Soochow University, Suzhou, China.
Department of Hepatic Hydatidosis, Qinghai Provincial People's Hospital, Xining, China.
Front Public Health. 2022 Feb 8;9:816704. doi: 10.3389/fpubh.2021.816704. eCollection 2021.
Hepatic alveolar echinococcosis (AE) is a zoonotic parasitic disease. There are more than 16,000 new cases each year, approximately 60 million people are threatened, and the annual direct economic loss is RMB 3 billion. The prevalence of AE in some areas of the Qinghai-Tibet Plateau is as high as 6.0%. Radical resection, including anatomic and non-anatomic hepatectomy, for advanced AE can significantly prolong the survival time of patients. However, there is no literature compared the efficacy of anatomic and non-anatomic hepatectomy. Therefore, by comparing various clinical evaluation indices between anatomic and non-anatomic hepatectomy, this study explored the short-term and long-term efficacy of these two surgical methods for AE.
The clinical data of patients with AE who underwent radical hepatectomy at Qinghai Provincial People's Hospital from January 2015 to January 2021 were retrospectively analyzed. The patients were divided into two groups by surgical method, that were, non-anatomic hepatectomy group and anatomic hepatectomy group. We compared these two groups focusing on basic preoperative data, such as age, sex, lesion size, and liver function parameters; main intraoperative evaluation indices, such as operation time, intraoperative porta hepatis occlusion time, intraoperative blood loss, and blood transfusion; and postoperative recovery evaluation indicators, such as postoperative liver function, incidence of surgical complications, and AE recurrence.
A total of 240 patients were enrolled in this study, including 123 in anatomic hepatectomy group and 117 in non-anatomic hepatectomy group. There were no significant differences ( > 0.05) between baseline characteristics. Anatomic hepatectomy group was advantageous than non-anatomic hepatectomy group regarding intraoperative blood loss ( < 0.001), blood transfusion ( < 0.001), and porta hepatis occlusion time ( < 0.001). There were statistically significant differences in postoperative liver function (aspartate aminotransferase: < 0.001; alanine aminotransferase: < 0.001), surgical complications ( < 0.001), and AE recurrence rate ( = 0.003). The median survival of patients in the anatomic hepatectomy group was 66 months, compared to 65 months in the non-anatomic hepatectomy group (χ = 4.662, = 0.031).
Anatomic hepatectomy was not only safe for AE but also showed better short-term and long-term superiority than non-anatomic hepatectomy.
肝泡型包虫病（AE）是一种人畜共患的寄生虫病。每年新增病例超过 16000 例，受威胁人数约 6000 万，年直接经济损失达 30 亿元。在青藏高原某些地区，AE 的患病率高达 6.0%。对于晚期 AE，包括解剖性和非解剖性肝切除术在内的根治性切除术可以显著延长患者的生存时间。然而，目前尚无文献比较解剖性和非解剖性肝切除术的疗效。因此，通过比较解剖性和非解剖性肝切除术的各种临床评估指标，本研究探讨了这两种手术方法治疗 AE 的短期和长期疗效。
回顾性分析 2015 年 1 月至 2021 年 1 月在青海省人民医院行根治性肝切除术的 AE 患者的临床资料。根据手术方式将患者分为非解剖性肝切除术组和解剖性肝切除术组。我们比较了两组患者的基本术前数据，如年龄、性别、病变大小和肝功能参数；主要术中评估指标，如手术时间、肝门阻断时间、术中出血量和输血；以及术后恢复评估指标，如术后肝功能、手术并发症发生率和 AE 复发率。
本研究共纳入 240 例患者，其中解剖性肝切除术组 123 例，非解剖性肝切除术组 117 例。两组患者的基线特征比较差异均无统计学意义（>0.05）。解剖性肝切除术组在术中出血量（<0.001）、输血（<0.001）和肝门阻断时间（<0.001）方面均优于非解剖性肝切除术组。术后肝功能（天冬氨酸转氨酶：<0.001；丙氨酸转氨酶：<0.001）、手术并发症（<0.001）和 AE 复发率（=0.003）方面差异均有统计学意义。解剖性肝切除术组患者的中位生存时间为 66 个月，而非解剖性肝切除术组为 65 个月（χ=4.662，=0.031）。
解剖性肝切除术不仅对 AE 安全，而且在短期和长期效果上均优于非解剖性肝切除术。
