The preliminary experience of two-step hepatectomy in treatment of hepatic alveolar echinococcosis invaded the second and the third porta hepatis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

FANG Dan ¹ ,  CHEN Zheyu ¹ , YANG Kangming ² , CHEN Kefei ¹ , HUANG Xiang ² , MA Zhi ² , LI Zhihong ² , TANG Youyin ¹ , XIE Jie ¹ , WEI Gengfu ²

1. Department of Hepatic Surgery, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;
2. Hepatobiliary Department, The People’s Hospital of Ganzi Tibetan Autonomous Prefecture of Sichuan Province, Ganzi, Sichuan 626000, P.R.China;

Corresponding author：

CHEN Zheyu, Email: chenzheyu71@163.com

Keywords：

hepatic alveolar echinococcosis; two-step hepatectomy; the second porta hepatis; the third porta hepatis

DOI：

10.7507/1007-9424.201708020

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ObjectiveTo discuss the clinical application of two-step hepatectomy for hepatic alveolar echinococcosis which invaded the second and the third porta hepatis.MethodsThe clinical data of 60 patients with hepatic alveolar echinococcosis invaded the second and the third porta hepatis who treated with two-step hepatectomy in West China Hospital of Sichuan University and The People’s Hospital of Ganzi Tibetan Autonomous Prefecture of Sichuan Province from Jan. 2013 to Jun. 2017 were analyzed retrospectively.ResultsSixty patients had underwent radical hepatectomy successfully and no death happened during perioperative period. The average operative time was 309.17 min (150–475 min) and intraoperative blood loss was 586.67 mL (100–3 000 mL). Forty-eight patients blocked the blood flowing into the liver, the average blocking time was 25.85 min (15–50 min); 24 patients suffered red blood cell suspension, the average amount was 3.79 U (2–8 U), and 9 patients were infused with fresh frozen plasma, the average amount was 527.78 mL (350–850 mL). The average of hospital stays was 17.5 days (7–39 days) and average of hospitalization cost was 49 323.43 yuan (28 045.32–61 243.15 yuan). The liver function indicators returned to normal within 7 days after operation. After operation, 3 patients suffered from biliary fistula, 3 patients suffered from pleural effusion, 3 patients suffered from peritoneal effusion, 10 patients suffered from effusion. According to the rank of complication: 10 patients were defined as grade Ⅰ, 3 patients were defined as grade Ⅱ, 6 patients were defined as grade Ⅲa. The average follow-up time of 60 patients was 14.47 months (1–31 months). No recurrence and death occurred during follow-up period.ConclusionThe two-step hepatectomy in treatment of hepatic alveolar echinococcosis invaded the second and the third porta hepatis can avoid the large flucyuations of intraoperative blood pressure and other vital signs, can increase the safety of surgery and reduce the difficulty and risk of surgery.

Citation： FANG Dan, CHEN Zheyu, YANG Kangming, CHEN Kefei, HUANG Xiang, MA Zhi, LI Zhihong, TANG Youyin, XIE Jie, WEI Gengfu. The preliminary experience of two-step hepatectomy in treatment of hepatic alveolar echinococcosis invaded the second and the third porta hepatis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(9): 1066-1070. doi: 10.7507/1007-9424.201708020 Copy

