Fifty-five cases of hepatic alveolar echinococcosis combined with lymph node metastasis:A retrospective study

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.

Portal vein embolization combined with ex vivo liver resection and autotransplantation: A novel treatment strategy for end-stage and metastatic hepatic alveolar echinococcosis

Alveolar echinococcosis(AE)is a lethal parasitic disease caused by Echinococcus multilocularis larvae,and more than 90%of pri-mary AE lesions occur in the liver.Most of the affected individ-uals remain asymptomatic and the disease is often diagnosed at an advanced stage.The infection may spread to organs adjacent to the liver or distant locations,eventually causing end-stage multi-ple organ AE.Brain metastasis of AE is the most fatal with an inci-dence rate of 0.2%[1].

免疫检查点阻断剂PD-1抗体在小鼠肝细胞癌治疗中的应用

目的探讨PD-1抗体在小鼠原位肝癌中的治疗作用。方法通过肝脏原位注射Hepa1-6肝癌细胞株构建小鼠原位肝癌模型,随机分为治疗组(n=14)和模型组(n=14),每组8只取标本,6只观察生存状态。治疗组小鼠腹腔注射PD-1抗体200μg/只,每3 d一次,共注射3次;模型组给予相同体积的生理盐水;给药后每天观察小鼠生存状态。末次给药后第2天,流式细胞术检测肿瘤组织CD3^(+)T、CD4^(+)T、CD8^(+)T、B淋巴细胞和NK细胞比例,及外周血Th1类细胞因子(IL-2、IFN-γ、TNF-α)浓度。结果治疗组小鼠肿瘤直径明显小于模型组(t=3.74,P=0.002)。治疗组小鼠肿瘤组织CD3^(+)T细胞、CD4^(+)T细胞、CD8^(+)T细胞、B细胞和NK细胞比例均明显高于模型组(P<0.001)。治疗组小鼠外周血IL-2水平明显高于模型组(P<0.001),IFN-γ、TNF-α浓度在两组间差异无统计学意义(P>0.05)。治疗组小鼠中位生存时间显著长于模型组(P<0.05)。结论PD-1抗体治疗可以明显增强原位肝癌模型小鼠肿瘤微环境抗肿瘤免疫反应并显著延长小鼠生存期。

小肝癌手术切除后肿瘤复发的危险因素分析

目的探讨小肝癌手术切除治疗后肿瘤复发的危险因素为预测术后复发提供理论依据。方法研究回顾性分析了自2010年1月至2015年1月收治于新疆医科大学第一附属医院并行根治性手术切除治疗的157例原发性小肝癌患者的临床病理资料,并对患者复发情况进行追踪随访,随访至2020年1月。随访期间发生肿瘤复发的为A组、未发生肿瘤复发的B组。采用单因素分析肿瘤复发与患者临床病理资料之间的关系,多因素logistic回归模型分析小肝癌在根治性切除术后患者发生肿瘤复发的独立危险因素。结果根治性手术切除术后肿瘤复发患者(A组)66例(43.04%)。单因素分析结果显示:术前AFP浓度>400ug/L(P=0.01)、合并肝硬化(P=0.01)、合并乙肝(P=0.03)、术前HBV-DNA水平>200U/m L(P=0.03)、肿瘤包膜完整(P=0.04)、肿瘤最大直径>2 cm(P=0.04)、肿瘤细胞分化中低度(P=0.02)、预防性肝动脉化疗栓塞治疗(P=0.01)及术后规律性服用抗病毒药物(P=0.03)在A、B两组间差异具有统计学差异。多因素分析结果显示:术前AFP浓度>400 ug/L、合并肝硬化、合并乙肝、肿瘤细胞分化中低度是小肝癌切除术后导致肿瘤复发的独立危险因素(OR=1.44,1.45,3.79,1.60;95%CI=1.074.85,1.093.08,1.479.81,1.075.89;P=0.03、0.03、0.01、0.04);术后规律性服用抗病毒药物是小肝癌术后降低复发的保护因素(OR=0.41,95%Cl 0.450.97,P=0.04)。结论手术切除是治疗小肝癌的首选方法,术前AFP>400ug/L、合并肝硬化、合并乙肝及肿瘤细胞分化中低度是术后肿瘤复发的独立危险因素;术后预防性肝动脉化疗栓塞术不能降低患者术后肿瘤复发,而规律性服用抗病毒药物是降低肿瘤复发的保护因素。

