Hepatic hydatid cystectomy

Hepatic hydatid cystectomy for the surgical treatment of hepatic hydatidosis. Hepatic echinococcosis, also known as hepatic hydatidosis, is a parasitic disease caused by parasitic larvae of the dog mites (Echinococcus granulosus) parasitic in the liver. The pathogen is a fine echinococcosis, a multi-atrial echinococcosis or a echinococcosis. There are two types of hepatic hydatidosis: one is a single atrial hydatid disease caused by the infection of Echinococcus granulosus (ie, hydatid cyst disease); the other is a multi-atrial hydatid or sputum A echinococcosis caused by infection with Echinococcus granulosus or a follicular hepatic hydatid disease. Clinically, single-atrial echinococcosis is more common. Hepatic hydatid cysts are divided into external capsules and internal capsules. The former fibrous membrane formed by liver tissue does not actually belong to the hydatid cyst itself; the latter is the envelope of the liver hydatid cyst itself. The wall of the capsule can be divided into two layers, the outer layer is a slightly transparent semi-transparent film of white powder, called the stratum corneum; the inner layer is the germinal layer, which consists of a row of cells with remarkable reproductive ability, which can produce the sac, head Sections and ascus, etc., the capsule contains a transparent liquid and a large number of nodules and ascus. The vesicle fluid breaks into the abdominal cavity or the chest cavity to produce anaphylactic shock, and the continuation of the anterior segment and the ascus in the cyst fluid can lead to secondary hydatid cysts. The treatment of this type of liver hydatid cyst is based on surgical treatment. The principle of surgery is to remove the internal capsule, prevent the leakage of the cyst fluid, eliminate the residual cavity of the outer capsule, and prevent infection. Hepatectomy can be performed in the following cases: 1 the lesion may be resected; 2 the thick wall chronic abscess is formed after cyst infection. Can not be removed liver hydatid cysts, generally hepatic hydatid cyst cystectomy. Treatment of diseases: liver hydatid disease Indication Hepatic hydatid cystectomy is suitable for simple hepatic hydatid cysts without concurrent infection. Preoperative preparation 1. Regular blood, urine, feces examination; liver, kidney function and coagulation mechanism examination. 2. Liver CT and B-ultrasound should be performed before surgery to understand the location, extent and number of lesions, and to make a surgical plan. 3. Give high protein and high vitamin diet before surgery. 4. Oral vitamin B, C and E before surgery, intramuscular injection of vitamin K11 3 days before surgery. For patients with prolonged prothrombin time or bleeding tendency, a large dose of vitamin K is administered until the coagulation function is normal. 5. Place the stomach tube and catheter in the morning. Surgical procedure 1. The incision is determined according to the position of the cyst, and the oblique incision is generally taken from the lower edge of the rib. After entering the abdominal cavity, explore the entire liver. Hepatic hydatid cysts can be seen on the surface of the liver with grayish white bulging walls. 2. First do the puncture point positioning. Before the puncture, the gauze pad should be used to cover the incision and the surrounding organs of the cyst. Then, a gauze soaked with 10% formaldehyde solution is placed on the gauze pad to prevent the cyst fluid from spreading or causing allergic reactions. Then, two traction lines are sutured on the wall of the capsule, and the liquid in the capsule is punctured and sucked out between the two lines, and after the cyst is confirmed as a hydatid cyst, the needle is pulled out. If the tension inside the capsule is large, some liquid should be sucked out as much as possible. After the tension is reduced, the needle is pulled out. The normal cyst fluid is a colorless, transparent liquid. 3. Connect the cannula of the trocar to the Y-tube, then connect it to the syringe and the aspirator, respectively, and temporarily clamp the rubber tube that connects the syringe with a hemostat. The trocar is inserted into the capsule cavity along the puncture site, and the needle is pulled out to the sleeve of the sleeve, and the liquid in the capsule is sucked out by the suction device, so that the liquid in the capsule can be aspirated as much as possible under the condition of no pollution. If the inner capsule or sac of the hydatid cyst occludes the cannula, the suction tube can be clamped with a hemostat, the needle can be re-inserted, the cannula can be unblocked, and the position of the tip of the trocar can be moved, and the needle can be pulled out. Relax the hemostat and continue to pump until the fluid in the capsule is as dry as possible. 4. After the liquid in the capsule is sucked, the hemostatic forceps can be used to clamp the rubber tube of the suction device, and the hemostatic forceps clamped to the rubber tube of the syringe can be relaxed. Inject the appropriate amount of 10% formaldehyde solution from the syringe according to the size of the capsule cavity, wait for 5-10 minutes, then use the aspirator to suck out, so repeat 2 or 3 times, finally drain the liquid in the capsule as much as possible, and pull out the trocar. Note: If the cyst fluid is found to be golden yellow (normally a colorless, transparent liquid), there may be bile duct spasms. In this case, the formaldehyde solution cannot be injected to prevent the large amount of formaldehyde solution from entering the bile duct and causing serious damage to the bile duct. 5. Cut the wall between the two traction lines. Use two tissue clamps to clamp the edge of the incision and lift it up. The incision is then enlarged to facilitate removal of the inner capsule. 6. Use a sponge pliers to remove the inner capsule (the inner capsule is a translucent powdery skin sample), or use a curette to remove the thick liquid and all the ascus in the capsule, absorb the liquid in the capsule, and remove all the debris in the capsule. , including the germinal layer inside the capsule. All surgical instruments should be immersed in 10% formaldehyde solution after use to avoid contamination of surgical fields and surgical towels. 7. Gently wipe the inner wall of the capsule with a gauze swab dipped in 10% formaldehyde solution, then rinse the cyst with saline, and finally dry the residual liquid in the capsule with gauze. 8. When the wall of the capsule is large and there is no adhesion, part of the wall can be removed. After hemostasis, the wall of the capsule is sutured with a 2 chrome gut to eliminate the dead space inside the capsule. No drainage tube is placed inside the capsule. 9. If the cystic cavity is found in the bile duct, the fistula should be found as much as possible and sutured with a thin thread. A double cannula is then placed in the lumen of the capsule, and the drainage tube is withdrawn from another puncture of the abdominal wall. If the fistula is larger or there is jaundice before surgery, after the internal capsule is removed, in addition to the double-cannula drainage of the cyst, a common bile duct drainage is required. For the cysts with concurrent infection, in addition to sucking the pus inside the capsule, the contents of the capsule should be aspirated as much as possible, and then double cannula drainage should be placed in the capsule cavity, and the suction tube should be continuously attracted after the drainage tube.