State Key Lab Breeding Base of Xinjiang Major Disease Research and Department of Liver and Laparoscopic Surgery, First Affiliated Hospital of Xinjiang Medical University, Xinjiang Organ Transplantation Research Institute, Urumqi, Xinjiang 830054, China.
Chin Med J (Engl). 2011 Sep;124(18):2813-7.
For patients with end-stage hepatic alveolar echinococcosis (AE), in vivo resection of the involved parts of the liver is usually very difficult, therefore, allogenic liver transplantation is indicated. However, we hypothesize that for selected patents, ex vivo liver resection for thorough elimination of the involved tissues and liver autotransplantation may offer a chance for clinical cure.
We presented a 24-year-old women with a giant hepatic AE lesion who was treated with hepatectomy, ex vivo resection of the involved tissue and hepatic autotransplantation. The patient had moderate jaundice and advanced hepatic AE lesion which involved segments I, IV, V, VI, VII, VIII and retrohepatic inferior vena cava. The lateral segments (II and III) of the left liver remained normal with over 1000 ml in its volume. No extrahepatic metastases (such as to the lung or brain) could be found. As the first step of treatment, X-ray guided percutaneous transhepatic cholangiodrainage (PTCD) was performed twice for bile drainage in segment III and II separately until her serum total bilirubin decreased gradually from 236 to 88 µmol/L. Total liver resection was then performed, followed by extended right hepatic trisegmentectomy and the entire retrohepatic vena cava was surgically removed en bloc while her hemodynamics parameters were stable. Neither veino-veinous bypass nor temporary intracorporeal cavo-caval or porto-caval shunt was used during the 5.7-hour anhepatic phase. The remained AE-free lateral segments of the left liver were re-implanted in situ. The left hepatic vein was directly anastomosed end-to-end to the suprahepatic inferior vena cava due to the lack of the retrohepatic inferior vena cava with AE total infiltration. Because compensatory retroperitoneal porto-caval collateral circulation developed, we enclosed remained infrahepatic inferior vena cava at renal vein level without any haemodynamics problems.
During a 60-day following-up after operation, the patient had a good recovery except for a mildly elevated serum total bilirubin.
As a radical approach, ex vivo liver resection and liver autotransplantation in a case has shown a optimal potential for treatment of the end-stage hepatic AE. Strict compliance with its indications, evaluation of vessels of patients pre-operatively, and precise surgical techniques are the keys to improve the prognosis of patients.
对于终末期肝泡型包虫病（AE）患者，体内切除受累肝脏的部分通常非常困难，因此需要进行同种异体肝移植。然而，我们假设对于某些特定患者，体外肝脏切除以彻底清除受累组织和进行肝自体移植可能提供临床治愈的机会。
我们介绍了一位 24 岁的女性患者，她患有巨大的肝泡型包虫病，接受了肝切除术、体外受累组织切除和肝自体移植治疗。患者有中度黄疸和晚期肝泡型包虫病，病变累及 I、IV、V、VI、VII、VIII 段和肝后下腔静脉。左肝外侧段（II 和 III 段）正常，体积超过 1000ml。未发现肝外转移（如肺或脑）。作为治疗的第一步，进行了两次 X 射线引导经皮经肝胆管引流（PTCD），分别引流 III 段和 II 段的胆汁，直到她的血清总胆红素逐渐从 236µmol/L 降至 88µmol/L。然后进行全肝切除术，随后进行右肝三叶切除术，并在血流动力学参数稳定的情况下整块切除整个肝后下腔静脉。在无肝 5.7 小时期间，未使用静脉-静脉旁路或临时体内腔静脉-腔静脉或门腔静脉分流术。剩余的无包虫病的左肝外侧段原位再植入。由于肝后下腔静脉完全被包虫病浸润，左肝静脉直接端端吻合至肝上腔静脉。由于代偿性腹膜后门腔侧支循环的发展，我们在肾静脉水平将剩余的肝下下腔静脉包裹起来，没有任何血流动力学问题。
术后 60 天随访时，患者除血清总胆红素轻度升高外，恢复良好。
作为一种根治性方法，体外肝脏切除和肝自体移植在治疗终末期肝泡型包虫病方面显示出了很好的治疗潜力。严格遵守其适应证，术前评估患者血管情况，并采用精确的手术技术是改善患者预后的关键。
