This type of operation in the treatment of hydatid disease is the most classic, clinical application of more than 100 years of history; the operating method is simple and feasible, doctors and medical equipment requirements are relatively low, and it is easy for all levels of hospital, but the operative complications (2.6–10 %) and the rate of recurrence (4.5–20.2 %) are higher [36–40].

Figure 19.1 shows the lesion site and lesion position containing 20 % NaCl solution gauze, preventing extravasation of the cystic fluid and allergic reaction. Two stitches hanging in the cyst wall, diagnostic puncture in two lines, pumping out the cystic fluid, preliminary judgment without infection or biliary fistula occurred, if the cyst fluid cool, no infection; suctioning clean of the cystic content, reinjection of slightly less than the protoscolex reagent kill suction quantity, currently recommend the use of 20 % NaCl solution [42], for 15 min, once again suction clean the cystic content. (see below)

Cut the cystic wall, see Fig. 19.2 below

Bluntly dissect and remove the jellylike endocyst (see Fig. 19.3) below

had been soaked in 20 %NaCl solution gauze wipe repeatedly external capsule wall, note there is no bile leakage, carefully and find out the external capsule wall fistula, for by the cystic duct injection of methylene blue check without biliary fistula wound. See below as found in the fistula with thread or 4–0 vascular suture closure of the fistula routine abdominal drainage tube; the wound larger when necessary feasible “T” tube drainage of common bile duct. See Figs. 19.4 and 19.5 below.

Cyst enucleation takes place along the gap between the internal and external capsule of the cyst; the operation wound is small in liver resection, but the process of stripping of echinococcosis rupture spreads risk, and there is also the risk of biliary fistula.

Revealed lesions (Fig. 19.6)

Incise the liver capsule; find out the space between external capsule and outer cystic membrane; (Fig. 19.7)

along the gap spiral turn to deep stripping external capsule, until the whole external capsule is completely stripped (Fig. 19.8);

in the stripping process, should be carefully distinguished by the outer bag oppression of intrahepatic duct system, the membrane and the pipeline system integrity retained in the liver parenchyma on one side, the pipeline system to the outer sac ligation of membrane (Fig. 19.9);

check whether the biliary fistula and bleeding, the full treatment, plasma layer placed drainage tube after abdominal closure.

The cyst along with normal liver tissue around a certain range is resected. The operating method is thoroughly reliable [41], and there is no residual cavity, so this method can effect a radical cure to problems, depending on the site selection of the cyst for anatomical liver resection or non-anatomical liver resection.

For hepatic hydatid, whether cystic or alveolar, hepatectomy is a radical method. Liver resection can be divided into anatomical liver resection and non-anatomical liver resection. Operating methods can be divided into hepatic segment resection, lobectomy of liver, hemihepatectomy and trisegmentectomy. Earlier, the operating method for liver resection was described in detail. Here, the emphasis is on the resection of liver hydatid.

In view of the clinical characteristics of alveolar hydatid disease, the difficulty of treatment is higher than that of cystic echinococcosis. Radical resection is the first choice for hydatid disease of the liver [43, 44]. In the whole operation for resection of the lesion, the process for malignant tumor treatment follows the “tumor-free principle.” Operation excision grades are as follows: (1) R0 resection (parasitic tissue is excised completely, without any residue), (2) R1 resection (the parasitic tissues are excised; microscopic examination shows positive margin), (3) R2 resection (the parasitic tissue is not completely removed, but the gross margin is positive). The R0 resection is regarded as radical resection; the other two approaches are considered palliative resection [45, 46]. Although radical resection is the first choice, if the lesion is larger, with invasion of the portal vein or inferior vena cava, then palliative resection combined with drug treatment can obtain good clinical efficacy [47]. The selection of a bubble-type liver resection as an example:

Alveolar hydatid showing a lesion (Fig. 19.10)

Alveolar hydatid showing invasive growth, invasion of the surrounding organs, as shown in Fig. 19.11.

Separation, organ and resection of hydatid violations such as graph (Fig. 19.12);

Anatomy of hepatic portal (Fig. 19.13);

If the hydatid invades more than half of liver, it’s helpful to preset a blocking tape encircling the hepatoduodenal ligament, suprahepatic inferior vena cava and infrahepatic inferior vena cava, respectively (see Fig. 19.14).

If the lesion is localized in the hepatic segment, it is generally not necessary to block the hepatic portal, bleeding, temporary blocking of the hepatoduodenal ligament; if the lesion is localized to within half the liver, hemihepatectomy would be applicative with hemi-hepatic flow occlusion or directly cutting off the right hepatic artery and portal vein.