血清降钙素原在肝胆外科术后诊断细菌感染的临床价值

目的探讨血清降钙素原(PCT)联合白细胞(WBC)、中性粒细胞百分比(NE%)在肝胆外科术后诊断细菌感染模式的临床价值。方法选取本院2018年7月-2020年6月483份肝胆外科手术病例,记录术后3 h-12 h PCT、WBC、NE%值,并根据相关诊疗指南判断是否感染,利用方差分析比较感染和未感染病例PCT、WBC、NE%的差异性,采用受试者工作特征曲线(ROC曲线)评估诊断效能和截值;通过截值将上述病例分组,并运用统计学方法验证预测感染率与实际感染率的差异。结果(1)方差分析显示,术后感染和未感染患者PCT、WBC、NE%水平存在显著性差异(P<0.05);(2)术后PCT、WBC、NE%的ROC曲线下面积分别为0.858、0.776、0.784均有较好的预测效能,其截值分别为1.030 ng/ml、13.98×10^(9)/L、85.30%;(3)当PCT<1.030 ng/ml时,根据截值分组的预测感染率与实际感染率有显著性差异(P<0.05),没有临床意义;当PCT>1.030 ng/ml时,根据截值分组的预测感染率与实际感染率无显著性差异(P>0.05),有临床意义。结论血清PCT的截值筛选术后感染人群有一定的价值,同时联合WBC、NE%等指标对肝胆外科术后诊断感染及治疗有良好的指导意义,PCT>1.03 ng/ml可作为诊断术后细菌感染的诊断截点。

多房棘球蚴感染早期肝纤维化的实验动物研究

目的建立多房棘球蚴感染小鼠模型,观察感染早期肝脏纤维化的动态变化。方法将40只C57BL/6小鼠分为实验组和对照组,其中实验组为25只,对照组15只。实验组采用小鼠门静脉注入多房棘球蚴原头节混悬液,对照组门静脉注射等量的生理盐水。分别于感染后1、2、3、4、8周采集标本,通过苏木精-伊红(HE)染色动态观察组织的病理学改变及幼虫病灶、炎性病灶和肉芽肿组织的变化情况;采用天狼猩红染色观察小鼠肝组织胶原蛋白的沉积程度;通过免疫组化染色观察不同时间点的α-SMA表达情况。结果实验组小鼠的肝组织随着感染时间的延长其带虫病灶的数量逐周降低,而肉芽肿数量则逐周增多;炎性病灶无明显变化,脾脏和肾脏组织亦未见多房棘球蚴感染征象。天狼星红染色显示,对照组小鼠中的胶原沉积在胆管及血管周围,而实验组小鼠中则主要沉积在病灶及其周围,而且随着感染时间的延长其沉积程度越重。免疫组化结果提示对照组小鼠的α-SMA未见明显表达,而实验组小鼠的肝脏阳性表达多在原头蚴周围的组织增生区域,感染后α-SMA的表达逐周增加。结论经门静脉感染多房棘球蚴的动物模型,可为肝泡型包虫病的相关研究提供良好的模拟环境。多房棘球蚴感染早期肝脏的纤维化可能与α-SMA相关。

Application of 3D reconstruction for surgical treatment of hepatic alveolar echinococcosis

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.

Compared efficacy of University of Wisconsin and histidine-tryptophan-ketoglutarate solutions in ex-situ liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis patients

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.

Approaches to reconstruction of inferior vena cava by ex vivo liver resection and autotransplantation in 114 patients with hepatic alveolar echinococcosis

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.

