Application of hepatic vein reconstruction with various vascular materials in treatment of end-stage hepatic alveolar echinococcosis by ex-vivo liver resection and autologous liver transplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HUANG Liang ^1,2 , ZHANG Na ³ , YANG Chong ¹ , TIAN Mingwu ¹ , PANG Beichuan ¹ , LIAO Yubo ^1,2 , YANG Wenhao ¹ , YUAN Chengxiang ^1,2 ,  ZHANG Yu ^1,2

1. Affiliated Hospital of University of Electronic Science and technology ? Department of Hepatobiliary and Pancreas Surgery, Sichuan Provincial People’s Hospital, Chengdu 610072, P. R. China”;
2. Clinical College, Chengdu Medical College, Chengdu 610599, P. R. China;
3. Department of The 5th Assignment Outpatient, Western Theater General Hospital, Chengdu 610083, P. R. China;

Corresponding?author：

ZHANG Yu, Email: 68532815@qq.com

Keywords：

hepatic alveolar echinococcosis; hepatic outflow reconstruction; in vivo first; autologous liver transplantation; ex-vivo liver resection

DOI：

10.7507/1007-9424.202202038

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Objective To summarize the key operative points and efficacy of ex-vivo ex-vivo liver resection and autologous liver transplantation (ELRA) using various vascular materials for hepatic vein reconstruction in the treatment of end-stage hepatic alveolar echinococcosis (HAE). Method The clinicopathologic data of a patient with end-stage HAE who underwent ELRA combined with complex hepatic vein reconstruction were retrospectively analyzed. Results The patient was a 60-year-old male who was admitted to the Sichuan Provincial People’s Hospital due to giant alveolar hydatid in the liver, with a body weight of 60 kg and a standard liver volume of 1 024.5 mL. The imaging showed that the hydatid invaded the first and second hepatic portals, middle hepatic vein, left hepatic vein, and retrohepatic inferior vena cava. The three-dimensional reconstruction of CT showed that the residual liver volume was 1 270.6 mL. The patient received supportive treatment after admission and underwent ELRA following strict evaluation. Intraoperatively, it was found that the multiple hepatic veins and retrohepatic inferior vena cava were widely invaded. The liver was split in vivo and the mass was excised ex vivo by “in vivo first” principle. The hepatic vein was repaired and reconstructed into a wide mouth outflow tract using allogeneic veins, autologous inferior mesenteric vein, and hepatic round ligaments, then performed the autotransplantation by wide mouth outflow-artificial inferior vena cava anastomosis (end to side). The operative time was 16 h, and the intraoperative blood loss was approximately 2 000 mL. FK506 was orally administered after operation, and low-molecular-weight heparin sodium was administered 24 h later for anticoagulation. The patient was returned to the general ward on the 6th day after the operation, and the enhanced CT scan showed that the hepatic outflow tract was unobstructed, without stenosis and thrombosis, and the patient was discharged on day 18 after the operation. The patient was pathologically diagnosed with alveolar echinococcosis. Conclusions From the results of this case, combination of multiple vascular materials to reconstruct the hepatic outflow tract is an optional procedure for ELRA in treatment of end-stage HAE. Strict preoperative evaluation, skillful vascular anastomosis technique, and postoperative anticoagulation are important measures to maintain patency of postoperative reconstruction vessel.

Citation： HUANG Liang, ZHANG Na, YANG Chong, TIAN Mingwu, PANG Beichuan, LIAO Yubo, YANG Wenhao, YUAN Chengxiang, ZHANG Yu. Application of hepatic vein reconstruction with various vascular materials in treatment of end-stage hepatic alveolar echinococcosis by ex-vivo liver resection and autologous liver transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(9): 1169-1173. doi: 10.7507/1007-9424.202202038 Copy

