Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China.
Clinical Medical Research Center of Echinococcosis and Hepatobiliary Disease of Xinjiang Uygur Autonomous Region, Urumqi, 830054, Xinjiang, China.
BMC Surg. 2022 Dec 6;22(1):415. doi: 10.1186/s12893-022-01864-w.
This study was designed to investigate clinical efficiency and application indications of hepatic lobe hyperplasia techniques for advanced hepatic alveolar echinococcosis (AE) patients.
A retrospective case series covering 19 advanced hepatic AE patients admitted to the First Affiliated Hospital of Xinjiang Medical University from September 2014 to December 2021 and undergoing hepatic lobe hyperplasia techniques due to insufficient remnant liver volume were analyzed. Changes of liver function, lesions volume, remnant liver volume, total liver volume before and after operation have been observed.
Among the patients, 15 underwent portal vein embolization (PVE). There was no statistical difference in total liver volume and lesions volume before and after PVE (P > 0.05). However, the remnant liver volume was significantly increased after PVE (P < 0.05). The median monthly increase rate in future liver remnant volume (FLRV) after PVE stood at 4.49% (IQR 3.55-7.06). Among the four patients undergoing two-stage hepatectomy (TSH), FLRV was larger than that before the first stage surgery, and the median monthly increase rate in FLRV after it stood at 3.34% (IQR 2.17-4.61). Despite no statistical difference in total bilirubin (TBil), albumin (Alb), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transpeptidase (GGT) in all patients with PVE, four patients who underwent TSH showed a decrease in ALT, AST and GGT. During the waiting process before the second stage operation, no serious complications occurred in all patients.
For patients suffering from advanced hepatic AE with insufficient FLRV, PVE and TSH are safe and feasible in promoting hepatic lobe hyperplasia.
本研究旨在探讨肝叶增生技术在治疗晚期肝泡型包虫病（AE）患者中的临床疗效和适应证。
回顾性分析了 2014 年 9 月至 2021 年 12 月新疆医科大学第一附属医院收治的 19 例因剩余肝体积不足而接受肝叶增生技术的晚期肝泡型包虫病患者的临床资料。观察患者术前、术后肝功能、病变体积、剩余肝体积、全肝体积的变化。
15 例患者接受了门静脉栓塞术（PVE）。PVE 前后全肝体积和病变体积无统计学差异（P>0.05）。但 PVE 后剩余肝体积明显增加（P<0.05）。PVE 后未来肝残留体积（FLRV）的中位月增长率为 4.49%（IQR 3.55-7.06）。在接受两阶段肝切除术（TSH）的 4 例患者中，FLRV 大于第一阶段手术前，FLRV 的中位月增长率为 3.34%（IQR 2.17-4.61）。尽管 PVE 后所有患者的总胆红素（TBil）、白蛋白（Alb）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）和γ-谷氨酰转肽酶（GGT）无统计学差异，但接受 TSH 的 4 例患者 ALT、AST 和 GGT 均有所下降。在第二阶段手术前的等待过程中，所有患者均未发生严重并发症。
对于剩余肝体积不足的晚期肝泡型包虫病患者，PVE 和 TSH 均可安全有效地促进肝叶增生。
