Objective To study the influence of echinococcus multilocularis(Em) infection on the immunology state and the allograft heart survival in the infected rats.Methods SD-to-Wistar(allograft) heart transplantation models were established to observe the influence of the disturbed(immune) system in Em infected rat on the heart graft.Sixteen healthy SD rats,8 healthy Wistar rats and 8 Em infected rats were used in the study.Animals were randomly divided into:(1) control group:SD-to-healthy Wistar rats(n=8) and(2) Em infection group:SD-to-Em infected Wistar rat(n=8).The(allograft) heart transplantation was performed by anastomosis of the donor heart of SD rats into the cervices of the Wistar rats.All the agents were administrated orally q.d.Graft samples were harvested for histopathological examination and immunohistochemical study.IL-4 and IFN-? in peripheral blood were assessed.CD4~(+),CD8~(+)and CD15Tc infiltration in the graft was detected.Results The mean survival time of the grafts in Em infected rats was 11.63?6.02 days and 6.00?0.53 days in no-infected rats respectively with the difference being significant(P

Objective To compare the efficacy of radical and quasi-radical hepatectomy for the treatment of end-stage hepatic alveolar echinococcosis(HAE)with involvement of major blood vessels and viscera.Methods The clinical data of 41 patients with end-stage HAE who were admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2002 to January 2010.All patients were divided into radical hepatectomy group (13 patients)and quasi-radical hepatectomy group(28 patients)according to whether blood vessels were reconstructed and repaired.The operation time,blood loss,length of hospital stay,recurrence and metastasis of HAE,pleural effusion,ascites,biliary complications and death between the 2 groups were compared.All data were analyzed by using the t test or chi-square test.Results The volume of blood loss,length of hospital stay,number of patients with recurrence and metastasis of HAE,obstructive jaundice and number of dead patients were(326 ±115)ml,(22 ± 18)days,0,0,and 0 in the radical hepatectomy group,and were(24 ± 20)ml,(15 ± 12)days,10,10 and 10 in the quasi-radical hepatectomy group,there were significant differences between the 2 groups(t =13.41,1.47;x2 = 4.36,4.36,4.36,P ＜ 0.05).The operation time,number of patients with pleural effusion and ascites,bile leakage,cholangitis and number of patients died perioperatively were(407 ± 146)minutes,4,0,1 and 1 in the radical hepatectomy group,and(263 ± 93)minutes,2,2,2 and 1 in the quasi-radical hepatectomy group,there were no significant differences between the 2 groups(t = 3.81;x2 = 2.30,0.04,0.34,0.04,P ＞ 0.05).Conclusions Radical hepatectomy should be the first choice when construction of infringed vessels can be achieved.Quasi-radical hepatectomy has lower operation risks for avoiding important vessels injury.

Objective To review our experience in treatment of liver hydatid diease.Methods The data of 819 patients who underwent surgery for hepatic hydatid disease were reviewed retrospectively.Exploration of common bile duct was done in 172 cases.There were men 95 and women 77with a mean age of 31.5±0.5 years.In addition to treatment of the cyst cavity,patients was divided into two groups.The patients in group A received cholangiography and exploration of common bile duct through cystic duct while those in group B underwent cholangiography and common bile duct ex-pioration through T tube.Results The length of hospital stay and cavity-related problems for both groups had no significant difference.Biliary tract-related problems in two groups had significant differ-ence.Conclusion Cholangiography and common bile duct exploration through cystic duct can com-pletely solve the cavity-related problems while avoiding T-tube related problems.

