Hydatid cysts in the liver

　　The hydatid cysts in humans are the asexual stage of the Echinococcus granulosus, with humans as the intermediate host. The main hosts of this tapeworm are dogs, foxes, or wolves, while the intermediate hosts are sheep, cattle, horses, pigs, and humans. The worm resides in the villi of the dog's small intestine, continuously excreting hexacanth eggs with a shell, which are excreted with feces and adhere to dog fur or wool. Humans or other intermediate hosts can be infected by consuming water or food contaminated with these eggs. After digestion in the stomach or upper small intestine, the hexacanth eggs shed their shell and penetrate the gastrointestinal wall into the portal vein, with most staying in the liver and a few escaping to the lungs and other organs. The hydatid larvae first form an initial hydatid cyst in the relevant organs, and the wall of this cyst is the inner capsule after that. The fibrous capsule formed around the intermediate host tissue is the outer capsule. The inner capsule is further divided into the outer layer and the inner layer, with the outer layer being the cuticle and the inner layer being the germinative layer. The germinative layer produces germinative cysts, scolex, daughter cysts, and granddaughters. When the internal organs of sheep, cattle, or other intermediate hosts infected with Echinococcus are eaten by dogs, foxes, or wolves, this parasite completes its life cycle.

　　Rupture of hydatid cysts in the liver can cause severe upper abdominal pain, bleeding, and shock symptoms, and may also lead to necrosis, with symptoms such as severe abdominal pain, fever, weakness, and even shock, which require urgent treatment. Rupture of the cyst may also cause allergic reactions, anaphylactic shock, or secondary hydatid cyst formation in the peritoneum due to the entry of the scolex. In some cases, due to the large size of the cyst, an arteriovenous fistula may form, leading to increased return blood volume and increased cardiac burden, causing heart failure and endangering the patient's life.

　　The clinical manifestations of hydatid cysts in liver patients are often not obvious, more common in middle-aged and young adults, and can be asymptomatic in the early stage. With the enlargement of the cyst, palpable mass in the upper abdomen may occur, accompanied by symptoms of abdominal distension and abdominal pain. If located in the right upper part of the liver, diaphragmatic elevation may occur, and respiratory symptoms may be present. Many patients have had allergic reaction symptoms, and a few may experience jaundice due to compression of the bile duct by the cyst. There may also be complications such as infection or perforation into the bile duct, leading to cholangitis or even sepsis. Perforation into the pleural cavity may cause respiratory symptoms or bronchopleural fistula. The main signs are a cystic mass in the upper abdomen, and in cases with complications, corresponding signs may appear.

　　Echinococcosis of the liver is a common disease in pastoral areas, mainly appearing in cities with developed animal husbandry in the northwestern part of China, such as Xinjiang, Qinghai, Gansu, and Inner Mongolia. The transmission routes of echinococcosis of the liver are various, and preventive measures should be taken.

　　1, Carry out extensive publicity on echinococcosis knowledge in pastoral areas, eliminate wild dogs, and strengthen the management of domestic dogs.

　　2, Children should not play with dogs to prevent contamination of pastures, feed, and water sources by dog feces, prevent the sheep from being infected, strengthen the management of slaughtering, and bury or burn the dead sheep bodies deeply.

　　3, Pay attention to personal hygiene, protect water sources, and do a good job of environmental sanitation.

　　4, Vegetables are commonly used, nutrient-rich, and beneficial in people's lives, and can be eaten regularly. Not only are they rich in vitamins, but they also contain a large amount of fiber, lignin, organic acids, inorganic salts, and other substances, which are essential nutritional components in the recovery process of liver patients.

　　The auxiliary examinations for liver echinococcosis include complement fixation test, liver function test, liver disease ultrasound, liver, gallbladder, and spleen CT examination, liver palpation, and percussion of the upper and lower liver borders.

　　1, The Casoni test for echinococcal fluid is a specific immune reaction. The method is to filter the head of the uninfected echinococcal fluid, sterilize it under high pressure, and use it as the stock solution. Generally, a 0.1 ml isotonic saline dilution of 1:1000, 1:100, and 1:10 is used. The test is performed on the volar side of the forearm, starting from a low concentration. After 15 minutes, the results are observed. A red macule appears locally, and a red halo with a diameter greater than 1 cm is positive. If the positive reaction appears 6-24 hours later, it is a delayed reaction, which still has diagnostic value. The positive rate of this test is 75% to 95%, but there can be false positives.

