Modern treatment of liver alveococcosis

  • Authors: Yurkovskaya A.1, Zhao A.V.2, Stepanova Y.A.2
  • Affiliations:
    1. A.V. Vishnevsky National Medical Research Center of Surgery
    2. ФГБУ «Национальный медицинский исследовательский центр хирургии им. А.В. Вишневского» Минздрава России ул. Большая Серпуховская, д.27
  • Issue: Vol 11, No 2 (2022): Materials of the XV International Surgical Forum "INNOVATIVE TECHNOLOGIES IN SURGERY"
  • Pages: 83-86
  • Section: Хирургические дисциплины
  • URL: https://new.vestnik-surgery.com/index.php/2415-7805/article/view/7479

Cite item

Abstract

Alveolar echinococcosis of the liver (AE) occurs as a result of infection with larval forms of E. multilocularis. The only radical method of treating liver alveococcosis is surgery. However, the use and introduction of new methods of treatment (antegrade and retrograde stenting, cryodestruction of the remaining alveolar tissue), in addition, long-term use of albendazole can improve the results of treatment of such patients, as well as their quality of life.

The aim of the study: to improve the results of treatment, as well as the quality of life of patients with liver alveococcosis.
Materials and methods. The study included 150 patients with liver alveococcosis treated at the Vishnevsky National Research Medical Center of Surgery in the period from 2009 to 2021. There were 66 men (44%), 84 women (56%), the average age was 54 years (18-78 years). Scope of examination of patients: ultrasound + MSCT+MRI.
The results of the study. 140 (93%) patients underwent surgery, 21 (16.5%) patients underwent palliative interventions, the rest (n = 119) underwent liver resection in various volumes: radical (in volume R0) – 64 (53.8%); cytoreductive (in volume R 1-2) - 55 (46.2%). All patients were prescribed chemotherapy after surgery.
In 10 (7%) patients, the prevalence of the process did not allow surgical intervention (antiparasitic therapy with albendazole was prescribed).
At the time of admission, 21 (15%) hospitalized patients had mechanical jaundice. In order to resolve it, before surgery on the liver, he performed the following minimally invasive interventions: Bile duct stenting - 15; bile duct stenting - 7. In 18 cases, in the presence of a massive alveococcal lesion with a decay cavity in the center, external drainage of this cavity was performed.
Since 2012, we have been using cryodestruction (CD) of the remaining parasitic tissue using the Russian CRYO-01 apparatus and porous permeable cryoapplicators made of titanium nickelide. According to this method, 31 (26%) patients were operated on. Cryolysis was performed on the remaining/suspicious part of the pathological tissue on the right dome of the diaphragm (4), in the liver gate (7), on the remaining parenchyma of the left lobe after PGGE (10), on the remaining segments of the right lobe after resection (6), in the paraaortic tissue (3), along the right ureter (1).
The nature and frequency of complications in the postoperative period is presented
as follows: fluid accumulation – 4 (3.4%); biloma 10 (8.4%); failure
of biliodigestive anastomosis - 1 (0.8%); biliary peritonitis - 2 (1.7%); biliary fistula –
12 (10.1%); residual alveococcosis with the formation of bile duct stricture -
5 (4.2%); purulent cholangitis - 1 (0.8%); bleeding - 1 (0.8%); liver failure -3 (2.5%); suppuration of postoperative wound - 2 (1.7%). The postoperative period in 12 patients was complicated by the formation of a complete
external biliary fistula, which required the performance of CHCS, external-internal
drainage of the ducts of the right and left lobes of the liver (n = 8); ERPG, EPST, stenting
of the bile ducts (n=4). Stricture against the background of residual alveococcal lesion
developed in 5 patients, which required endoscopic intervention.
4 (4.8%) deaths were noted. One fatal outcome after RPPGE, supplemented by resection of segment 1 and NSAIDs with cryodestruction along the edge of liver resection along the right ureter. The reason is progressive multiple organ failure.
Conclusions. The use of combined treatment (radical resection; liver resection, supplemented by cryodestruction of the remaining parasitic tissue), minimally invasive methods of treatment under the control of radiation examination methods can be considered the most optimal and modern methods of treating liver AE. The decision on the choice of treatment method for such patients should be strictly individual, and the use of chemotherapy (taking albendazole) must be carried out in the postoperative period. These methods make it possible to correct complications in the n\o period, as well as to improve the quality of life of patients with liver alveococcosis.

