关键词: 棘球蚴病, 肝, 患病率, 疾病特征, 诊断, 预后

Abstract: Background　Hepatic echinococcosis is a high-prevalent disease that seriously threatens the health of nomads in western China.Surgical approaches for this disease（especially laparoscopic treatment），are seen to have fundamental changes during the process of gradually maturing along with the development of precise and minimally invasive surgical theories.We performed a 10-year retrospective study of the impact of changes regarding the diagnosis and treatment on the prognosis in such patients Objective　To explore the clinical characteristics，diagnosis and treatment and prognosis of patients with hepatic echinococcosis during a 10-year period in Xinjiang.Methods　By reviewing the electronic medical record system of People's Hospital of Xinjiang Uygur Autonomous Region，723 hepatic echinococcosis patients with surgical treatment were enrolled from January 2009 to June 2018 and were divided into first-phase group（324 receiving surgeries completed mainly via open approach during 2009 to 2013） and second-phase group（399 receiving surgeries completed mainly via laparoscopic approach during 2014 to June 2018） for ease of comparing postoperative recurrence before and after the widening application of laparoscopic surgical treatment for hepatic echinococcosis since 2014 in Xinjiang.Clinical data，such as age of onset，surgical method，prevalence of postoperative grade C bile leakage，recurrence，disease detection method，admission check-up，postoperative adherence to oral albendazole，and local recurrence or metastasis were collected.All of them were followed up once every 3 months within 3 years after surgery，and once every 6 months between 4 and 5 years after surgery by outpatient review，inpatient review，letter and telephone，and prognostic data during the follow-up were obtained.Results　Two groups showed no significant difference in average age of onset（P>0.05）.Second-phase group had higher prevalence of laparoscopic subtotal removal of endocysts and/or exocysts，laparoscopic complete removal of exocysts，and laparoscopic anatomical hepatectomy，and lower prevalence of open subtotal removal of endocysts and/or exocysts，and open complete removal of exocysts compared with the first-phase group（P<0.05）.The second-phase group showed lower proportion of detecting hepatic echinococcosis by treating discomfort，but higher proportion of detecting hepatic echinococcosis by mass health examination or health screening（P<0.05）.The second-phase group had higher proportions of undergoing color Doppler sonography（CDS） of the abdomen，low- and high-frequency CDS of the abdomen，and contrast-enhanced abdominal CT at admission（P<0.05）.Moreover，higher percent of patients in the second-phase group had good postoperative adherence to oral albendazole（P<0.05）.Also，local recurrence rate of echinococcosis，and prevalence rates of Grade C bile leakage，postoperative liver dysfunction and intra-abdominal infection as well as intraoperative bleeding greater than 775 ml were lower in the second-phase group（P<0.05）.Occupation- and sex-specific analysis showed that female nomads from minority ethnic groups were the high-risk group for hepatic echinococcosis.Conclusion　During the 10-year period in Xinjiang，the onset of age of hepatic echinococcosis showed no significant changes，but diagnosis and treatment for this disease as well as patient prognosis were improved obviously.Laparoscopic complete excision of the hydatid cysts has gradually become the first surgical method，with unique advantages in terms of reducing complications，small trauma，and good curativeness.Combined with the comprehensive development of early screening，it has benefited an increasing number of such patients.

Key words: Echinococcosis, hepatic；Prevalence；Disease attributes；Diagnosis；Prognosis