Objective To summarize the research status of echinococcosis- specific vaccine antigens, analyze their sources and application prospects, and to provide new ideas for the development of echinococcosis vaccine antigens and drug treatment. Method Research on echinococcosis-specific vaccine antigens at home and abroad was searched and reviewed. Results Natural hydatid antigens, such as cystic fluid crude antigen, protoscolex segment, germinal layer, etc. often appear due to the difficulty of material acquisition and cumbersome preparation, resulting in unstable evaluation indicators such as sensitivity and specificity. The gene or protein sequences of a new recombinant hydatid antigen was accessible, the reproducibility and specificity were better, and it was more suitable for batch production testing, which was the main direction of current research, such as rAgB8/1, rEm18, rEm2, etc. Conclusions Vaccine development is one of the main directions for the elimination of hydatidosis. In the interaction between echinococcus and human or animal hosts, the natural structural proteins or excretion/secretion proteins of echinococcus stimulate the host to produce anti-parasites immunity and immune clearance, and the search for these specific protein antigens is of great significance for vaccine development, and new drug treatment.
ObjectiveTo explore the effect of the surgery with laparoscope combined with choledochoscope on plateau hepatic hydatid biliary fistulas. MethodsA total of 100 patients with liver hydatid disease diagnosed between January 2012 and June 2013 were divided into two groups according to the admitting time:laparoscope combined with choledochoscope group (combined group) and laparoscope group, with 50 patients in each group. The therapeutic results of the two groups were compared. ResultsA total of 186 biliary fistulas were found in the combined group during the operation, and there were 5 patients with biliary fistulas after the surgery; while 87 biliary fistulas were found in laparoscope group during the operation and there were 16 patients with biliary fistulas after the surgery. The difference in the occurrence rate of biliary fistulas after surgery between the two groups was significant (χ2=7.294, P=0.007). No infection of incisional wound was found in combined group but 5 infection was found in laparoscope group. The postoperative extubation time in the combined group and laparoscope group was (10.35±3.87) and (27.16±4.58) days, respectively, with a significant difference (t=12.538, P<0.001). ConclusionThe laparoscope combined with choledochoscope is a minimally invasive and safe therapeutic option for plateau hepatic hydatid biliary fistulas.
Hepatic alveolar echinococcosis (HAE) is a severe zoonotic disease caused by Echinococcus multilocularis, primarily affecting the liver. Due to its insidious nature, the patients are often diagnosed at advanced stage, posing significant treatment challenges. We comprehensively examines the progress in surgical techniques for HAE management, focusing on various strategies across different disease stages. For the patients with early-stage HAE, ablation therapy has emerged as an effective treatment option. In the moderate to advanced cases, numerous surgical techniques and innovative approaches have been introduced, including laparoscopic surgery and liver transplantation, with particular emphasis on ex vivo liver resection and autotransplantation. These advancements offer more effective treatment options for the patients with advanced HAE. However, significant challenges persist, notably the preservation of adequate liver function while achieving complete lesion removal. Future research should prioritize the exploration and optimization of existing surgical methods, especially for advanced HAE cases. This includes refining surgical techniques through precise preoperative evaluation and staging, as well as developing novel surgical approaches to enhance safety and efficacy. Furthermore, multicenter and long-term follow-up prospective studies are crucial for validating the effectiveness of new surgical techniques and strategies. Through these concerted efforts, it is anticipated that the survival rates and quality of life for HAE patients will significantly be improved, marking a new era in the management of this complex disease.