Multiple recurrent cystic echinococcosis with abdominal aortic involvement: A case report

BACKGROUND Recurrent cystic echinococcosis(CE)with vital organ involvement is a challenge for clinicians.Herein,we report a case of aortic involvement in recurrent retroperitoneal CE lesions following primary splenic CE resection.CASE SUMMARY A 60-year-old male was admitted due to progressive abdominal pain and poor appetite.He was diagnosed with multiple recurrent CE with abdominal aortic involvement according to preoperative evaluation.During surgical resection,major aortic bleeding accidentally occurred while dissecting the cyst,which was firmly attached to the abdominal aortic wall.Hemostasis attempts were conducted to deal with this emergency situation and maintain circulation.Postinterventional recovery was uneventful,and 2-year follow-up showed no sign of recurrence or any other complications.CONCLUSION Radical resection of recurrent complicated CE with aortic involvement should be carefully planned and performed to prevent possible severe adverse complications,thereby improving the postoperative outcome.

Complex inferior vena cava reconstruction during ex vivo liver resection and autotransplantation:A case report

BACKGROUND Ex vivo liver resection and autotransplantation(ELRA)is an essential approach for treating patients with end-stage hepatic alveolar echinococcosis(AE),and its surgical indications involve severe invasion of important hepatic vessels,which makes in vivo resection impossible.Revascularization is a major step in the process of ELRA,which is extremely challenging when the invaded vessels have huge defects.CASE SUMMARY Herein,we have reported the case of a 26-year-old patient with hepatic AE in an autologous liver graft who underwent complex inferior vena cava(IVC)reconstruction using disease-free IVC,autologous portal vein fragments,and umbilical vein within the ligamentum teres hepatis.The patient showed good surgical recovery without vascular-related complications during the long-term follow-up.CONCLUSION We reviewed three studies that have reported complex revascularization of the IVC.This case report and systematic review showed that the use of autologous perihepatic vessels prevents donor-area trauma,immune rejection,and other adverse reactions.When the blood vessel is severely invaded and a single vascular material cannot repair and reconstruct the defect,ELRA may provide a safe and feasible surgical approach,which has good prospects for clinical application.

肝细胞癌行根治性肝切除术后早期复发的危险因素分析及其预测模型的建立

目的分析肝细胞癌行根治性肝切除术后早期复发的危险因素并构建列线图预测模型。方法回顾性收集2017年8月至2021年8月期间在新疆医科大学第一附属医院行根治性肝切除术的肝细胞癌患者的临床资料,同时采用单因素和多因素logistic回归分析筛选肝细胞癌行根治性肝切除术后早期复发的危险因素并据此建立列线图预测模型,采用受试者操作特性曲线和校准曲线对该模型的预测效能进行评价,并用决策曲线分析评估其临床实用性。结果本研究根据纳入和排除标准纳入了302例患者,有145例(48.01%)发生了早期复发。多因素logistic回归模型筛选出术前中性粒细胞与淋巴细胞比率、血小板与淋巴细胞比率、γ-谷氨酰转移酶、甲胎蛋白、肿瘤大小及微血管侵犯是肝细胞癌行根治性肝切除术后早期复发的影响因素(P<0.05),据此建立的列线图预测模型区分术后早期复发的受试者操作特征曲线下面积为0.858[95%CI(0.816,0.899)],校准曲线评价列线图预测模型的Brier指数为0.152,列线图预测模型的预测值与真实值之间比较接近(Hosmer–Lemeshow检验,P=0.913);决策曲线分析结果显示,当阈值概率在0.1~0.8的范围内,根据模型的预测概率来对肝细胞癌进行干预的临床净收益高于对所有肝细胞癌患者不进行干预和进行干预。结论本研究结果提示,对于术前中性粒细胞与淋巴细胞比率>2.13、血小板与淋巴细胞比率>108.15、γ-谷氨酰转移酶>46.0 U/L、甲胎蛋白>18.96μg/L、肿瘤大小>4.9 cm及术前存在微血管侵犯的患者需密切关注其术后早期复发,根据这些风险因素构建的列线图模型具有良好的区分度和准确性,模型的阈值概率范围0.1~0.8范围内具有一定的临床净获益。

