Studying different surgical methods in the management of pulmonary hydatid cysts for five years at Al-Mujtahid Hospital

doi:10.21203/rs.3.rs-3978341/v1

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Research Article

Studying different surgical methods in the management of pulmonary hydatid cysts for five years at Al-Mujtahid Hospital

https://doi.org/10.21203/rs.3.rs-3978341/v1

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Research objective:

To study and analyze the surgical methods used to treat hydatid cysts in Al-Mujtahid Hospital for a period of five years, including new techniques and compare them to determine the best methods to treat this condition effectively and safely.

Place of study:

Damascus (Al-Mujtahid) Hospital, Damascus, Syria.

Duration of study:

for a period of five years from 5/5/2019 to 5/10/2023.

Study design:

retrospective cross-sectional.

Patients:

221 patients visiting Al-Mujtahid Hospital with pulmonary hydatid cyst disease.

Results

The percentage of single cysts was 66.5%, while the percentage of multiple cysts was 33.5%, and the percentage of cysts on one side and two sides was 85.1% and 14.9%, respectively, and the percentage of symptomatic cysts was 96.8%, while the rest of the cases were asymptomatic (by chance), and the percentage of complications ( Pneumonia, rupture, bleeding, vomiting, abscess) 39.4%, and the percentage of the presence of a right cyst was 47%, while the percentage of the presence of a left cyst was 41%, and both were 11%, 66.5% of the cysts were single, and the most common treatment method was by cyst puncture at a rate of 56.1%, and 65%. 2% of patients had fistulas closed. There is no significant effect of the patient’s sex, age, medical history, presence of extrapulmonary cysts, multiple cysts within the lung, affected lung, symptomatic or not, and the number of cysts on the type of surgical procedure. There is a significant effect of cyst complications on the type of surgical operation.

Conclusion

The optimal surgical management appropriate to the patient's condition must be chosen, with fewer complications, and work to preserve the lung and prevent removal of any part of it.

Cardiothoracic Surgery

Hydatid cysts

lung

surgical management

Al-Mujtahid Hospital

Echinococcosis is a contagious parasitic disease of the human being caused by the larval stage (metacestode) of tapeworms of the genus Echinococcus.

Echinococcosis is caused by infection with the larval stage of Echinococcus granulosus, which belongs to the Taeniidae family.

There are four types of echinococcosis that cause infections in humans: E.granulosus and E.Multilocularis are the most common, and cause hydatidiosis and alveolar echinococcosis, respectively.

The other two species, E. vogeli and E. oligarthrus, cause polycystic echinococcosis but are rarely associated with human infection [1].

Two relatively new species have been identified: Echinococcus shiquicus in small mammals from the Tibetan Plateau and Echinococcus felidis in African lions [2, 3], and the possibility of their transmission to humans is not known.

The geographic distribution and host animal species vary by Echinococcus species, and mixed infections involving more than one species have been reported.

In addition, different strains within Echinococcus species may have variable morphology, genetic characteristics, infectivity to humans, and pathogenicity [2, 3].

Echinococcosis remains a significant community health burden in many countries, and in some areas it is a visible and endemic disease. [3]

Cystic echinococcosis is the most common human disease in this genus and accounts for more than 95% of the estimated 2–3 million cases worldwide. [4]

Cystic echinococcosis is endemic in many parts of the world such as the Mediterranean countries, South America, Australia, eastern and northern Africa, and in the Tibetan terrain of Asia. [5]

Cystic echinococcosis is often diagnosed incidentally because the individual may remain asymptomatic for a long time due to the silent nature of the pathogen. [6]

Study design

A retrospective descriptive study to determine the prevalence, diagnostic methods, and surgical methods used in treating lung hydatid disease among patients who visited Damascus Hospital. Years 5/5/2019 10/5/2023.

Patients

The study included 221 patients who were admitted to Damascus Hospital with hydatid disease of the lung.

