Surgical Treatment of Alveococcosis Complicated by Obstructive Jaundice
https://doi.org/10.16931/1995-5464.201649-15
Abstract
Aim. To analyze clinical features and surgical results in patients with liver alveococcosis complicated by obstructive jaundice.
Material and Methods. 39 patients with liver alveococcosis complicated by obstructive jaundice were operated. 49 different interventions were carried out. General clinical diagnosis and modern instrumental methods of examination were used.
Results. The incidence of jaundice in liver alveococcosis was 14.1%, duration of the disease was over 10 years, duration of jaundice – from several months to several years. 3 types of clinical course were observed. 65.5% of patients had other complications of parasitic process, 30% – combination of several complications. 55.4% of patients have already been operated previously. 65% of patients had severe liver failure at admission. The main method of diagnosis was ultrasound. Nasobiliary drainage and percutaneous transhepatic cholangiostomy were used for preoperative biliary decompression. All patients underwent only drainage operations (within two stages as a rule). NiTi-stents were used for external drainage, fistuloenterostomy in 11 patients with good results. The mortality rate was 10.2%.
Conclusion. Obstructive jaundice in liver alveococcosis has three types of course depending on process localization. They have different duration and severity of cholestasis. Two-stage surgery is advisable and NiTi-stents are perspective. Drainage operations prolong life of inoperable patients for about 6.5 ± 1.2 years.
About the Authors
N. V. Merzlikin
Siberian State Medical University, Russian Ministry of Health
Russian Federation
Depatment of Surgical Diseases, Faculty of Pediatrics
Russian Federation
Depatment of Surgical Diseases, Faculty of Pediatrics
B. I. Alperovich
Siberian State Medical University, Russian Ministry of Health
Russian Federation
Depatment of Surgical Diseases, Faculty of Pediatrics
Russian Federation
Depatment of Surgical Diseases, Faculty of Pediatrics
V. F. Tskhai
Siberian State Medical University, Russian Ministry of Health
Russian Federation
Depatment of Surgical Diseases, Faculty of Pediatrics
Russian Federation
Depatment of Surgical Diseases, Faculty of Pediatrics
N. A. Brazhnikova
Siberian State Medical University, Russian Ministry of Health
Russian Federation
Depatment of Surgical Diseases, Faculty of Pediatrics
Russian Federation
Depatment of Surgical Diseases, Faculty of Pediatrics
V. G. Navasardyan
Siberian State Medical University, Russian Ministry of Health
Russian Federation
Depatment of Surgical Diseases, Faculty of Pediatrics
Russian Federation
Depatment of Surgical Diseases, Faculty of Pediatrics
I. S. Zaytsev
Tomsk City Hospital №3
Russian Federation
Russian Federation
References
1. Bregadze I.L. Al'veoljarnyj jehinokokkoz [Alveolar hydatid disease]. Moscow: Medicina, 1963. 218 p. (In Russian)
2. Zhuravlev V.A. Liver alveococcosis. Annaly khirurgicheskoy gepatologii. 1997; 2 (1): 9–14. (In Russian)
3. Rudakov V.A., Okhotina G.N., Rudakova O.V. Khirurgicheskoe lechenie al'veokokkoza pecheni, oslozhnennogo mehanicheskoj zheltuhoj [Surgical treatment of liver alveococcosis complicated by obstructive jaundice]. Actual problems of surgical hepatology: Proceedings of the fifth conference of surgeons-hepatologists. 1997. P. 58. (In Russian)
4. Tskhai V.F., Brazhnikova N.A., Alperovich B.I., Merzlikin N.V.,Mar'ina M.E., Yaroshkina T.N., Kuracheva N.A. Parazitarnye mehanicheskie zheltuhi [Parasitic mechanical jaundice]. Tomsk, 2013. 230 p. (In Russian)
5. Merzlikin N.V., Al'perovich B.I., Brazhnikova N.A., Tskhai V.F., Sotnikov A.A., Komkova T.B., Avdeev S.V., Gyunter V.E., Mar'ina M.E., Yaroshkina T.N., Tolkaeva M.V., Klino vitskiy I.Yu. Rukovodstvo po khirurgii ochagovyh parazitarnyh zabolevanij pecheni [Guidelines for surgery of focal parasitic liver disease]. Ed. Merzlikin N.V. Tomsk: Publishing house “Print Manufactory”, 2014. 468 p. (In Russian)
6. Al'perovich B.I. Кhirurgija pecheni [Liver Surgery]. Moscow: GEOTAR-MED, 2010. 352 p. (In Russian)
7. Ishizu H., Uchino J., Sato N., Aoki S., Suzuki K., Kuribayashi H. Effect of albendazole on recurrent and residual alveolar echinococcosis of the liver after surgery. Hepatology. 1997; 25 (3): 528–531.
