Diagnosis And Management Of Hepatic Cystic Echinococcosis In Children

Objective: To summarize the clinical features of hepatic cystic echinococcosis(HCE) in children, and to evaluate the efficacy of different surgical approaches for removal HCE lesions; to analyze the relavant factors of postoperative compliacation from them, search risk factors of postoperative compliacation; to apply imagings and serology methods for their diagnosis; to produce the recombinant antigen(rAgB) and compare its diagnostic effect with natural antigens. Methods: 1. 191 HCE children underwent surgical treatment between January 2002 to December 2014 were retrospectively evaluated. Data collection included symptom、characteristic of cyst(location, size, quantity) 、surgical option、hospitalization duration、postoperation complications were analyzed, the patients were divided into three groups with respect to the treatment modality: modified endocystectomy(group A), sub-total pericyctectomy(group B), total pericyctectomy(group C). We performed univariate and multivariate analyses to determine the independent risk factors for postoperation complications for HCE; 2. From January 2002 to December 2014, 100 pediatric patients with liver cystic lesions were examined with CT,ultrasound and serological test, and compared the diagnostic value of CT、ultrasound and serological test for patients with suspected HCE. 3. A total of 50 serum samples including 25 sera from HCE children and 25 sera from health children were used to evaluate the diagnostic sensitivity and specificity of the rAgB by ELISA and immunoblotting. Results: 1. There were 63 children underwent modified endocystectomy(Group A), 89 children underwent sub-total pericyctectomy(Group B), and 39 children underwent total pericyctectomy(Group C). Recurrence rate and cavity-related complications were lower in Group B versus Group A and the mean operation time and blood loss were lower in Group B versus Group C; 2. Postoperative complication occurred in 26 cases, and it was associated with abdominal pain 、 cystobiliary communication and ruptured cyst(P < 0.05); 3. The sensitivity of the ultrasound, CT scanning, serological test in diagnosis of HCE in children is 96%, 80%, 86% respectively, the specificity is 98%, 60%, 72%, respectively; 4. When testing serum IgG1 against rAgB, the sensitivity and specificity were 76% and 100%, respectively. However, when testing serum IgG4 against rAgB, the sensitivity of recombinant AgB was 36% and the specificity was 100%. The sensitivity is much less than this in adult HCE patients, indicating the difference between pediatric and adult HCE patients. Conclusion: ⑴ Sub-total pericyctectomy may be the preferred treatment of HCE in chiledren because of its low rate of recurrence and postoperaton complication, as well as short operation time and blood loss; ⑵Abdominal pain、cystobiliary communication and ruptured cyst were the independent risk factors for postoperation complications; ⑶ Ultrasound can be used to differentiate hydatid cyst and simple hepatic cyst. serological test can be an important supplement; ⑷ The recombinant AgB prediction is stable, indicates the advantages of no cross-reaction with nonparasite hepatic diseases. Recombinant antigen B can be considered to increase the specificity while the sensitivity still not satisfied.