Methods: A group of patients who were admitted to Damascus Hospital was studied according to the following inclusion criteria: all patients with lung hydatid disease, accepting patients who had symptoms and signs indicating a diagnosis of lung hydatid disease, while the exclusion criteria were as follows: patients who Patients suffering from lung cysts, patients suffering from lung cell carcinoma, patients suffering from metastases of lung tumors, patients who have obstructive and obstructive lung diseases, and patients who drink alcohol. Patient records and records in which there was insufficient information to serve our study were destroyed. Information according to the search form to adjust inclusion and exclusion criteria, clinical history information was recorded in detail, which included: age, sex, place of residence, habits, vital signs, clinical symptoms, duration of symptoms, pain characteristics, presence of other symptoms, cyst location, and lung segments. infected, and medical examinations were performed that included (complete blood count, C-reactive protein (CRP) and electrolytes), and information was taken about the results of CT and chest scans, and all patient measurements were taken with devices present in the hospital, and analyzes were performed in the hospital laboratories and the relationship between Variables and treatment

Statistical analysis:

The data was completed from the forms into an Excel file, and special simple statistics were conducted. The results were summarized and explained with tables and charts. The Spss-28 statistics program was used, and descriptive statistics were reviewed based on percentages and graphical shapes, in addition to measures of central tendency (arithmetic mean and standard deviation), the chi-square test was used to study the relationships between qualitative variables.

Ethical considerations:

Ethical approval was obtained from the Institutional Review Board (IRB), Faculty of Medicine, Al-Sham Private University and the Director of Al-Mowasat University Hospital.

In our study, the sample size was 221 patients (54.8% females, 45.2% males). The age group most present in our study was (11–20 years), with a rate of 40.7%, followed by the age group (21–30 years), with a rate of 19.9%, 10% of Patients suffer from accompanying chronic diseases, and the percentage of presence of extrapulmonary hydration cysts is 31.2%, the percentage of presence of single pulmonary hydration cysts is 66.5%, the percentage of presence of multiple hydration cysts is 33.5%, and the percentage of presence of hydration cysts on one side is 85.1%, while the percentage of presence of hydration cysts on two sides is 85.1%. The percentage of accidental hydration cysts was 14.9%, the percentage of cysts that were discovered by chance was 3.2%, the percentage of complications was 39.4%, the percentage of right lung injury was 47%, while the percentage of left lung injury was 41%, and the percentage of both lungs being affected was 11%. Removal of one cyst was the most likely at a rate of 66.5%, followed by removal of 2–10 cysts at a rate of 30.35. Speaking of the surgical method used, the most common surgical method was cyst acentesis at a rate of 56.1%, followed by the generation of a complete cyst at a rate of 19%, followed by an open hydatid cyst whose ice cyst was removed. At a rate of 16.7%, either removing a cyst with an affected lung lobe or removing part of a lung with reconstructing the affected lobe at a rate of 5%. The most common method for dealing with formed bronchial fistulas was closing the cavity and fistulas at a rate of 65.2%, followed by closing the cavity without fistulas at a rate of 34.4%, according to a study. Statistical Relationships: We saw that there was no statistically significant relationship between gender and the surgical method followed. Also, there was no statistically significant significance between age and the surgical method followed. There was no relationship between the presence of a previous chronic disease and the surgical method followed. There was no significant relationship between the presence of extrapulmonary cysts and the method. There is no significant effect of the number of cysts on the surgical method followed. There is no effect of the cyst, whether accidental or not, on the surgical method. There is an important relationship between cyst confusion and the type of surgical method followed.

We conducted a study on a sample size of 221 patients, the percentage of males was 45.2%, while the percentage of females was 54.8%.

Then, the age groups of patients were studied, and the largest percentage of the sample was between 11 and 20 years old, representing 40.7% of the sample, while the percentage of patients older than 60 was only about 4%.

The vast majority of the sample, 90%, confirmed that they do not suffer from any accompanying chronic diseases, and only about 10% of the sample suffer from chronic diseases.

The percentage of patients who suffer from hydration cysts in an organ other than the lung is about 31.2%, while 68.8% of the sample does not have hydration cysts in an organ other than the lung.

The largest percentage of the sample, about 66.5%, showed a single pulmonary cyst, while 33.5% of the sample had several cysts.

