Laparoscopic management of benign solid and cystic lesions of the liver.
(1/289)
OBJECTIVE: The authors present their experience in the laparoscopic management of benign liver disease. The aim of the study is to analyze technical feasibility and evaluate immediate and long-term outcome. SUMMARY BACKGROUND DATA: Indications for the laparoscopic management of varied abdominal conditions have evolved. Although the minimally invasive treatment of liver cysts has been reported, the laparoscopic approach to other liver lesions remains undefined. METHODS: Between September 1990 and October 1997, 43 patients underwent laparoscopic liver surgery. There were two groups of benign lesions: cysts (n = 31) and solid tumors (n = 12). Indications were solitary giant liver cysts (n = 16), polycystic liver disease (n = 9), hydatid cyst (n = 6), focal nodular hyperplasia (n = 3), and adenoma (n = 9). Only solid tumors, hydatid cysts, and patients with polycystic disease and large dominant cysts located in anterior liver segments were included. All giant solitary liver cysts were considered for laparoscopy. Patients with cholangitis, cirrhosis, and significant cardiac disease were excluded. Data were collected prospectively. RESULTS: The procedures were completed laparoscopically in 40 patients. Median size was 4 cm for solid nodules and 14 cm for solitary liver cysts. Conversion occurred in three patients (7%), for bleeding (n = 2) and impingement of a solid tumor on the inferior vena cava (n = 1). The median operative time was 179 minutes. All solitary liver cysts were fenestrated in less than 1 hour. There were no deaths. Complications occurred in 6 cases (14.1%). Two hemorrhagic and two infectious complications were noted after management of hydatid cysts. There were no complications after resection of solid tumors. Three patients received transfusions (7%). The median length of stay was 4.7 days. Median follow-up was 30 months. There was no recurrence of solitary liver or hydatid cysts. One patient with polycystic disease had symptomatic recurrent cysts at 6 months requiring laparotomy. CONCLUSION: Laparoscopic liver surgery can be accomplished safely in selected patients with small benign solid tumors located in the anterior liver segments and giant solitary cysts. The laparoscopic management of polycystic liver disease should be reserved for patients with a limited number of large, anteriorly located cysts. Hydatid disease is best treated through an open approach. (+info)
Alveolar echinococcosis in China.
(2/289)
DATA SOURCES: All reference data originated from related Chinese- or English-language literature in Chinese journals. STUDY SELECTION: Twenty-three original articles published in 1992-1996 were selected according to the stated purpose and 9 of them were written by myself. DATA EXTRACTION: The present paper dealt with 5 subtopics, i.e. epidemiology, parasitology, pathology, diagnosis, treatment and prognosis. RESULTS: Five hundred and eighty-four patients with alveolar echinococcosis (AE) have been reported from 7 provinces or autonomous regions. Human infection rate was 19.2% or 2.8%, and the morbidity was 2.4%-5.0%. The intermediate hosts of Echinococcus multilocularis included 7 species of rodents and 3 species of livestocks, and the final hosts of that were fox, dog or wolf. Diagnosis of AE was chiefly based on imaging examination (ultrasound and CT) and immunological test. The operative resection rate for liver AE was only 10.5% (27/258). Albendazole was a certain remedy for the chemotherapy of AE, and TCM "Xiao-Bao" pill may be a hopeful drug. CONCLUSIONS: In the past 30 years, a lot of work concerning basic and clinical studies has been done in China and some achievements have been achieved. However, some important problems such as how to conduct further research on molecular biology, how to make early diagnosis, how to improve the chemotherapeutic effect, and how to control the prevalence of AE, need to be studied more deeply in the 21st century. (+info)
Diagnosis and classification of hepatic echinococcosis by ultrasonography.
(3/289)
OBJECTIVE: To make an early and correct diagnosis of hepatic echinococcosis. METHODS: A total of 1092 patients with hepatic echinococcosis underwent operation in our hospital between 1984 and 1995. Of these patients, 427 (39.1%) were cases with complications, including secondary infection, rupture, obstructive jaundice, anaphylactic shock, disseminated implantation with resultant multiple echinococcosis and portal hypertension. The ultrasonic examination has been generally used in clinical practice for comprehensive evaluation which can dectedct the preoperative diagnostic accuracy rate. RESULTS: B-mode ultrasonography can be used not only to detect the location, dimension and pathological characteristics of hydatid cyst but also to show the pathological changes of various complications caused by echinococcosis. Seven patterns specific ultrasonic scanning images were revealed. In this series the diagnostic accuracy rate reached 98.8%. CONCLUSIONS: Ultrasonic examination is harmless to human body, and has been widely used in combination with immunological tests in clinical and epidemiological studies to detect the asymptomatic parasite carriers in early stage and to improve the preoperative diagnostic accuracy rate. (+info)
Immunological diagnosis of human cystic echinococcosis: utility of discriminant analysis applied to the enzyme-linked immunoelectrotransfer blot.