Objective By analyzing 2 560 echinococcosis cases through telemedicine,to explore a new mode for preventing,diagnosing,and treating of echinococcosis.Method From January 2009 to December 2013 in our hospital through remote medical care and consulting we analyzed cases and conducted statistics on consultation's person time,location difference,spectrum of disease and upward referral rate as well as the cost of hospitalization.Result (1) The amount of consultation rose from 182 cases in 2009 to 873 cases in 2013.(2) The proportion of consultation from northern Xinjiang is about 83％-91％,obviously higher than that from south Xinjiang and eastern Xinjiang,which fits those areas mainly with the economical character of the husbandry.(3) Most consultation cases are echinococcosis (99.42％) followed by echinococcosis (0.24％),pelvic cystic echinococcosis (0.19％),cerebral echinococcosis (0.12％),and cardiac echinococcosis (0.03％).(4) Upward referral rate is nearly 7.97％ and about 92.03％ patients were treated in local community hospitals saving medical care budget by RMB 14.78 million.Conclusions Use and establishment of the three level network system for preventing,diagnosing,and treating the echinococcosis by telemedicine effectively enhances primary hospital's ability in the care of these patients and alleviates patients economical burden.

Objective To evaluate the clinical pathway (CP) for treatment of hepatic cystic echinococcosis.Methods Data were retrospectively obtained from hospitalized patients with hepatic cystic echinococcosis (CE) who were treated surgically between April 2011 to December 2012.Patient treated with the clinical pathway (the CP group) were compared with patients who were treated with conventional treatment (the non-CP group).The following outcomes were compared:the average length of in-hospital stay,the hospital charges,patient's satisfaction,patient's knowledge about his/ her own health and postoperative complications.Results For the CP groups,the length of in-hospital stay,the hospital charges,the patient's satisfaction and the health knowledge for the patients were (10.25±1.26)d,(19600.25±1520.73) yuan,(46.4 5±2.14),(83.50±8.02),respectively.The corresponding figures for the non-CP group were (14.25 ± 1.50) d,(23931.25 ± 1629.17) yuan,(42.65 ± 1.93),(74.50 ± 12.60),respectively.There were significant differences between the 2 groups (t=-4.086,-4.074,8.351,3.811 ; P＜0.05).The postoperative complications,including bile leakage,bleeding,ascites and pleural effusion,were 2,0,2 cases in the CP group,and 0,4,5 cases in the non-CP group.There were no significant difference between the 2 groups (x2 =0.17,0,0.6; P＞0.05).Conclusion Our initial clinical experience showed that the clinical pathway decreased the length of in-hospital stay and hospital charges,and provided quality and efficient clinical services to patients with hepatic cystic echinococcosis.

Objectiye To investigate the value of liver transplantation for the treatment of end-stage hepatic alveolar echinococcosis(HAE).Methods The clinical data of 8 patients with end-stage HAE who received liver transplantation at the First Affiliated Hospital of Xinjiang Medical University from December 2000 to August 2010 were retrospectively analyzed.The operation time,anhepatic phase,infusion of suspension of red blood cells and postoperative complications were observed.Results The median operation time,anhepatic phase and infusion of suspension of red blood cells were 635 minutes(range,490-760 minutes),66 minutes(range,44-240 minutes)and 20 U(range,4-40 U).Liver transplantation was successfully carried out on 7 patients except for 1 patient who received emergent liver transplantation died of severe hepatic encephalopathy,renal failure and coagulation disorder on postoperative day 1.The median follow-up time was 6 months(range,3-29 months).One patient died of septicopyemia in postoperative month 3,1 died of incurable infection of bile duct in postoperative month 5,and 1 died of acute rejection in postoperative month 6.One patient was complicated with stricture of the bile duct anastomosis,and was cured by choledochojejunostomy.The size of the metastatic lesion in the left lung of 1 patient was reduced.One patient who underwent liver autotransplantation had no signs of residual liver disease with good liver function.Conclusion End-stage HAE is an indication for liver transplantation.A minimum dose of immunosuppressive agent and systemic administration of anti-HAE drugs are necessary to prevent the recurrence of HAE and ensure a long-term survival.Liver autotransplantation is the optimal method for the treatment of end-stage HAE,because no immunosuppressive agent is needed after operation.