The vast majority, 85.1%, had cysts on one side of the lung, while 14.9% of the sample had hydatid cysts on both sides of the lung.

In a majority of 96.8% of the sample, the cysts showed various symptoms, while a very small percentage, about 3.2%, had cysts discovered by chance.

Regarding complications, 39.4% had complications such as rupture, bleeding, or vomiting, while 60.6% did not have any complications.

Regarding the location of the cyst appearance, the most common lung is the right lung, at a rate of 47%, while the percentage of cysts in the left lung is 41%, and both lungs together is 11%.

Regarding the number of cysts, 30.3% of the sample had cysts whose number was between 2 and 10, while 2.3% of the sample, corresponding to 5 participants, recorded that their number of cysts was between 11 and 20, while only two patients recorded that they had more than 20 cysts. .

Regarding the surgeries used, the most commonly used surgical method is cyst acentesis, which was applied to 56.1% of the sample, while cysts were generated in 19% of the sample. While we notice a decline in the use of the surgical procedure (removal of the cyst with an articular piece or destroyed lobe), as the percentage of Very few patients, only about 5%, were subjected to lobar resection, and the method of injecting a lethal solution was not used at all within Al-Mujtahid Hospital.

Regarding dealing with the cavity and bronchial fistulas, the largest percentage of the sample, about 65.2% of the sample, had the cavity and fistulas closed, while the fistulas were closed and the cavity was left open in only 0.5% of the sample, that is, one patient.

The best surgical method for treating liver cysts is the puncture method and the method of generating the cyst. Prevention methods must be followed in order to prevent infection with the causative factor.

Ethics approval and consent to participate:

The Research Ethics Committee at Al-Sham Private University and the general administration at Damascus Hospital approved the study protocol, and all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or Similar ethical standards.

Consent for publication:

Not applicable.

Availability of data and materials:

All data related to this paper’s conclusion are available and stored by the authors. All data are available from the corresponding author on a reasonable request.

Conflict of interest:

The authors declare that they have no conflict of interest

Funding:

This research received no specific grant from ASPU or any other funding agency in the public, commercial or non-profit sectors.

Authors’ contributions:

F.A conceptualized the study L.A wrote the study protocol, performed the statistical analysis, participated in data collection, L.A did the literature search and participated in the literature search, interpret the results, wrote the main manuscript A.A. revised the draft. All authors read and approved the final draft.

Acknowledgments:

We thank the administration of Al-Sham Private University for their support in the field of medical training and research. And the medical staff at Damascus Hospital.We would also like to thank Dr. Issam Alkhayer for his assistance and supervision of the paper.

Wen H, Vuitton L, Tuxun T, et al. Echinococcosis: Advances in the 21st Century. Clin Microbiol Rev 2019; 32.
Frider B, Larrieu E, Odriozola M. Long-term outcome of asymptomatic liver hydatidosis. J Hepatol 1999; 30:228.
Moro PL, Gilman RH, Verastegui M, et al. Human hydatidosis in the central Andes of Peru: evolution of the disease over 3 years. Clin Infect Dis 1999; 29:807.
Dadoukis J, Gamvros O, Aletras H. Intrabiliary rupture of the hydatid cyst of the liver. World J Surg 1984; 8:786.
Bektaş M, Dökmeci A, Cinar K, et al. Endoscopic management of biliary parasitic diseases. Dig Dis Sci 2010; 55:1472.
Santivanez S, Garcia HH. Pulmonary cystic echinococcosis. Curr Opin Pulm Med 2010; 16:257.

The authors declare potential competing interests as follows: All authors agreed to publish

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Version 1

posted

You are reading this latest preprint version

Studying different surgical methods in the management of pulmonary hydatid cysts for five years at Al-Mujtahid Hospital

Status:

Version 1

Abstract

Research objective:

Place of study:

Duration of study:

Study design:

Patients:

Results

Conclusion

Introduction

Materials and methods

Statistical analysis:

Ethical considerations:

Results

Discussion

Conclusion

Declarations

References

Additional Declarations

Status:

Version 1