Clinical study of 17 patients with <i>ex vivo</i> liver resection followed by autotransplantation for advanced hepatic alveolar echinococcosis in high altitude area_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WEI Gengfu ^1,2 , YANG Kangming ^1,2 , SHI Yiyang ^1,2 , MA Zhi ^1,2 , CHEN Ying ^1,2 , LI Zhihong ¹ , QUAN Li ¹ , ZHI Ming ¹ , ZHOU Mingliang ¹ , CHEN Xuelin ¹ , FAN Qian ¹ , CHANG Xiuping ¹ , YANG Xianwei ³ , HUANG Bin ⁴ , CHEN Zheyu ^2,3 ,  WANG Wentao ^2,3

1. Department of Hepatobiliary Surgery & Hydatid Treatment Center, Ganzi Tibetan Autonomous Prefecture People’s Hospital, Kangding, Sichuan 626000, P. R. China;
2. Sichuan Clinical Research Center for Hydatidosis, Kangding, Sichuan 626000, P. R. China;
3. Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
4. Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

WANG Wentao, Email: wwt02@163.com

Keywords：

hepatic alveolar echinococcosis; ex vivo liver resection followed by autotransplantation; inferior vena cava reconstruction

DOI：

10.7507/1007-9424.201911076

Video：

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Objective To summarize short-term and long-term effects of ex vivo liver resection followed by autotransplantation (Abbreviation: autotransplantation) in treatment of advanced hepatic alveolar echinococcosis (HAE).Method The clinical data and follow-up data of 17 patients with advanced HAE who underwent autotransplantation from November 2016 to July 2019 in the Ganzi Tibetan Autonomous Prefecture People’s Hospital were retrospectively analyzed.Results The autotransplantations were performed successfully in the 17 patients with advanced HAE. Ten patients underwent the inferior vena cava (IVC) reconstruction with autologous saphenous veins, 5 patients underwent the artificial revascularization, 1 patient underwent the direct anastomosis of the original IVC, and 1 patient didn’t reconstructed (the retroperitoneal collateral circulation was abundant). The mean liver graft mass was 681.3 g (365–1 350 g) and operation time was 11.5 h (9–16 h). The median anhepatic period was 312 min (175–450 min), blood loss was 2 000 mL(950–4 500 mL), red blood cell suspension transfusion was 6.4 U (1–20 U), and fresh frozen plasma was 1.1 L (0.8–2.0 L). The postoperative hospital stay was 5 to 45 d with an average of 25.6 d. There were 4 patients with the postoperative hepatic enveloping effusion, 1 patient with bile leakage, and 1 patient with bile duct stenosis. All of them were treated and cured, and no death occurred. The follow-up time of 17 patients was 3 to 35 months with an average of 9.5 months, no recurrence of HAE and distant metastasis were observed.Conclusions In highlands, autotransplantation in treatment of advanced HAE patients with different IVC reconstruction is satisfactory, but it has a higher risk and is difficult. Choice of intraoperative reconstruction materials, judgment of posterior peritoneal collateral circulation, presence or absence of tension in end-to-end anastomosis of the IVC require precise consideration. At the same time, anticoagulation therapy and complications management are difficult, and it is only suitable for plateau medical center with rich experience.

Citation： WEI Gengfu, YANG Kangming, SHI Yiyang, MA Zhi, CHEN Ying, LI Zhihong, QUAN Li, ZHI Ming, ZHOU Mingliang, CHEN Xuelin, FAN Qian, CHANG Xiuping, YANG Xianwei, HUANG Bin, CHEN Zheyu, WANG Wentao. Clinical study of 17 patients with ex vivo liver resection followed by autotransplantation for advanced hepatic alveolar echinococcosis in high altitude area. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(1): 24-29. doi: 10.7507/1007-9424.201911076 Copy