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,pleura]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 significant 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,dissemination and implantation of HCE of the classic group were significantly higher than those in the improved group(x2 =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 findings and serological examination are important for the diagnosis of ruptured HCE.Improved endocystectomy + peritoneal lavage with hypertonic saline + administration of anti-HCE drugs is the optimal treatment for ruptured HCE.

Ex-vivo liver resection and liver autotransplantation offers a chance to cure extensive regional liver diseases which are otherwise deemed untreatable in selected cases. A 33-year-old male patient with advanced alveolar echinococcosis (AE) which invaded the right lobes and adjacent retrohepatic inferior vena cava, while the left lobes were free from lesion and had proliferated to over 1200 ml in size except for a 1 cm × 1 cm solid lesion in the segment Ⅳ. No extrahepatic metastases were found in this patient. A lesion with a size of 4300 ml and other small lesions in the right lobes were removed extracorporeally,and the retrohepatic vena cava was repaired, then the remaining AE-free left lobes (more than 700 ml in size) and the retrohepatic inferior vena cava were re-implanted in situ. A temporary end-to-end cavo-caval shunt with interposition of a blood vessel prosthesis and end-to-side portocaval shunt were established to keep the blood flow during the four-hour anhepatic phase. The patient was followed up for six months, and he had no signs of residual liver disease with good hepatic function.

Objective To investigate the evolution of surgical treatment and it's influence on prognosis in reptured liver cystic echinococcosis.Method Clinical data of 110 surgically treated cases of reptured liver cystic echinococcosis from January 1990 to December 2008 were retrospectively analysed,and these cases were divided into three groups by different surgical approach;Group A(22 cases):removal of internal capsule,with formaldehyde or hydrogen peroxide regional anthelminthic,with residual cavity side edge of lock stitching or greater omentum filling or drainage after residual cavity closure;Group B (65 cases):Removal of intemal capsule,with hypertonic saline regional anthelminthic,with external capsule extrahepatic partial resection,with residual cavity bile leakage sutured,and with residual cavity open drainage,Group C(23 cases):the total or subtotal external capsule stripping operation,with hypertonic saline regional anthelminthic and drainage.Result The rate of overall postoperative complications of residual cavity was 40.9%、16.9%、0.0%(P<0.05)respectively and the recurrence rate was 18.2%、4.6%、0.0%(P<0.05)respectively;drainage time needed was the longest in group A,and shortest in group C,whereas the operation time was the longest in group C and it costed higher blood loss.Intraabdominal implantation of the hydatid significantly decreased with hypertonic saline treatment.Conclusion Total or near total removal of the external capsule of the hydatic cyst and hypertonic saline treatment with postoperative external drainage is the therapy of choice for reptured liver cystic echinococcosis.

Objective To study the results of emergency treatment of ruptured hepatic cystic echinococcosis (HCE).Methods A standardized management protocol for hepatic echinococcosis was introduced by the First Hospital of Xinjiang Medical University in 2002.This study included 185 patients who received emergency treatment for ruptured HCE between 1994 and 2009.The patients were divided into group A (from 1994 to 2001) and group B (from 2002 to 2009).The clinical characteristics and surgical treatment results were compared retrospectively.Results In patients with ruptured HCE into the abdomen,classical endocystectomy (Group A1 ) resulted in significantly more postoperative complications in residual hepatic cavity,time of drainage,postoperative hospital stay,recurrence and peritoneal seeding than improved endocystectomy (Group B1 ) (P＜0.05).The operation time and blood loss were not significantly different between group A1 and B1 (P＞0.05).For patients with ruptured HCE into the biliary tree,classical endocystectomy (Group A2 ) resulted in significantly higher postoperative complications in residual hepatic cavity,time of drainage,postoperative hospital stay and recurrence than improved endocystectomy (B2) (P＜0.05).Operation time,blood loss and peritoneal seeding were not significantly different between group A2 and B2 (P ＞ 0.05). Only one patient (0.54％) died from allergic shock in this series of patients.Conclusions Improved endocystectomy was an efficacious surgical treatment for ruptured HCE and it is recommended for emergency surgery.