中国棘球蚴病防诊治体系建设与创新实践

棘球蚴病(又称包虫病)是由棘球绦虫的幼虫感染所致的人兽共患寄生虫病,属于被忽视的热带病,呈全球性分布。在中国,细粒棘球蚴病和多房棘球蚴病流行情况均居全球首位,对公共卫生构成威胁并造成巨大经济损失。我国西部地区多房棘球蚴病的疾病负担占全球90%以上。自中华人民共和国成立以来,我国棘球蚴病的防治取得了巨大成就,临床治愈率得到显著提高,并发症和死亡率明显下降,人群及动物宿主的感染率降低。21世纪以来,我国在棘球绦虫的遗传学、基因组学、分子流行病学和免疫学,棘球蚴病的诊断措施、治疗技术、防控策略以及疫苗研发等方面取得了鼓舞人心的成就。本文着重提出并阐述棘球蚴病防诊治体系的建设与创新实践,主要包括:科学防控体系、规范诊断体系、创新术式与药物治疗体系以及创新研究与转化应用。

胆囊结石合并胆总管结石的相关危险因素分析

目的探讨胆囊结石合并胆总管结石相关的危险因素.方法回顾性分析2017年1月至2019年12月期间于新疆医科大学第一附属医院就诊并行手术治疗的140例胆囊结石或胆囊结石合并胆总管结石患者的相关临床资料,比较患者相关病史、影像学资料、部分血清学指标.结果本研究结果显示,结石最大直径(≥10 mm)(x^2=7.896,P=0.019),乳头旁憩室(有)(x^2=10.849,P=0.013),胆囊结石数量(多发)(x^2=9.760,P=0.080),年龄(t=2.767,P=0.006),胆总管直径(t=8.068,P=0.000),总胆红素(t=2.372,P=0.019),碱性磷酸酶(t=2.448,P=0.016)等与合并胆总管结石有关,差异有统计学意义.Logistic多因素回归结果显示胆囊结石最大直径≥10 mm、胆总管扩张、乳头旁憩室形成、胆囊多发结石是合并胆总管结石形成的独立危险因素.性别、有无糖尿病病史、有无高血压病病史、结石形状、体质量指数、胆囊最大直径、丙氨酸转氨酶、门冬氨酸转氨酶、三酰甘油、高密度脂蛋白、总胆固醇等与合并胆总管结石形成无关,差异无统计学意义.结论胆囊结石合并胆总管结石是由多种危险因素共同作用的结果.

加速康复外科理念在肝部分切除术后镇痛方案应用的效果研究

目的:探讨加速康复外科理念在肝部分切除术后的镇痛方案的应用效果。方法:回顾性分析2019年1月1日—2021年12月31日我院肝包虫患者中实行肝部分切除术109例患者的临床资料,采用随机对照的方法将患者分为A组和B组,其中A组给予地佐辛注射液镇痛治疗,B组给予氟比洛芬酯联合曲马多注射液镇痛治疗,比较两组术后的疼痛评分、平均住院时间、镇痛药物平均费用、患者满意度及术后并发症和不良反应的发生率。结果:两组术后24 h疼痛评分、术后住院时间、镇痛药物平均费用、患者满意度比较,差异有统计学意义(P<0.05);两组术后48、72 h疼痛评分比较,差异无统计学意义(P>0.05)。A组不良反应发生率、并发症发生率高于B组,差异有统计学意义(P<0.05)。结论:地佐辛注射液与氟比洛芬酯注射液均可以降低术后疼痛,但氟比洛芬酯注射液因不良反应发生率低,经济适用性更强,满意度更高,值得临床使用。