1.	Craig P. Echinococcus multilocularis. Curr Opin Infect Dis, 2003, 16(5): 437-444.
2.	陈哲宇. 肝包虫病的治疗. 中国普外基础与临床杂志, 2015, 22(2): 129-130.
3.	陈哲宇. 肝包虫病的治疗方法选择. 中华临床医师杂志(电子版), 2015, 9(18): 3329-3331.
4.	Torgerson PR, Schweiger A, Deplazes P, et al. Alveolar echinococcosis: from a deadly disease to a well-controlled infection. Relative survival and economic analysis in Switzerland over the last 35 years. J Hepatol, 2008, 49(1): 72-77.
5.	Eckert J, Deplazes P. Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern. Clin Microbiol Rev, 2004, 17(1): 107-135.
6.	Kawamura N, Kamiyama T, Sato N, et al. Long-term results of hepatectomy for patients with alveolar echinococcosis: a single-center experience. J Am Coll Surg, 2011, 212(5): 804-812.
7.	Kasai Y, Koshino I, Kawanishi N, et al. Alveolar echinococcosis of the liver; studies on 60 operated cases. Ann Surg, 1980, 191(2): 145-152.
8.	Dulger AC, Esen R, Begenik H, et al. Alveolar echinococcosis of the liver: a single center experience. Pol Arch Med Wewn, 2012, 122(4): 133-138.
9.	Kadry Z, Renner EC, Bachmann LM, et al. Evaluation of treatment and long-term follow-up in patients with hepatic alveolar echinococcosis. Br J Surg, 2005, 92(9): 1110-1116.
10.	Buttenschoen K, Carli Buttenschoen D, Gruener B, et al. Long-term experience on surgical treatment of alveolar echinococcosis. Langenbecks Arch Surg, 2009, 394(4): 689-698.
11.	Emre A, Ozden I, Bilge O, et al. Alveolar echinococcosis in Turkey. Experience from an endemic region. Dig Surg, 2003, 20(4): 301-305.
12.	Wen H, Dong JH, Zhang JH, et al. Ex vivo liver resection and autotransplantation for end-stage alveolar echinococcosis: a case series. Am J Transplant, 2016, 16(2): 615-624.
13.	四川省包虫病诊疗专家组. 四川省肝包虫病诊治规范. 中国普外基础与临床杂志, 2017, 24(7): 798-803.
14.	Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
15.	Joliat GR, Melloul E, Petermann D, et al. Outcomes after liver resection for hepatic alveolar echinococcosis: a single-center cohort study. World J Surg, 2015, 39(10): 2529-2534.
16.	方丹, 杨康明, 陈哲宇, 等. 分期切除治疗多发泡型肝包虫病的初步经验. 中国普外基础与临床杂志, 2017, 24(7): 804-807.
17.	Brunetti E, Kern P, Vuitton DA, et al. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop, 2010, 114(1): 1-16.
18.	Li W, Wu H. Multiorgan resection with inferior vena cava reconstruction for hepatic alveolar echinococcosis: a case report and literature review. Medicine (Baltimore), 2016, 95(23): e3768.
19.	陈哲宇. 复杂肝包虫病的外科治疗. 中国普外基础与临床杂志, 2017, 24(7): 785-787.
20.	方丹, 陈哲宇. 肝泡状棘球蚴病的诊断和治疗. 临床肝胆病杂志, 2017, 33(5): 990-993.
21.	方丹, 陈哲宇, 曾勇, 等. 泡型肝包虫病的外科治疗. 中国普外基础与临床杂志, 2016, 23(5): 521-525.
22.	Bresson-Hadni S, Blagosklonov O, Knapp J, et al. Should possible recurrence of disease contraindicate liver transplantation in patients with end-stage alveolar echinococcosis? A 20-year follow-up study. Liver Transpl, 2011, 17(7): 855-865.
23.	Lei JY, Hao JC, Wang WT, et al. Ex vivo liver resection followed by autotransplantation to a patient with advanced alveolar echinococcosis with a replacement of the retrohepatic inferior vena cava using autogenous vein grafting: a case report and literature review. Medicine (Baltimore), 2015, 94(7): e514.
24.	陈哲宇. 泡型肝包虫病的外科治疗现状. 中国普外基础与临床杂志, 2016, 23(5): 513-516.

