Tuerganaili Aji, Shao Y M, Zhao J M, Li T, Ran B, Jiang T M, Zhang R Q, Tuerhongjiang Tuxun, Wu L, Guo M, Wen H
Hepatobiliary & Hydatid Surgery Department, Digestive & Vascular Surgery Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China.
Zhonghua Yi Xue Za Zhi. 2017 Jan 24;97(4):270-275. doi: 10.3760/cma.j.issn.0376-2491.2017.04.007.
To investigate the clinical significance of accurate assessment of "volume and quality" of functional liver in Autologous liver transplantation (ALT) in the treatment of the advanced hepatic alveolar echinococcosis (HAE). The clinical data of 12 patients with advanced HAE who underwent ALT at the First Affiliated Hospital of Xinjiang Medical University from May 2015 to July 2016 were retrospectively analyzed. The preoperative hepatic functions of 12 patients were 8 Child-Pugh Grade A, 1 Grade B, and 3 Grade C. Three of the patients had moderate or severe jaundice. Three of the patients calculated functional liver graft volume (GV) and standard liver volume (SLV) ratio (GV/SLV) were <30%. After the protection of liver function, anti-infection, percutaneous transhepatic cholangiography drainage (PTCD), selective portal vein embolization (PVE), and staging liver resection, liver function Child-Pugh grade of 11 patients was raised to A grade, and the other patient was B grade, meanwhile the bilirubin was reduced to 2 times the normal value. The GV/SLV ratios of 3 patients with low GV/SLV ratio had reached 44.4%, 47.2% and 56.2% respectively. In this study, the GV/SLV ratios of the 12 patients were between 73.2% and 40.8% with an average of 55.6%. Operation time was 11.5-20.5 h, with an average of 12.3 h. Anhepatic phase time was 193-375 min with median 253.5 min. The red blood cell suspension was 0-6 U during the operation. The average hospitalization was 10-42 d, with the average 22.7 d. Total hospital costs were 121 600-434 800 Yuan, with the median cost of 174 400 Yuan. One patient died of septic shock a week after surgery. (1)ALT may provide feasibility for the advanced HAE. (2)Accurate assessment of functional liver "volume and quality" appeared as the key points to the ALT. (3)Precise surgery and individualized treatment could improve and protect the functional liver "volume and quality" .
探讨自体肝移植（ALT）治疗晚期肝泡型包虫病（HAE）中准确评估功能性肝脏“体积和质量”的临床意义。回顾性分析2015年5月至2016年7月在新疆医科大学第一附属医院接受ALT治疗的12例晚期HAE患者的临床资料。12例患者术前肝功能Child-Pugh分级为A级8例、B级1例、C级3例。3例患者有中度或重度黄疸。3例患者计算的功能性肝移植体积（GV）与标准肝体积（SLV）比值（GV/SLV）<30%。经过肝功能保护、抗感染、经皮肝穿刺胆道造影引流（PTCD）、选择性门静脉栓塞（PVE）及分期肝切除后，11例患者肝功能Child-Pugh分级升至A级，另1例为B级，同时胆红素降至正常值2倍。3例GV/SLV比值低的患者GV/SLV比值分别达到44.4%、47.2%和56.2%。本研究中，12例患者的GV/SLV比值在73.2%至40.8%之间，平均为55.6%。手术时间为11.5 - 20.5小时，平均12.3小时。无肝期时间为193 - 375分钟，中位数为253.5分钟。术中红细胞悬液用量为0 - 6U。平均住院时间为10 - 42天，平均22.7天。总住院费用为121600 - 434800元，中位数费用为174400元。1例患者术后1周死于感染性休克。（1）ALT可为晚期HAE提供可行性。（2）准确评估功能性肝脏“体积和质量”是ALT的关键。（3）精准手术和个体化治疗可改善和保护功能性肝脏“体积和质量”。