选择性阻断肝动脉在肝囊型包虫外囊完整剥离术中的应用分析

目的探讨选择性阻断肝动脉血流在肝囊型包虫外囊完整剥离术中的应用效果。方法回顾分析新疆医科大学第一附属医院2017年1月至2019年1月连续接受手术治疗的80例肝囊型包虫病患者资料,其中男性36例,女性44例,平均年龄47岁。所有患者均行肝包虫外囊完整剥离术,依据术中血流阻断不同分为:A组(n=42),选择性阻断肝动脉;B组(n=38),阻断第一肝门血流。比较两组住院天数、术中出血量、术后通气时间以及并发症。比较两组术后丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、白蛋白、总胆红素。结果A组术中出血量(215.7±29.6)ml、术后通气时间(2.3±0.1)d、住院天数(11.6±1.0)d,少于B组(254.8±20.6)ml、(3.2±0.2)d、(12.7±0.7)d,差异有统计学意义(均P<0.05)。A组术后发生并发症4例(9.5%),B组发生并发症5例(13.2%),两组比较差异无统计学意义(P>0.05)。A组术后第3天ALT、AST、白蛋白和总胆红素均优于B组,差异有统计学意义(均P<0.05)。A组术后第5天ALT(62.8±5.2)U/L、AST(32.7±2.6)U/L、白蛋白(39.1±0.3)g/L、总胆红素(12.1±0.5)μmol/L,均优于B组(121.9±5.6)U/L、(53.9±8.0)U/L、(32.2±0.6)g/L、(19.3±0.9)μmol/L,差异有统计学意义(均P<0.05)。结论肝囊型包虫病外囊完整剥离术中选择性阻断肝动脉,在控制术中出血以及术后肝功能恢复等方面优于传统第一肝门血流阻断法。

离体肝切除和自体肝移植术治疗终末期肝多房棘球蚴病的住院医疗费用分析

收集2010-2018年新疆医科大学第一附属医院因终末期肝多房棘球蚴病实施离体肝切除和自体肝移植术(ELRA)治疗的患者人口学信息和相关临床病历资料数据,根据ELRA术前是否接受相应的诊疗分为6个组,无相关病史(A组)、抗虫化疗史(B组)、抗虫化疗+药物保肝史(C组)、穿刺或内镜减黄+药物保肝史(D组)、肝血管介入治疗+抗虫化疗史(E组)、肝切除+抗虫化疗史(F组)。采用Mann-Whinty检验比较分析各组之间医疗费用差异。共82例患者接受ELRA手术,男、女性别比为39:43,平均年龄(36.1±11.8)岁,主要民族有藏族、哈萨克族和汉族,患者主要来自新疆、西藏和四川。肝多房棘球蚴病患者接受ELRA治疗的医疗费用主要包括西药费、检查类费、材料费、手术费和特殊材料费等。82例患者平均总费用为(241 155.0±119 746.5)元,其中西药费占比最高(41.1%),其次是检查费(15.7%)、材料费(13.4%)、手术费(9.6%)、特殊材料费(7.5%)。C、D组总费用高于其他4组(P<0.01);西药费、检查费、护理费和治疗费C、D组高于其他4组(P<0.05);特殊材料费、血费、抢救费和床位费C、D组高于A组(P<0.05)。术前无相关病史者总体费用和各项费用均比有其他相关病史者低;术前有黄疸/肝功能不全因素可增加总体费用及大部分子项费用。

肝泡型棘球蚴病病灶微环境摄取氟代脱氧葡萄糖的特征研究

目的:研究肝泡型棘球蚴病病灶微环境在正电子发射计算机断层显像(PET/CT)中摄取氟代脱氧葡萄糖(^(18)F-FDG)的特征。方法:采用前瞻性研究方法,收集2017年1月至2019年12月在新疆医科大学第一附属医院治疗并行PET/CT检查的39例肝泡型棘球蚴病患者临床资料,其中男性17例,女性22例,中位年龄34岁,年龄范围15-65岁。根据CT所示的钙化和液化程度将患者病灶分6组:A-无钙化+无液化(n=7);B-明显钙化+无液化(n=7);C-部分钙化+部分液化(n=10);D-明显钙化+部分液化(n=5);E-部分钙化+近全液化(n=5);F-明显钙化+近全液化(n=5)。基于PET/CT测量病灶微环境摄取比值(TBR)及宽度W值,应用Mann-Whitney检验对各组进行比较。进行相关分析。结果:A-F各组TBR值依次为[M(Q_(1),Q_(3))]4.40(3.66,7.03)、2.55(1.69,3.60)、3.73(3.37,5.21)、2.90(2.75,3.60)、3.80(3.49,6.36)、2.49(2.21,3.97),其中A>B、A>D、A>F、C>B、E>B(U=3.0、4.0、4.5、11.0、5.0,P<0.05),从各组病灶的钙化程度的角度分析发现钙化越轻,TBR值越大。A-F各组的W值依次为[M(Q1,Q3)]12.5(10.0,19.5)、11.2(10.5,12.5)、12.2(10.9,13.2)、7.8(7.3,9.3)、10.0(7.3,13.4)、7.3(6.8,7.6)mm,其中A>D、A>F、B>D、B>F、C>D、C>F(U均为0,均P<0.05)。从各组病灶的钙化和液化程度的角度分析发现,钙化越轻,W值越大;液化越重,W值越小。TBR值与W值呈线性相关关系(r=0.4136,P<0.05)。结论:可根据基于^(18)F-FDG摄取的不同肝泡型棘球蚴病灶类型进行个体化选择根治性手术切缘和取材。