(4/289)
An enzyme-linked immunoelectrotransfer blot for the diagnosis of human hydatid disease was performed, and the different antibody responses were analyzed by a discriminant analysis. This multivariate technique gave us, first, a selection of the most important responses against Echinococcus granulosus infection and, second, a procedure for the classification of patients into two groups: patients with hydatid disease and patients without a history of hydatid disease. This method was applied to 67 patients, 25 with active hydatid cysts (24 hepatic and 1 pulmonary) and 42 without a history of hydatid disease and was compared with the results obtained by conventional serology: indirect hemagglutination, latex particle agglutination, and basophil degranulation. An immunoelectrotransfer blot coupled to a discriminant analysis was more sensitive than conventional serological diagnosis and detected 100% of patients with an active hepatic hydatid cyst with a specificity of 100%. This method, however, failed to detect an uncomplicated hyaline pulmonary hydatid cyst. (+info)
The real incidence of extracapsular (satellite) cysts of liver echinococcus.
(5/289)
BACKGROUND: The presence of extracapsular (Satellite) cysts in liver echinococcus granulosus is known for many years. In one of our previous studies of radiological (CT) material they were found to be present in 16% of cases. METHODS: In the present study the operative findings, in cases of total capsectomy (cystopericystectomy) or partial lobectomy are presented. RESULTS: The real incidence of these cysts in operative specimens was as high as 29,5%. They were present in 15 out of 51 totally excised cysts. CONCLUSIONS: We conclude that satellite cysts are present more often than they are radiologically detected. As they can be incriminated as a cause of recurrence of the disease they must be excised en block with the main parasitic cysts, by means of more radical procedures such as cystopericystectomy or partial hepatectomy, whenever it is feasible. (+info)
Surgical management of calcified hydatid cysts of the liver.
(6/289)
Hydatid disease of the liver is still a major cause of morbidity in Greece. Beside the common complications of rupture and suppuration, calcification of the hepatic cysts represent a not well studied, less frequent and sometimes difficult surgical problem. In the present study 75 cases with calcified symptomatic liver echinococcosis were operated on in the 1st Propedeutic Surgical Clinic between 1964 to 1996. Twenty-eight patients were male and 47 female with ages from 23 to 78 years. The diagnosis was based mainly on the clinical picture and radiological studies. In 5 cases the operative method was cystopericystectomy. We performed evacuation of the cystic cavity and partial pericystectomy and primary closure of the residual cavity in 6 cases, omentoplasty or filling of the residual cavity with a piece of muscle of the diaphragm in 4 cases and external drainage by closed tube, in 60 cases. In 12 of those with drainage, after a period of time, a second operation with easy, removal of most of the calcareous wall plaques was performed. The mortality rate was 2%. Our results could be considered satisfactory. In the calcified parasitic cysts of the liver the proposed technique is cystopericystectomy. An alternative procedure is pericystectomy and drainage with a "planned" reoperation with a bloodless, due to intervening inflammation, chiseling of the calcification. (+info)
Long-term evaluation of patients with hydatidosis treated with benzimidazole carbamates.
(7/289)
Four hundred forty-eight patients with 929 Echinococcus granulosus hydatid cysts received 3- to 6-month continuous cycles of mebendazole or albendazole treatment and underwent prolonged follow-up by clinical visits and imaging studies (range, 1-14 years) to assess the long-term outcome of treatment. Degenerative changes and relapse were assessed by imaging techniques. At the end of therapy, 74.1% of the hydatid cysts showed degenerative changes. These were more frequent in albendazole-treated than in mebendazole-treated cysts (82.2% vs. 56.1%; P < .001). During long-term follow-up, 104 cysts (22%) had degenerative changes that progressed, whereas 163 cysts (approximately 25%) relapsed. The percentages of relapses in the two drug-treated groups were almost the same. Relapses occurred more frequently in type II cysts of the liver. Cysts recurred most often (78.5%; P < .001) within the first 2 years after treatment ended. Further chemotherapy cycles induced degenerative changes in >90% of relapsed cysts without inducing more frequent or more severe side effects than those observed during the initial cycles. (+info)
Pericystic metabolic activity in alveolar echinococcosis: assessment and follow-up by positron emission tomography.
(8/289)
Information on parasite viability in alveolar echinococcosis (AE) cannot be obtained by conventional imaging techniques. We evaluated the glucose metabolism of AE lesions by use of [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) in 12 inoperable patients. Eight patients showed either perilesional or focal enhancement ("hot spots"), whereas 4 patients had nonenhancing (metabolically inactive) lesions. With PET, necrotic parasitic lesions and areas of enhanced metabolic activity could be clearly discriminated. Most notably, 3 of 8 patients with metabolically active lesions who were reexamined after chemotherapy treatment clearly showed improvement: the initial surrounding hot spots had disappeared in 2 of them, and had significantly decreased in 1. PET may prove valuable in assessing the efficacy of chemotherapy by showing the disappearance of metabolic activity and may also be useful for timely detection of relapses and metastases. Although costly and not readily available, FDG-PET is a promising tool toward improved management of AE and may thus help lower costs of long-term chemotherapy. (+info)