Clinical Characteristics Of 193 Patients With Hepatic Alveolar Echinococcosis Complicated With Extrahepatic Organ Involvement

Objective: The clinical and imaging features of 193 patients with hepatic alveolar echinococcosis affected by extrahepatic organs were retrospectively analyzed.The relationship between extrahepatic metastatic organs and the location of lesions was analyzed,and 98 cases of hepatic alveolar echinococcosis with surgical intervention were further explored.The clinical treatment strategy of echinococcosis provides the necessary theoretical basis and detailed clinical materials for the diagnosis,clinical observation and treatment of hepatic alveolar echinococcosis in the endemic areas.Methods: 1.To retrospectively analyze the clinical and imaging features of 193 patients with hepatic alveolar echinococcosis involving extrahepatic organs admitted to the Affiliated Hospital of Qinghai University from October 2015 to December 2017.To analyze the differences in age,gender,group and region of patients with hepatic alveolar echinococcosis,and to further investigate whether the primary liver metastasis was statistically significant in extrahepatic organ metastasis.2.According to the distribution of lesions,98 patients who underwent surgical intervention were divided into quasi-radical resection group(n=61),palliative resection group(n=29),and liver transplantation group(n=8)according to the treatment.The patient’s operation time,intraoperative blood loss,postoperative complications and recurrence follow-up were analyzed.Statistical analysis was performed on the data using SPSS 20.0 statistical software.Results: 1.Of the 193 patients,89 were male and 104 were female,with an age range of 5 to 72 years,a median age of 41 years,and a male to female ratio of 1:1.17.Tibetans and low-education patients(72.53% of illiterates,primary school accounted for 72.53%)11.92%)is the key population of the disease;all patients are from Qinghai,and the distribution is mostly in Guoluo and Yushu Qinghai.2.Multivariate logistic analysis found that liver lesion diameter(Hazard ratio [HR],0.535;95% confdence interval [CI]: 0.327 to 0.874;P = 0.013),liver S8 segment(Hazard ratio [HR],1.877;95% confdence Interval [CI]: 1.026 to 3.437;P = 0.041)was closely related to lung metastasis of extrahepatic organs;liver S7(Hazard ratio [HR],5.689;95% confdence interval [CI]: 1.913 to 16.915;P = 0.002)Significant correlation with brain metastasis of extrahepatic organs.3.The incidence of complications in palliative resection was 41.4%(12/29),including 5 cases of bile leakage complicated with residual cavity infection,3 cases of pulmonary infection with pleural effusion,2 cases of obstructive jaundice;1 case of wound infection;1 case Bile duct-bronchial leak;postoperative recurrence rate was 17.2%(9/29),and 3 patients died during follow-up.There was no statistically significant difference in postoperative complications and recurrence rates between the quasi-radical resection group and the palliative resection group(P < 0.05),but the difference in operative time and blood loss was statistically significant(P < 0.05).Among the 8 patients who underwent liver transplantation,1 patient had multiple organ failure after acute rejection,2 patients had gastrointestinal bleeding due to coagulopathy,1 patient had hepatorenal syndrome,and the remaining 4 patients had long-term survival.Conclusions: 1.The location of the primary liver is located in the S7 and S8 segments of the right liver.The adjacent organs or tissues of the liver are involved in the gallbladder,kidney,diaphragm,pancreas,etc.The extrahepatic distant metastases are mostly lung,brain,etc.,and by using single factor and Multivariate logistic regression analysis showed that the primary S8 segment of the liver was closely related to the lung.The S7 segment of the liver was significantly associated with brain metastasis,and there was a statistical difference in the diagnosis of specific organ metastasis outside the liver.2.Hepatic alveolar echinococcosis has a higher incidence of postoperative complications and a lower rate of postoperative recurrence.The treatment plan for complicated hepatic alveolar echinococcosis should be individualized,in combination with multidisciplinary and highlighting damage controlduring surgery,in order to maximize patients benefits.