8. Kawamura N., Kamiyama T., Sato N., Nakanishi K., Yokoo H., Kamachi H., Tahara M., Yamaga S., Matsushita M., Todo S. Long-term results of hepatectomy for patients with alveolar echinococcosis: a single-center experience. J. Am. Coll. Surg. 2011; 212 (5): 804–812. doi: 10.1016/j.jamcollsurg.2011.02.007.
9. Ammann R.W., Eckert J. Cestodes. Echinococcus. Gastroenterol. Clin. North Am. 1996; 18 (13): 655–689.
10. Vogel J., Gorich J., Kramme E., Merkle E., Sokiranski R., Kern P., Brambs H.J. Alveolar echinococcosis of the liver: percutaneous stent therapy in Budd-Chiari syndrome. Gut. 1996; 39 (5): 762–764.
11. Heyd B., Weise L., Bettschart V., Gillet M. Surgical treatment of hepatic alveolar echinococcosis. Chirurg. 2000; 71 (1): 16–20.
12. Zhuravlev V.A. Ochagovye zabolevanija pecheni i giljusnye opuholi, oslozhnennye mehanicheskoj zheltuhoj [Focal liver disease and hylic tumors complicated by obstructive jaundice]. Saratov: Publishing House of Saratov University, 1992. 204 p. (In Russian)
13. Zhuravlev V.A. Repeated radical operations in so-called “inoperable” patients with liver alveococcosis. Annaly khirurgicheskoy gepatologii. 2000; 5 (2): 11–18. (In Russian)
14. Zhuravlev V.A., Sukhorukov V.P., Bakhtin V.A., Rusinov V.M., Yanchenko V.A. Radikal'noe lechenie al'veokokkoza s vovlecheniem magistral'nyh sosudov i nizhnej poloj veny [Radical treatment of alveococcosis involving great vessels and inferior vena cava]. International Congress of Surgeons-hepatologists of Russia and CIS countries. Ufa, 2010. P. 263–264. (In Russian)
15. Bresson-Hadni S., Koch S., Miguet J.P., Gillet M., Mantion G.A., Heyd B., Vuitton D.A. Indications and results of liver transplantation for echinococcus alveolar infection: an overview. Langenbecks Arch. Surg. 2003; 388 (4): 231.
16. Bresson-Hadni S., Blagosklonov O., Knapp J., Grenouillet F., Sako Y., Delabrousse E., Brientini M.P., Richou C., Minello A., Antonino A.T., Gillet M., Ito A., Mantion G.A.,Vuitton D.A. Should possible recurrence of disease contraindicate liver transplantation in patients with end-stage alveolar echinococcosis? A 20-year follow-up study. Liver Transpl. 2011; 17 (7): 855–856. doi: 10.1002/lt.22299.
17. Haider H.H., Nishida S., Selvaggi G., Levi D., Tekin A., Moon J.I., Tzakis A.G. Alveolar echinococcosis induced liver failure: salvage by liver transplantation in an otherwise uniformly fatal disease. Clin. Transplant. 2008; 22 (5): 664–667. doi: 10.1111/j.1399-0012.2008.00821.x.
18. Nahorski W.L., Knap J.P., Pawlowski Z.S., Krawczyk M., Polanski J., Stefaniak J., Patkowski W., Szostakowska B., Pietkiewicz H., Grzeszczuk A., Felczak-Korzybska I., Golab E., Wnukowska N., Paul M., Kacprzak E., Sokolewicz-Bobrowska E., Niscigorska-Olsen J., Czyrznikowska A., Chomicz L., Cielecka D., Myjak P. Human alveolar echinococcosis in Poland: 1990–2011. PLoS Negl. Trop. Dis. 2013; 7 (1): 1–8. doi: 10.1371/journal.pntd.0001986.
19. Yaroshkina T.N. Jehosemiotika al'veokokkoza pecheni i ego oslozhnenij [Semiotics of liver alveococcosis and its complications: dis. … cand. med. sci.]. Tomsk, 1991. 20 p. (In Russian)
20. Zaytsev I.S. Povtornye operacii pri al'veokokkoze pecheni [Repeated operations for liver alveococcosis: dis. … cand. med. sci.]. Tomsk, 2015. 153 p. (In Russian)
Review
For citations:
Merzlikin N.V., Alperovich B.I., Tskhai V.F., Brazhnikova N.A., Navasardyan V.G., Zaytsev I.S. Surgical Treatment of Alveococcosis Complicated by Obstructive Jaundice. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2016;21(4):9-15. (In Russ.) https://doi.org/10.16931/1995-5464.201649-15
Views:
452
Email this article 