State Key Laboratory of Pathogenesis, Prevention, and Management of High Incidence Diseases in Central Asia, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China; Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China; Xinjiang Uyghur Autonomous Region Key Laboratory of Echinococcosis, Clinical Medical Institute, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
State Key Laboratory of Pathogenesis, Prevention, and Management of High Incidence Diseases in Central Asia, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China; Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China; Xinjiang Uyghur Autonomous Region Key Laboratory of Echinococcosis, Clinical Medical Institute, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
Surgery. 2021 Sep;170(3):822-830. doi: 10.1016/j.surg.2021.03.040. Epub 2021 May 11.
Patients with extensive hepatic alveolar echinococcosis might require ex vivo liver resection and autotransplantation to remove the lesion. Patients with extensive vascular invasion will need reconstruction, but the selection of the proper graft is complicated. This study aimed to investigate the effectiveness and adverse events of using the ligamentum teres hepatis as a vascular replacement graft in ex vivo liver resection and autotransplantation.
This was a retrospective case series of patients with hepatic alveolar echinococcosis who underwent ex vivo liver resection and autotransplantation between August 2010 and October 2018 and in whom the ligamentum teres hepatis was used to repair the remnant liver. The operative outcomes, recurrence, and survival were examined.
Twenty-four patients were included (10 men, 14 women). The anhepatic period was 290 to 672 minutes (median of 450 minutes). The ratio of the remnant liver volume to the standard liver volume was 0.43 to 0.97 (median of 0.71). The blood loss was 1,000 (500-5,000) mL. The postoperative hospital stay was 23 (1-85) days. Of the 24 patients, 3 died after the operation, but those deaths were unrelated to liver vascular complications.
The ligamentum teres hepatis could be used as a vascular replacement graft in ex vivo liver resection and autotransplantation. It has the advantages of convenient specimen extraction, no donor site injury, and no immunological rejection, which has promising clinical application prospects.
广泛的肝泡状棘球蚴病患者可能需要进行离体肝切除和自体移植以切除病变。广泛血管侵犯的患者需要进行重建，但合适移植物的选择较为复杂。本研究旨在探讨使用肝圆韧带作为离体肝切除和自体移植中血管替代移植物的有效性和不良事件。
这是一项回顾性病例系列研究，纳入了 2010 年 8 月至 2018 年 10 月期间接受离体肝切除和自体移植且使用肝圆韧带修复残肝的肝泡状棘球蚴病患者。检查了手术结果、复发和生存情况。
共纳入 24 例患者（男 10 例，女 14 例）。无肝期为 290 至 672 分钟（中位数为 450 分钟）。残肝体积与标准肝体积的比值为 0.43 至 0.97（中位数为 0.71）。出血量为 1000（500-5000）mL。术后住院时间为 23（1-85）天。24 例患者中，3 例术后死亡，但这些死亡与肝血管并发症无关。
肝圆韧带可作为离体肝切除和自体移植中的血管替代移植物。它具有标本提取方便、供体部位无损伤和无免疫排斥等优点，具有广阔的临床应用前景。