　　2, Complement fixation test: The positive rate can reach 70% to 80%.

　　3, Blood test: Increased eosinophils.

　　4, B-ultrasound examination: A liquid shadow can be seen in the liver area, and the location, size, and diagnosis of cystic echinococcosis need to be combined with medical history and Casoni test for diagnosis.

　　5, Liver radionuclide scan: Lesions with a diameter greater than 2-3 cm can be displayed in the liver.

　　6, X-ray examination: Enlarged liver shadow, right elevation or bulging of the diaphragm, shadow or calcification shadow can be seen in the liver area, and the cyst below the liver can show signs of gastrointestinal compression.

　　7, CT: Selective abdominal aortic angiography is helpful for differential diagnosis.

　　Vegetables are commonly consumed foods in people's lives. Not only are they rich in vitamins, but they also contain a large amount of fiber, lignin, organic acids, inorganic salts, and other substances, which are essential nutritional components in the recovery process of liver patients, and are also necessary for patients with liver echinococcosis. In addition, patients with liver echinococcosis can also alleviate symptoms through diet therapy.

　　1) Take 4 grams of Jilin ginseng and 3 grams of American ginseng and stew with lean meat.

　　2) Take 4-5 shiitake mushrooms and stew with lean meat or chicken breast (drink the soup).

　　3) Take 15 grams of Astragalus membranaceus, 21 grams of Dangshen, 30 grams of山药, and 15 grams of lotus seeds and stew with lean meat.

　　4) Take 30 grams of Rhizoma Smilacis glabrae, 30 grams of Coix seed, and 3 pieces of Yuanzhi and stew with grass carp or water turtle.

　　5) Take 17 grams of Dangshen, 21 grams of Euryale ferox, 10 grams of Fructus Lycii, and 15 grams of Coix seed and stew with lean meat or chicken.

　　6) Take 3 grams of Tianqi, 3 grams of ginseng (or red ginseng) and stew with lean meat or chicken.

　　For small hydatid cysts in the liver that are deeply hidden, close follow-up can be conducted, with regular ultrasound examination. If they grow to be close to the liver surface, surgical treatment can be considered. The most commonly used surgical method is the removal of the inner cyst, and the key points are:

　　① When exposing the hydatid cyst, the wound and surrounding organs should be carefully protected to avoid contamination of the cyst fluid, implantation of the scolex, and allergic reactions.

　　② Before incising the cyst cavity, gradual decompression should be performed, and it is still possible to distinguish whether there is concomitant infection or bile leakage by aspirating the cyst fluid through puncture.

　　③ To kill the scolex, the traditional method is to inject 10% formaldehyde solution or 3% hydrogen peroxide after decompression, and then further aspirate the cyst fluid 5 minutes later. However, some people believe that this method cannot guarantee the killing of the scolex, as the dilution of the cyst fluid reduces the efficacy of the drug. There have been reports of acute poisoning or complications such as cholangitis caused by formaldehyde; in addition, it is difficult to be effective for those with multiple cysts.

　　④ Before incising the outer cyst, the cyst fluid can be further aspirated to separate the inner and outer cysts. Ensure that the aspirator is unobstructed, and use 2-3 aspirators if necessary, which is extremely important for draining fluid from large and tense cysts. Then incise the outer cyst, remove the inner cyst, and then apply hydrogen peroxide or formaldehyde dilute solution to the inner wall of the outer cyst, and wipe clean with saline gauze.

　　⑤ To eliminate the residual cavity, the inner wall of the outer cyst can be inverted and sutured, or the omentum with a pedicle can be packed. However, before dealing with the residual cavity, it is necessary to carefully check for bile leaks and seal them.

　　Drainage surgery is required for patients with concomitant infection. Hepatectomy is rarely used and is only suitable for individual patients, such as those with thick cyst wall, calcification, and difficulty in removing the inner cyst, multiple hydatid cysts confined to one lobe, and those with an estimated residual cavity or sinus tract that is difficult to heal after drainage.