ObjectiveTo investigate the risk factors affecting severe postoperative complications (Clavien-Dindo classification Ⅲa or higher) in patients with end-stage hepatic alveolar echinococcosis (HAE) underwent ex vivo liver resection and autotransplantation (ELRA), and to develop a nomogram prediction model. MethodsThe clinical data of end-stage HAE patients who underwent ELRA at the West China Hospital of Sichuan University from January 2014 to June 2024 were retrospectively analyzed. The logistic regression was used to analyze the risk factors affecting severe postoperative complications. A nomogram prediction model was established basing on LASSO regression and its efficiency was evaluated using receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis. Simultaneously, a generalized linear model regression was used to explore the preoperative risk factors affecting the total surgery time. Test level was α=0.05. ResultsA total of 132 end-stage HAE patients who underwent ELRA were included. The severe postoperative complications occurred in 47 (35.6%) patients. The multivariate logistic analysis results showed that the patients with invasion of the main trunk of the portal vein or the first branch of the contralateral portal vein (type P2) had a higher risk of severe postoperative complications compared to those with invasion of the first branch of the ipsilateral portal vein (type P1) [odds ratio (OR) and 95% confidence interval (CI)=8.24 (1.53, 44.34), P=0.014], the patients with albumin bilirubin index (ALBI) grade 1 had a lower risk of severe postoperative complications compared to those with grade 2 or higher [OR(95%CI)=0.26(0.08, 0.83), P=0.023]. Additionally, an increased total surgery time or the autologous blood reinfusion was associated with an increased risk of severe postoperative complications [OR(95%CI)=1.01(1.00, 1.01), P=0.009; OR(95%CI)=1.00(1.00, 1.00), P=0.043]. The nomogram prediction model constructed with two risk factors, ALBI grade and total surgery time, selected by LASSO regression, showed a good discrimination for the occurrence of severe complications after ELRA [area under the ROC curve (95%CI) of 0.717 (0.625, 0.808)]. The generalized linear regression model analysis identified the invasion of the portal vein to extent type P2 and more distant contralateral second portal vein branch invasion (type P3), as well as the presence of distant metastasis, as risk factors affecting total surgery time [β (95%CI) for type P2/type P1=110.26 (52.94, 167.58), P<0.001; β (95%CI) for type P3/type P1=109.25 (50.99, 167.52), P<0.001; β (95%CI) for distant metastasis present/absent=61.22 (4.86, 117.58), P=0.035]. ConclusionsFrom the analysis results of this study, for the end-stage HAE patients with portal vein invasion degree type P2, ALBI grade 2 or above, longer total surgery time, and more autologous blood transfusion need to be closely monitored. Preoperative strict evaluation of the first hepatic portal invasion and distant metastasis is necessary to reduce the risk of severe complications after ELRA. The nomogram prediction model constructed based on ABLI grade and total surgery time in this study demonstrates a good predictive performance for severe postoperative complications, which can provide a reference for clinical intervention decision-making.
Objective To investigate the indication and possibility of orthotopic liver transplantation for patient with alveolar hydatid disease. Methods An orthotopic liver transplantaion was successfully performed on two cases with unresectable alveolar hydatid disease using the new approach of venovenous bypass first.Results The recovery of liver graft function was good after the operation in these patients. Following up for nine and three months, the patients returned to his work without any complications. Conclusion It suggests that the case with advanced alveolar hydatid disease are an indication for liver transplantation. The new technique of venovenous bypass prior to mobilization of liver is feasible and safe.
ObjectiveTo evaluate the effect of dilute autotransfusion in liver resection for patients with hepatic hydatid disease. MethodThirty patients with hepatic hydatid disease met the inclusion criteria were included. The changes of intraoperative hemodynamics, internal environment, and each system functions at different time point were observed. Results①There were no significant differences among mean arterial pressure, central venous pressure, heart rate in all the patients at each time point (P > 0.05), while, the other indexes including the concentrations of hemoglobin (Hb), hematocrit (Hct) after blood collection were all greatly lower than those before blood collection (P < 0.05), Na+, K+, Cl-, pH, and base excess after blood collection were all greatly lower than those before blood collection (P < 0.05). But all the indexes above mentioned (except for ph and base excess) returned to normal.②Compared with these indicators before surgery, the blood concentrations of AST, ALT, cardiac troponin I, and creatinin were all greatly increased (P < 0.05), the blood concentrations of Hb, Hct, platelet were all decreased apparently after surgery 1 day (P < 0.05). The prothrombin time and activated partial thromboplastin time were all prolonged (P < 0.05). But after surgery one week, those indicators had rebounded to the normal range. ConclusionThe application of dilute autotransfusion in liver surgery for patients with hepatic hydatid disease is safe, feasible, and saving.
