Clinical Diagnosis And Treatment Of Fifty-Five Cases Of Hepatic Alveolar Echinococcosis Combined With Lymph Node Metastasis

Objective: 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 1January 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.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(=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 of16.4%,21.7%,and 34.2% were reported for preoperative abdominal ultrasound,magnetic resonance imaging,and computed tomography examinations.All patients were intraoperatively suspected with enlarged lymph nodes and underwent radical liver resection 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 51single-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(=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: A particular type of metastasis in hepatic AE is lymph node metastasis.A higher rate of lymph node metastasis was observed in women and patients with intermediate to advanced hepatic AE.Single or multiple groups of lymph nodes can be involved in lymph node metastasis through the deep and superficial lymphatic reflux of the liver.Additionally,jumping metastasis,affecting the para-hepatoduodenal ligament lymph nodes,is commonly observed.A low preoperative detection rate was observed for all imaging types,and histopathological examination was considered the gold standard for diagnosis.Hepatic AE can be safely,feasibly,and effectively treated with radical hepatectomy combined with regional lymph node dissection when lymph node metastasis is highly suspected preoperatively or intraoperatively.