Department of Graduate School, Qinghai University, Xining, China.
Department of General Surgery, Qinghai Provincial People's Hospital, Xining, China.
Am J Trop Med Hyg. 2023 Aug 7;109(3):640-644. doi: 10.4269/ajtmh.23-0276. Print 2023 Sep 6.
Hepatic alveolar echinococcosis (AE) is a zoonotic disease caused by the metacestode of Echinococcus multilocularis. Although surgical resection is the optimal treatment for hepatic AE, some patients with hepatic AE located in special introhepatic sites cannot be radically cured by conventional surgery. Here, we report that a 10-year-old female patient was admitted to the hospital with occupying liver lesions for 6 months. Computed tomography examination showed irregular mixed-density masses in the right lobe and caudate lobe of the liver, with partial invasion of the right hepatic artery, right hepatic vein, and right branch of the portal vein. The patient was preoperatively diagnosed with hepatic AE, which cannot be cured by conventional liver lobectomy. The patient underwent semi-ex vivo liver resection with autologous liver transplantation (second hepatic portal reconstruction, posterior hepatic inferior vena cava repair, and hepatic artery repair) and biliary-intestinal anastomosis. After hospital discharge, she has kept living a healthy life without disease recurrence for 13 months until the end of the last follow-up. This case shows that semi-ex vivo hepatectomy with autologous liver transplantation might be a feasible and safe choice for certain patients with AE located in special introhepatic sites, which has provided novel experiences for the surgical treatment of hepatic AE.
肝泡型包虫病（AE）是一种由多房棘球绦虫的囊尾蚴引起的人畜共患疾病。尽管手术切除是肝泡型包虫病的最佳治疗方法，但某些位于特殊肝内部位的肝泡型包虫病患者不能通过传统手术根治。在这里，我们报告了一名 10 岁女性患者，因占位性肝病变入院 6 个月。计算机断层扫描检查显示肝右叶和尾状叶不规则混合密度肿块，部分侵犯肝右动脉、肝右静脉和门静脉右支。患者术前诊断为肝泡型包虫病，不能通过常规肝叶切除术治愈。患者接受了半离体肝切除术和自体肝移植（第二肝门重建、后下腔静脉修复和肝动脉修复）及胆肠吻合术。出院后，患者已健康生存 13 个月，无疾病复发，直至最后一次随访结束。该病例表明，对于某些位于特殊肝内部位的 AE 患者，半离体肝切除术和自体肝移植可能是一种可行且安全的选择，为肝泡型包虫病的手术治疗提供了新的经验。