ObjectiveTo explore the safety and efficacy of preoperative liver regeneration and then two-stage liver resection for advanced hepatic alveolar echinococcosis (HAE) patients pre-evaluating insufficient future liver remnant (FLR) after resection. MethodThe clinical data of the advanced HAE patients who were expected to have insufficient FLR after liver resection and underwent two-step liver resection in the Sichuan Provincial People’s Hospital from December 2016 to December 2022 were retrospectively collected and summarized. ResultsA total of 11 patients with advanced HAE pathologically confirmed were collected. Among them, 2 cases underwent portal vein embolization (PVE), 2 cases underwent liver vein deprivation (LVD), and 7 cases underwent associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) to promote residual liver regeneration in the first stage. The FLR/standard liver volume (SLV) exceeded the surgical requirement standard of 40%. Then the ex-vivo liver resection and autotransplantation, or directly radical liver resection was performed in the second stage. Only one patient underwent surgery to remove packed gauze on day 3 postoperatively due to massive intraoperative bleeding (approximately 4 000 mL). The median (P25, P75) follow-up time after surgery was 36 (15, 75) months, only one case was found to relapse at the third year after surgery and underwent surgical resection again, and the rest patients had no recurrence, long-term complications, or death. ConclusionsBased on the results from these cases, applying PVE, LVD, or ALPPS in the patients with advanced HAE who were expected to have insufficient FLR after resection aids to residual liver regeneration, creating conditions for the second stage radical resection. The second stage treatment including ex-vivo liver resection and autotransplantation or directly radical liver resection could achieve good results and is feasible and safe, which brings a hope of survival for the advanced HAE patients who could not previously undergo curative resection. However, this treatment strategy still incurs high costs and requires further optimization in the future.
【Abstract】ObjectiveTo introduce the clinical appliance of liver transplantation (LT) in the therapy of alveolar hydatid disease (AHD).MethodsThe related literatures were collected and reviewed.ResultsThe 5year survival rate of AHD was 71% after LT. Removing the liver and preventing the recurrence are the two major difficulties in the treatment.ConclusionAs the only feasible and effective therapy for advanced AHD, LT should be studied further.
We comprehensively outlined the application of imaging, immunology, and molecular biology techniques in the detection of hepatic echinococcosis (HE). Imaging techniques, represented by ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography, not only provided some critical information about the morphology, location, and characteristics of HE lesions, but also could be combined with artificial intelligence technologies to enhance the diagnostic capabilities and expand the application scenarios. These techniques were essential tools for the diagnosis, screening, and prevention of HE. Immunological techniques, such as the indirect hemagglutination assay, enzyme-linked immunosorbent assay, immunoblotting, and chemiluminescence immunoassay, aided in diagnosis and differential diagnosis by detecting the specific antibodies. Molecular biology techniques, such as polymerase chain reaction and high-throughput sequencing, provided a strong support for the diagnosis and pathogen identification of HE due to their high sensitivity and specificity. Based on these three major technologies, more sensitive, specific, convenient, and cost-effective detection techniques had emerged, offering more options for the detection and control of HE. Additionally, constructing comprehensive diagnostic models by combining the advantages of different detection technologies will aid to improve the diagnostic efficiency of HE.
Objective To summarize the research status of percutaneous ultrasound interventional therapy for the patients with hepatic echinococcosis, and to provide some experience and reference for the treatment of disease in clinical medical personnel. Method The relevant literature on percutaneous ultrasound intervention therapy for hepatic echinococcosis both domestically and internationally was summarized and analyzed. Results For the patients with hepatic cystic echinococcosis (HCE), ultrasound-guided percutaneous transhepatic drainage is safe and effective for the World Health Organization Informal Working Group classification CE1 and CE3a cysts. For the patients with hepatic alveolar chinococcosis (HAE), although radical resection is still the gold standard, ultrasound-guided microwave ablation had better postoperative recovery and less trauma for patients with lesion diameter ＜5 cm; Due to limited research on the efficacy and safety of ultrasound-guided radiofrequency ablation for patients with HAE, further exploration is needed; Ultrasound guided percutaneous cyst puncture drainage is used for external drainage of necrotic material in the cyst cavity, which can effectively control infection and remove necrotic tissue; percutaneous transhepatic cholangial drainage (PTCD) could effectively relieve biliary obstruction, improve liver function, and enhance the quality of life of patients with advanced HAE complicated with obstructive jaundice. Conclusions Ultrasound-guided percutaneous interventional techniques have their own advantages and disadvantages in treatment of hepatic echinococcosis. For patients with HCE, strict indications and contraindications should be followed when performing percutaneous ultrasound interventions. For patients with HAE, early-stage small lesions should be prioritized for microwave ablation, and patients in the middle and late stages with larger lesions or those with intra-cyst infection or jaundice should be treated with percutaneous cyst puncture drainage and PTCD to alleviate symptoms, following the second stage operation.