1.	中国医师协会外科医师分会包虫病外科专业委员会. 肝两型包虫病诊断与治疗专家共识(2019版). 中华消化外科杂志, 2019, 18(8): 711-721.
2.	Wen H, Vuitton L, Tuxun T, et al. Echinococcosis: Advances in the 21st century. Clin Microbiol Rev, 2019, 32(2): e00075-18.
3.	Qiu Y, Yang X, Shen S, et al. Vascular infiltration-based surgical planning in treating end-stage hepatic alveolar echinococcosis with ex vivo liver resection and autotransplantation. Surgery, 2019, 165(5): 889-896.
4.	温浩, 董家鸿, 张金辉, 等. 体外肝切除联合自体肝移植治疗肝泡型包虫病. 中华消化外科杂志, 2011, 10(2): 148-149.
5.	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.
6.	Yang X, Qiu Y, Huang B, et al. Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: A study of 31 cases. Am J Transplant, 2018, 18(7): 1668-1679.
7.	王燚, 张宇, 邓绍平, 等. 自体肝移植技术治疗晚期肝泡型包虫病16例临床疗效分析. 实用医院临床杂志, 2019, 16(3): 59-63.
8.	祖丽菲耶·艾则孜, 郭敏, 王乐, 等. 自体肝移植治疗肝泡型包虫病经济负担研究. 中国公共卫生, 2017, 33(7): 1105-1109.
9.	李富贵, 严律南, 李波, 等. 中国成人标准肝体积评估公式的临床研究. 四川大学学报(医学版), 2009, 40(2): 302-306.
10.	Shen S, Qiu Y, Yang X, et al. Remnant liver-to-standard liver volume ratio below 40% is safe in ex vivo liver resection and autotransplantation. J Gastrointest Surg, 2019, 23(10): 1964-1972.
11.	邱逸闻, 杨先伟, 沈舒, 等. 计算机三维可视化重建技术在肝泡型包虫病切除术中的应用. 中国普外基础与临床杂志, 2018, 25(5): 540-546.
12.	何翼彪, 白磊, 李涛, 等. 三维可视化技术在肝泡型包虫病外科治疗中的应用. 中华外科杂志, 2016, 54(9): 704-709.
13.	王文涛, 杨先伟, 严律南. 离体肝切除联合自体肝移植治疗晚期肝泡型包虫病. 中国普外基础与临床杂志, 2017, 24(7): 792-794.
14.	杨先伟, 黄斌, 邱逸闻, 等. 离体肝切除联合自体肝移植治疗晚期肝泡型包虫病21例报道. 中国普外基础与临床杂志, 2017, 24(6): 685-690.
15.	马海林, 范晓棠, 石绣江, 等. 离体肝切除自体肝移植术治疗终末期肝泡型包虫病临床研究. 中华移植杂志(电子版), 2017, 11(1): 1-4.

1. 中国医师协会外科医师分会包虫病外科专业委员会. 肝两型包虫病诊断与治疗专家共识(2019版). 中华消化外科杂志, 2019, 18(8): 711-721.
2. Wen H, Vuitton L, Tuxun T, et al. Echinococcosis: Advances in the 21st century. Clin Microbiol Rev, 2019, 32(2): e00075-18.
3. Qiu Y, Yang X, Shen S, et al. Vascular infiltration-based surgical planning in treating end-stage hepatic alveolar echinococcosis with ex vivo liver resection and autotransplantation. Surgery, 2019, 165(5): 889-896.
4. 温浩, 董家鸿, 张金辉, 等. 体外肝切除联合自体肝移植治疗肝泡型包虫病. 中华消化外科杂志, 2011, 10(2): 148-149.
5. 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.
6. Yang X, Qiu Y, Huang B, et al. Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: A study of 31 cases. Am J Transplant, 2018, 18(7): 1668-1679.
7. 王燚, 张宇, 邓绍平, 等. 自体肝移植技术治疗晚期肝泡型包虫病16例临床疗效分析. 实用医院临床杂志, 2019, 16(3): 59-63.
8. 祖丽菲耶·艾则孜, 郭敏, 王乐, 等. 自体肝移植治疗肝泡型包虫病经济负担研究. 中国公共卫生, 2017, 33(7): 1105-1109.
9. 李富贵, 严律南, 李波, 等. 中国成人标准肝体积评估公式的临床研究. 四川大学学报(医学版), 2009, 40(2): 302-306.
10. Shen S, Qiu Y, Yang X, et al. Remnant liver-to-standard liver volume ratio below 40% is safe in ex vivo liver resection and autotransplantation. J Gastrointest Surg, 2019, 23(10): 1964-1972.
11. 邱逸闻, 杨先伟, 沈舒, 等. 计算机三维可视化重建技术在肝泡型包虫病切除术中的应用. 中国普外基础与临床杂志, 2018, 25(5): 540-546.
12. 何翼彪, 白磊, 李涛, 等. 三维可视化技术在肝泡型包虫病外科治疗中的应用. 中华外科杂志, 2016, 54(9): 704-709.
13. 王文涛, 杨先伟, 严律南. 离体肝切除联合自体肝移植治疗晚期肝泡型包虫病. 中国普外基础与临床杂志, 2017, 24(7): 792-794.
14. 杨先伟, 黄斌, 邱逸闻, 等. 离体肝切除联合自体肝移植治疗晚期肝泡型包虫病21例报道. 中国普外基础与临床杂志, 2017, 24(6): 685-690.
15. 马海林, 范晓棠, 石绣江, 等. 离体肝切除自体肝移植术治疗终末期肝泡型包虫病临床研究. 中华移植杂志(电子版), 2017, 11(1): 1-4.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical study of 17 patients with ex vivo liver resection followed by autotransplantation for advanced hepatic alveolar echinococcosis in high altitude area

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