Full Text

The aim of the study: to improve the results of treatment, as well as the quality of life of patients with liver alveococcosis.
Materials and methods. The study included 150 patients with liver alveococcosis treated at the Vishnevsky National Research Medical Center of Surgery in the period from 2009 to 2021. There were 66 men (44%), 84 women (56%), the average age was 54 years (18-78 years). Scope of examination of patients: ultrasound + MSCT+MRI.
The results of the study. 140 (93%) patients underwent surgery, 21 (16.5%) patients underwent palliative interventions, the rest (n = 119) underwent liver resection in various volumes: radical (in volume R0) – 64 (53.8%); cytoreductive (in volume R 1-2) - 55 (46.2%). All patients were prescribed chemotherapy after surgery.
In 10 (7%) patients, the prevalence of the process did not allow surgical intervention (antiparasitic therapy with albendazole was prescribed).
At the time of admission, 21 (15%) hospitalized patients had mechanical jaundice. In order to resolve it, before surgery on the liver, he performed the following minimally invasive interventions: Bile duct stenting - 15; bile duct stenting - 7. In 18 cases, in the presence of a massive alveococcal lesion with a decay cavity in the center, external drainage of this cavity was performed.
Since 2012, we have been using cryodestruction (CD) of the remaining parasitic tissue using the Russian CRYO-01 apparatus and porous permeable cryoapplicators made of titanium nickelide. According to this method, 31 (26%) patients were operated on. Cryolysis was performed on the remaining/suspicious part of the pathological tissue on the right dome of the diaphragm (4), in the liver gate (7), on the remaining parenchyma of the left lobe after PGGE (10), on the remaining segments of the right lobe after resection (6), in the paraaortic tissue (3), along the right ureter (1).
The nature and frequency of complications in the postoperative period is presented
as follows: fluid accumulation – 4 (3.4%); biloma 10 (8.4%); failure
of biliodigestive anastomosis - 1 (0.8%); biliary peritonitis - 2 (1.7%); biliary fistula –
12 (10.1%); residual alveococcosis with the formation of bile duct stricture -
5 (4.2%); purulent cholangitis - 1 (0.8%); bleeding - 1 (0.8%); liver failure -3 (2.5%); suppuration of postoperative wound - 2 (1.7%). The postoperative period in 12 patients was complicated by the formation of a complete
external biliary fistula, which required the performance of CHCS, external-internal
drainage of the ducts of the right and left lobes of the liver (n = 8); ERPG, EPST, stenting
of the bile ducts (n=4). Stricture against the background of residual alveococcal lesion
developed in 5 patients, which required endoscopic intervention.
4 (4.8%) deaths were noted. One fatal outcome after RPPGE, supplemented by resection of segment 1 and NSAIDs with cryodestruction along the edge of liver resection along the right ureter. The reason is progressive multiple organ failure.
Conclusions. The use of combined treatment (radical resection; liver resection, supplemented by cryodestruction of the remaining parasitic tissue), minimally invasive methods of treatment under the control of radiation examination methods can be considered the most optimal and modern methods of treating liver AE. The decision on the choice of treatment method for such patients should be strictly individual, and the use of chemotherapy (taking albendazole) must be carried out in the postoperative period. These methods make it possible to correct complications in the n\o period, as well as to improve the quality of life of patients with liver alveococcosis.

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About the authors

Angelina Yurkovskaya

A.V. Vishnevsky National Medical Research Center of Surgery

Email: medicvichnya333@yandex.ru
ORCID iD: 0000-0002-6823-9929
SPIN-code: 6385-5486

General Surgery Resident of the Abdominal Department of A.V. Vishnevsky National Medical Surgery Research Center

Russian Federation

Alexey Vladimirovich Zhao

ФГБУ «Национальный медицинский исследовательский центр хирургии им. А.В. Вишневского» Минздрава России ул. Большая Серпуховская, д.27

Email: medicvichnya333@yandex.ru
ORCID iD: 0000-0002-0204-8337
SPIN-code: 1101-6874

Doctor of Medical Sciences, Professor, Head of the Department of the A.V. Vishnevsky National Medical Research Center for Surgery of the Ministry of Health of the Russian Federation for Surgery; Professor of the Department of Emergency and General Surgery named after Professor A.S. Ermolov, Russian Medical Academy of Continuing Professional Education

Russian Federation

Yulia Alexandrovna Stepanova

Author for correspondence.
Email: medicvichnya333@yandex.ru
ORCID iD: 0000-0002-5793-5160
SPIN-code: 1288-6141

Ученый секретарь, профессор ФГБУ «НМИЦ хирургии им. А.В. Вишневского» Минздрава России

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