1. Craig P. Echinococcus multilocularis. Curr Opin Infect Dis, 2003, 16(5): 437-444.
2. 陈哲宇. 肝包虫病的治疗. 中国普外基础与临床杂志, 2015, 22(2): 129-130.
3. 陈哲宇. 肝包虫病的治疗方法选择. 中华临床医师杂志(电子版), 2015, 9(18): 3329-3331.
4. Torgerson PR, Schweiger A, Deplazes P, et al. Alveolar echinococcosis: from a deadly disease to a well-controlled infection. Relative survival and economic analysis in Switzerland over the last 35 years. J Hepatol, 2008, 49(1): 72-77.
5. Eckert J, Deplazes P. Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern. Clin Microbiol Rev, 2004, 17(1): 107-135.
6. Kawamura N, Kamiyama T, Sato N, et al. Long-term results of hepatectomy for patients with alveolar echinococcosis: a single-center experience. J Am Coll Surg, 2011, 212(5): 804-812.
7. Kasai Y, Koshino I, Kawanishi N, et al. Alveolar echinococcosis of the liver; studies on 60 operated cases. Ann Surg, 1980, 191(2): 145-152.
8. Dulger AC, Esen R, Begenik H, et al. Alveolar echinococcosis of the liver: a single center experience. Pol Arch Med Wewn, 2012, 122(4): 133-138.
9. Kadry Z, Renner EC, Bachmann LM, et al. Evaluation of treatment and long-term follow-up in patients with hepatic alveolar echinococcosis. Br J Surg, 2005, 92(9): 1110-1116.
10. Buttenschoen K, Carli Buttenschoen D, Gruener B, et al. Long-term experience on surgical treatment of alveolar echinococcosis. Langenbecks Arch Surg, 2009, 394(4): 689-698.
11. Emre A, Ozden I, Bilge O, et al. Alveolar echinococcosis in Turkey. Experience from an endemic region. Dig Surg, 2003, 20(4): 301-305.
12. Wen H, Dong JH, Zhang JH, et al. Ex vivo liver resection and autotransplantation for end-stage alveolar echinococcosis: a case series. Am J Transplant, 2016, 16(2): 615-624.
13. 四川省包虫病诊疗专家组. 四川省肝包虫病诊治规范. 中国普外基础与临床杂志, 2017, 24(7): 798-803.
14. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
15. Joliat GR, Melloul E, Petermann D, et al. Outcomes after liver resection for hepatic alveolar echinococcosis: a single-center cohort study. World J Surg, 2015, 39(10): 2529-2534.
16. 方丹, 杨康明, 陈哲宇, 等. 分期切除治疗多发泡型肝包虫病的初步经验. 中国普外基础与临床杂志, 2017, 24(7): 804-807.
17. Brunetti E, Kern P, Vuitton DA, et al. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop, 2010, 114(1): 1-16.
18. Li W, Wu H. Multiorgan resection with inferior vena cava reconstruction for hepatic alveolar echinococcosis: a case report and literature review. Medicine (Baltimore), 2016, 95(23): e3768.
19. 陈哲宇. 复杂肝包虫病的外科治疗. 中国普外基础与临床杂志, 2017, 24(7): 785-787.
20. 方丹, 陈哲宇. 肝泡状棘球蚴病的诊断和治疗. 临床肝胆病杂志, 2017, 33(5): 990-993.
21. 方丹, 陈哲宇, 曾勇, 等. 泡型肝包虫病的外科治疗. 中国普外基础与临床杂志, 2016, 23(5): 521-525.
22. Bresson-Hadni S, Blagosklonov O, Knapp J, et al. Should possible recurrence of disease contraindicate liver transplantation in patients with end-stage alveolar echinococcosis? A 20-year follow-up study. Liver Transpl, 2011, 17(7): 855-865.
23. Lei JY, Hao JC, Wang WT, et al. Ex vivo liver resection followed by autotransplantation to a patient with advanced alveolar echinococcosis with a replacement of the retrohepatic inferior vena cava using autogenous vein grafting: a case report and literature review. Medicine (Baltimore), 2015, 94(7): e514.
24. 陈哲宇. 泡型肝包虫病的外科治疗现状. 中国普外基础与临床杂志, 2016, 23(5): 513-516.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The preliminary experience of two-step hepatectomy in treatment of hepatic alveolar echinococcosis invaded the second and the third porta hepatis

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