysts. In humans, its clinical spectrum ranges from asymptom-atic infection to severe, potentially fatal disease. Four approaches exist in the clinical management of CE: surgery, percutaneous techniques and drug treatment for active cysts, and the "watch and wait" approach for inactive cysts. Allocation of patients to these treat-ments should be based on cyst stage, size and location, available clinical expertise, and comorbidities. However, clinical decision algorithms, efficacy, relapse rates, and costs have never been properly evaluated. This paper reviews recent advances in classification and diagnosisand the currently available evidence for clinical deci-sion-making in cystic echinococcosis of the liver.
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AIM:To determine the long-term hepatobiliary complications of alveolar echinococcosis(AE) and treatment options using interventional methods.METHODS:Included in the study were 35 patients with AE enrolled in the Echinococcus Multilocularis Data Bank of the University Hospital of Ulm.Patients underwent endoscopic intervention for treatment of hepatobiliary complications between 1979 and 2012.Patients' epidemiologic data, clinical symptoms, and indications for the intervention, the type of intervention and any additional procedures, hepatic laboratory parameters(pre- and post-intervention), medication and surgical treatment(pre- and post-intervention), as well as complications associated with the intervention and patients‘ subsequent clinical courses were analyzed.In order to compare patients with AE with and without history of intervention, data from an additional 322 patients with AE who had not experienced hepatobiliary complications and had not undergone endoscopic intervention were retrieved and analyzed.RESULTS:Included in the study were 22 male and 13 female patients whose average age at first diagnosis was 48.1 years and 52.7 years at the time of intervention.The average time elapsed between first diagnosis and onset of hepatobiliary complications was 3.7 years.The most common symptoms were jaundice, abdominal pains, and weight loss.Thenumber of interventions per patient ranged from one to ten.Endoscopic retrograde cholangiopancreatography(ERCP)was most frequently performed in combination with stent placement(82.9%),followed by percutaneous transhepatic cholangiodrainage(31.4%)and ERCP without stent placement(22.9%).In 14.3%of cases,magnetic resonance cholangiopancreatography was performed.A total of eight patients received a biliary stent.A comparison of biochemical hepatic function parameters at first diagnosis between patients who had or had not undergone intervention revealed that these were significantly elevated in six patients who had undergone intervention.Complications(cholangitis,pancreatitis)occurred in six patients during and in 12patients following the intervention.The average survival following onset of hepatobiliary complications was 8.8years.CONCLUSION:Hepatobiliary complications occur in about 10%of patients.A significant increase in hepatic transaminase concentrations facilitates the diagnosis.Interventional methods represent viable management options.
文摘Alveolar echinococcosis(AE) is a zoonotic disease that is caused by Echinococcus multilocularis that affects liver and a variety of organs and tissues. It differs from other echinococcal disease because it shows tumor like behavior in the affected organ and tissues. The treatment of choice is concomitant medical therapy and resection with negative margins. Nevertheless, resection with the intent of negative margins(R0) may lead to serious complications such as liver failure. In the present case report, we used Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy(ALPPS) procedure, which was defined in 2012 by Schnitzbauer et al, in a 28-year-old male patient to avoid complications of major liver resection in order to treat alveolar echinococcosis. Until now, we have not encountered any study using ALPPS procedure for the treatment of alveolar echinococcosis. In the present case report we aimed to show that ALPPS procedure can be safely performed for marginnegative resection of primary or recurrent AE that shows a tumor like behavior. It is our opinion that this procedure should be performed in centers that have expertise and sufficient technical capacity to perform liver transplantation and advanced liver surgery.
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.
