It is presented care report of the patient with liver alveococcosis. Survey confirmed parasitic invasion of both liver lobes. Radical alveococcectomy was impossible under these conditions since remnant liver volume was less than 30%. Treatment was divided into two stages. Moreover, it was decided to perform cryodestruction of parasitic tumor besides surgical intervention per se. Liver resection combined with cryodestruction of remnant parasitic tumor may be considered as radical treatment especially in redo surgery. Diagnosis, treatment, outcomes and literature review are comprehensively described in the article.
Alveolar echinococcosis (AE) is a rare anthropozoonotic parasitic disease, which can affects the liver, lungs and other organs. R0-radical liver resection is the sole curative therapy for the patients with AE. Size of the parasitic foci, distant dissemination, and involvement of main liver vessels – all this information allows the surgeon to make the right decision about practicability and volume of operation. Formerly, ultrasonography (US) was not method of choice for the qualitative pre-operative diagnostic of AE. Nevertheless nowadays development of new technologies allows US to be an equal to CT and MRI.The aim:to estimate the possibilities of US in the planning of surgery in patients with AE.Materials and methods.The data of 64 patients who were undergone complete liver resection or reduction surgery in A.V. Vishnevsky Surgery Institute in period from January 2008 to December 2016 we respectively analyzed. Specificity and sensitivity of US, CT and MRI were analyzed and ROC-curves were constructed. Statistical significance was calculated using Chi-square.Results.The efficiency of US was significantly comparable to CT and MRI when we analyzed the involved of porta hepatis, vena cava, hepatic veins. Assessment of involvement of liver arteries and vena porta was not statistical significant.Conclusion.Accumulated experience of A.V. Vishnevsky Surgery Institute shows the possibility of qualitative preoperationUS evaluation of AE-lesion, which has to include assessment of distant dissemination and involvement of the liver main vessels. In a big surgical hospitals, which has an experience of AE treatment, pre-operative US can become the method of choice in planning of surgical operation.
Among parasitic diseases, liver alveococcosis is a particular complication. It is often compared with parasitic liver cancer, due to infiltrative growth, the possibility of metastasis, as well as the high frequency of relapse after surgical treatment. However, the main difference between the course of alveococcosis liver damage is a slow infiltrative growth, which, in combination with large compensatory capacities of the hepatic tissue, often leads to the fact that the clinical manifestations of the disease occur late, even with a significant spread of the pathological process, at the stage of complications. At the same time, complete operative re moval of the tumor remains the only radical treatment for such patients. We present the clinical case of the diagnosis and multistage treatment of the patient E., 57 years old, with the widespread liver alveococcosis involving the inferior vena cava.
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