棘球蚴病临床领域相关中文专业术语专家共识

棘球蚴病(亦称包虫病)研究领域几乎包括了所有不同学科,在研究过程中规范使用相关领域专业术语至关重要。为了规范相关术语,世界棘球蚴病学会秉承语言精炼、科学严谨的原则启动了专业术语共识编撰工作,并于2020年在Parasite杂志刊登成果,引起学术界共鸣。撰写这版棘球蚴病领域术语英文版的专家来自不同国家和地区、不同研究领域。作为世界卫生组织棘球蚴病预防与管理合作中心和中国医师协会外科分会包虫病外科委员会主持机构,笔者参与撰写英文版专家共识,现将棘球蚴病临床领域相关术语共识中文版与国内专家研究者分享。此项工作包含了棘球蚴病临床诊治的各个领域,是寄生虫病尤其是棘球蚴病相关领域的科学和医学术语规范化的初次尝试。

肝泡型棘球蚴病病灶微环境中免疫细胞浸润范围指导研究取材的前瞻性研究

目的研究肝泡型棘球蚴病不同类型病灶的病灶微环境(LME)中免疫细胞浸润范围,为基础研究中实验组和对照组肝组织取材提供依据。方法采用前瞻性研究方法,2017年1月至2019年12月,收集在新疆医科大学第一附属医院确诊并经外科治疗满足多位点取材法(MSS法)取材的肝泡型棘球蚴病患者作为研究对象。共纳入26例,年龄为34(15,65)岁,男女性别比为12/14。根据增强计算机断层成像(CT)所示的钙化和液化程度将病灶分组:A组为无钙化+无液化;B组为明显钙化+无液化;C组为部分钙化+部分液化;D组为明显钙化+部分液化;E组为部分钙化+近全液化;F组为明显钙化+近全液化。在LME中由近及远每隔5 mm留取肝组织,进行CD3、CD19、CD68免疫组织化学染色以及纤维组织Masson染色,经病理学评估确定免疫细胞浸润丰度锐减的层面作为最大浸润范围(width,W值)。实验组保守估计最大取材范围为W值第1四分位数(Q_(1))整数位数值,对照组保守估计最小取材范围为W值第3四分位数(Q_(3))小数进位后整数位数值加5 mm。通过Kruskal-Wallis H检验和Mann-Whitney U检验对检测数据进行统计学分析。结果A~F组W值依次为20.0(12.5,22.5)、15.0(10.0,15.0)、10.0(10.0,15.0)、5.0(5.0,10.0)、12.5(6.3,15.0)、5.0(5.0,10.0)mm,其中A>D、A>F、C>D、C>F组(均P≤0.05);从钙化角度W值比较:A>C+E、A>B+D+F组(均P<0.05);从液化角度W值比较:A+B>C+D、A+B>E+F组(均P<0.05)。在A~F组中,实验组保守估计取材最大距离分别为12.0、10.0、10.0、5.0、6.0、5.0 mm,对照组保守估计取材最小距离分别为28.0、20.0、20.0、15.0、20.0、15.0 mm。结论肝泡型棘球蚴病病灶类型钙化越弱/液化越轻提示在LME中具有更宽的免疫细胞浸润范围;在为基础研究获取肝组织时,要根据不同类型病灶个体化取材以提高研究质量。