Clinical Characteristics Of Patients With Hepatic Alveolar Hydatid And Cystic Echinococcosis Mixed Infection

Objective: The mixed infections of hepatic cystic echinococcosis(HCE)and hepatic alveolar ecinococcosis(HAE)are very rare and have not been reported at present.The present study show the clinical characteristic and treatment of the mixed infections of HAE and HCE to improve our understanding for the rare disease and to provide reference for clinical diagnosis of HAE&HCE patients.Methods: 1.The clinical data of 17 cases of HAE&HCE patients from January 2014 to December 2018(4 years)in the Department of Hepatobiliary Surgery,Affiliated Hospital of Qinghai University,and collected case data of 111 cases of HAE and 84 cases HCE diagnosed in 2017(1 year).2.Describe the clinical characteristics of HAE&HCE basic data,laboratory tests,and imaging features.Focus on the imaging features of the lesion.Finally,surgical information is collected to provide a reference for the treatment of this type of patient.3.The cases were divided into three groups according to HAE,HCE and HAE & HCE,the clinical characteristics of the statistical analysis and comparison,to assess the specific indicators of HAE & HCE patients.Results: There were a total of 17 subjects(9 male and 8 female)were diagnosed to the mixed infections of HAE and HCE.The age group was concentrated in 30-50 years old with an average age of 41.71±11.57 years old.(range from 19 to 74 years).94.1% of the cases were Tibetans,and the occupational distribution was mainly herders.Most patients come from the region of Guoluo(12 cases),the majority cases had a close animal contact in the past(16 cases).Most of the clinical manifestations are liver pain and right upper abdominal tenderness.Hepatitis B can be combined,The detection rate of Ig G in hydatid is 68.8%(11/16),and liver function is mainly in grade A,and obstructive jaundice is rare.CT imaging examination suggests that HAE&HCE covers the imaging features of HAE and HCE.The lesions involve both left and right hepatic livers.Six patients complicated the hydatid disease in lung,brain,bone,kidney and abdomen/pelvic cavity,the incidence rate was as high as 35.3%The maximum diameter of HAE and HCE lesions are 21.92 cm and 13.34 cm,the mean long-diameter of HAE and HCE lesions are 11.56±6.33 cm and 7.71 ± 2.86 cm,respectively.23.5% of the HAE lesions involved in the vascular invasion.Four case complicated with bile duct invasion with the obstructive jaundice.Most of HCE lesions located in left liver lobe.Among the 17 patients,3 cases underwent radical resection;4 refused surgery and 10 underwent palliative surgery.Compared with the HAE&HCE group and the HAE and HCE groups,there were significant differences in laboratory indexes such as HGB,ALB,PT and APTT between HAE&HCE group and HCE group(P <0.05).The HAE&HCE group had a longer path length than the HAE group,and the difference was statistically significant(P < 0.05).Conclusions: The mixed infections of HAE and HCE is a special and very rare disease with huge treatment difficulties,and pose a challenge for the surgeons.The clinical manifestations are similar to those of patients with simple HAE or HCE.