Diagnosis and treatment of ruptured hepatic cystic echinococcosis

Objective To investigate the diagnosis and treatment of ruptured hepatic cystic echinococcosis （HCE）. Methods The clinical data of 109 patients with HCE who were admitted to the First Affiliated Hospital of Xinjiang Medical University from January 1994 to December 2009 were retrospectively analyzed. The diagnosis was based on the results of serological examination, epidemiological history, clinical manifestation and imaging findings. Of the 108 patients who received surgical treatment, 67 received classic endocystectomy （classic group） and 41 received improved endocystectomy （improved group）. The operation time, operative blood loss, length of postoperative hospital stay, time of drainage, effusion and infection of residual cavity, biliary fistula, pleural effusion, local recurrence, dissemination and implantation of HCE, and death of the 2 groups were compared. All data were analyzed using the t test and chi-square test. Results The diagnostic rates of ultrasound, computed tomography and magnetic resonance imaging were 93% （101/109）, 99% （70/71） and 7/7, respectively. The positive rate of serological examination was 100% （61/61）. Of the 109 patients, 1 died of anaphylactic shock. The operation time and operative blood loss were （3.2 ± 0.3 ） hours and （ 104.0 ± 11.5 ） ml in the classic group and （3.3± 0.4）hours and （110.0 ± 23.8 ）ml in the improved group, respectively. There were no significant differences in the operation time and operative blood loss between the 2 groups （ t = - 1. 474, - 1. 758, P 〉 0.05）. The length of hospital stay and time of drainage were （ 15.3 ± 4.3 ） days and （28.0 ± 4.6） days in the classic group and （9.3 ± 1.2） days and （7.6 ± 0.8 ） days in the improved group, respectively. There were signifi-cant differences between the 2 groups in the length of hospital stay and time of drainage （t = 8. 628, 28.088, P 〈 0.05 ）. The incidence rates of effusion and infection of residual cavity, biliary leakage, local recurrence, dissemina-tion and implantation of HCE of the classic group were significantly higher than those in the improved group （ X^2 = 4. 335, 3. 888, 5. 691, 4. 581, 10. 153, P 〈 0.05）. Twenty-one patients received reoperation because of HCE recurrence or severe complications. Conclusions Epidemiological history, clinical manifestation, imaging find-ings and serological examination are important for the diagnosis of ruptured HCE. Improved endocystectomy ＋ pertoneal lavage with hypertonic saline ＋ administration of anti-HCE drugs is the optimal treatment for ruptured HCE. Key words: Hepatic cystic echinococcosis;  Rupture;  Diagnosis;  Treatment