Chen Ke-Fei, Tang You-Yin, Wang Rui, Fang Dan, Chen Jun-Hua, Zeng Yong, Li Bo, Wen Tian-Fu, Wang Wen-Tao, Wu Hong, Xu Ming-Qing, Yang Jia-Yin, Wei Yong-Gang, Huang Ji-Wei, Li Jia-Xin, Zhang Han-Zhi, Feng Xi, Yan Lü-Nan, Chen Zhe-Yu
Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu Institute of hydatid disease prevention and control, Ganze prefecture, Sichuan Province, China Molecular Pharmacology and Chemistry Program, Memorial Sloan-Kettering Cancer Center, New York, NY 10065.
Medicine (Baltimore). 2018 Feb;97(8):e0033. doi: 10.1097/MD.0000000000010033.
The aim of this study was to evaluate different surgical therapies for hepatic alveolar echinococcosis in different clinical stages.We analyze the clinical data of 115 patients who received surgical treatment in West China Hospital from January 2004 to June 2016. Among these patients, 77 cases underwent radical hepatic resection (group A, n = 77); 17 cases underwent palliative resection (group B, n = 17), and 21 cases underwent liver transplantation (group C, n = 21) with 12 cases of orthotopic liver transplantation and 9 cases of liver autotransplantation.The postoperative complication rate of radical hepatic resection group was 13.0% (10/77), which is statistically significant (P < .05) than the rate of palliative resection group 29.4% (5/17) or liver transplantation group 23.8% (5/21). The follow-up period ranged from 1 to 72 months. The overall median survival rate of radical resection was 72/77, higher than the rate of palliative group (12/17) or transplantation group (17/21), which was also statistically significant (P < .01).In our study, we believe in that all stages of hepatic alveolar echinococcosis should take active surgical interventions, and radical hepatic resection should be considered as the first-choice treatment for early stage of alveolar echinococcosis, while palliative surgery is still helpful to relieve symptoms and improve the life quality for advanced patients. Liver transplantation might also be an alternative option for the late-stage hepatic alveolar echinococcosis.
本研究旨在评估不同临床分期肝泡型包虫病的不同外科治疗方法。我们分析了2004年1月至2016年6月在华西医院接受手术治疗的115例患者的临床资料。其中，77例行根治性肝切除术（A组，n = 77）；17例行姑息性切除术（B组，n = 17），21例行肝移植术（C组，n = 21），其中原位肝移植12例，自体肝移植9例。根治性肝切除组术后并发症发生率为13.0%（10/77），与姑息性切除组的29.4%（5/17）或肝移植组的23.8%（5/21）相比，差异有统计学意义（P < 0.05）。随访时间为1至72个月。根治性切除的总体中位生存率为72/77，高于姑息组（12/17）或移植组（17/21），差异也有统计学意义（P < 0.01）。在我们的研究中，我们认为肝泡型包虫病各阶段均应积极采取手术干预，根治性肝切除应作为泡型包虫病早期的首选治疗方法，而姑息性手术对晚期患者缓解症状、提高生活质量仍有帮助。肝移植也可能是晚期肝泡型包虫病的一种替代选择。