1.	Vuitton D. Alveolar echinococcosis of the liver: a parasitic disease in search of a treatment. Hepatology, 1990, 12(3 Pt 1): 617-618.
2.	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.
3.	Craig PS, Li T, Qiu J, et al. Echinococcosis and Tibetan communities. Emerg Infect Dis, 2008, 14(10): 1674-1675.
4.	Li F, Yang M, Li B, et al. Initial clinical results of orthotopic liver transplantation for hepatic alveolar echinococcosis. Liver Transpl, 2007, 13(6): 924-926.
5.	Bresson-Hadni S, Koch S, Miguet JP, et al. Indications and results of liver transplantation for echinococcus alveolar infection: an overview. Langenbecks Arch Surg, 2003, 388(4): 231-238.
6.	Wen H, Dong JH, Zhang JH, et al. Ex vivo liver resection followed by autotransplantation for end-stage hepatic alveolar echinococcosis. Chin Med J (Engl), 2011, 124(18): 2813-2817.
7.	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.
8.	Wang H, Liu Q, Wang Z, et al. Clinical outcomes of ex vivo liver resection and liver autotransplantation for hepatic alveolar echinococcosis. J Huazhong Univ Sci Technolog Med Sci, 2012, 32(4): 598-600.
9.	王燚, 張宇, 鄧紹平, 等. 自體肝移植技術治療晚期肝泡型包蟲病16例臨床療效分析. 實用醫院臨床雜志, 2019, 16(3): 59-63.
10.	張宇, 楊沖, 王燚, 等. 原位保留部分殘余肝臟的離體肝切除聯合輔助性自體肝移植治療復雜肝泡型包蟲病. 中國普外基礎與臨床雜志, 2019, 26(8): 974-979.
11.	張宇, 楊沖, 王燚, 等. 離體肝切除和自體肝移植聯合復雜肝靜脈重建治療終末期肝泡型包蟲病. 中國普外基礎與臨床雜志, 2018, 25(10): 1236-1241.
12.	Li FG, Yan LN, Li B, et al. Estimation of standard liver volume in Chinese adult living donors. Transplant Proc, 2009, 41(10): 4052-4056.
13.	智明, 邱逸聞, 楊先偉, 等. 基于血管侵犯情況的晚期肝泡型包蟲病分型84例應用體會. 中國普外基礎與臨床雜志, 2022: 優先出版.
14.	何翼彪, 白磊, 吐爾干艾力·阿吉, 等. 數字化三維重建技術在肝泡型包蟲病肝移植中的應用. 中華肝臟外科手術學電子雜志, 2015, 4(5): 279-283.
15.	Ikegami T, Soejima Y, Taketomi A, et al. Explanted portal vein grafts for middle hepatic vein tributaries in living-donor liver transplantation. Transplantation, 2007, 84(7): 836-841.
16.	Wu H, Yan LN, Li B, et al. Hepatic venous outflow reconstruction in right lobe graft without middle hepatic vein. Hepatol Res, 2007, 37(12): 1044-1051.
17.	Ikegami T, Shirabe K, Yoshiya S, et al. One-step reconstruction of the right inferior hepatic veins using auto-venous grafts in living-donor liver transplantation. Surg Today, 2013, 43(7): 769-776.
18.	任章勇, 呂少誠, 賀強. 同種異體血管在肝膽胰手術中的應用現狀. 解放軍醫學院學報, 2020, 41(7): 724-727.
19.	Kilic M, Aydin U, Sozbilen M, et al. Comparison between allogenic and autologous vascular conduits in the drainage of anterior sector in right living donor liver transplantation. Transpl Int, 2007, 20(8): 697-701.
20.	李曉鋒, 何菊. 同種異體血管在血管外科的應用現狀. 實用器官移植電子雜志, 2019, 7(4): 305-307.
21.	Jashari R, Van Hoeck B, Ngakam R, et al. Banking of cryopreserved arterial allografts in Europe: 20 years of operation in the European Homograft Bank (EHB) in Brussels. Cell Tissue Bank, 2013, 14(4): 589-599.
22.	Gómez-Caro A, Martinez E, Rodríguez A, et al. Cryopreserved arterial allograft reconstruction after excision of thoracic malignancies. Ann Thorac Surg, 2008, 86(6): 1753-1761.
23.	Boulland LM, Naper C, Skauby MH. Presensitization revisited: pitfalls of vascular allografts in transplant candidates. Clin Kidney J, 2014, 7(1): 65-67.
24.	Ribbe EB, Alm P, Hallberg E, et al. Evaluation of peritoneal tube grafts in the inferior vena cava of the pig. Br J Surg, 1988, 75(4): 357-360.
25.	Ikegami T, Wang H, Imai D, et al. Pathological analysis of opened round ligaments as venous patch grafts in living donor liver transplantation. Liver Transpl, 2013, 19(11): 1245-1251.

1. Vuitton D. Alveolar echinococcosis of the liver: a parasitic disease in search of a treatment. Hepatology, 1990, 12(3 Pt 1): 617-618.
2. 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.
3. Craig PS, Li T, Qiu J, et al. Echinococcosis and Tibetan communities. Emerg Infect Dis, 2008, 14(10): 1674-1675.
4. Li F, Yang M, Li B, et al. Initial clinical results of orthotopic liver transplantation for hepatic alveolar echinococcosis. Liver Transpl, 2007, 13(6): 924-926.
5. Bresson-Hadni S, Koch S, Miguet JP, et al. Indications and results of liver transplantation for echinococcus alveolar infection: an overview. Langenbecks Arch Surg, 2003, 388(4): 231-238.
6. Wen H, Dong JH, Zhang JH, et al. Ex vivo liver resection followed by autotransplantation for end-stage hepatic alveolar echinococcosis. Chin Med J (Engl), 2011, 124(18): 2813-2817.
7. 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.
8. Wang H, Liu Q, Wang Z, et al. Clinical outcomes of ex vivo liver resection and liver autotransplantation for hepatic alveolar echinococcosis. J Huazhong Univ Sci Technolog Med Sci, 2012, 32(4): 598-600.
9. 王燚, 張宇, 鄧紹平, 等. 自體肝移植技術治療晚期肝泡型包蟲病16例臨床療效分析. 實用醫院臨床雜志, 2019, 16(3): 59-63.
10. 張宇, 楊沖, 王燚, 等. 原位保留部分殘余肝臟的離體肝切除聯合輔助性自體肝移植治療復雜肝泡型包蟲病. 中國普外基礎與臨床雜志, 2019, 26(8): 974-979.
11. 張宇, 楊沖, 王燚, 等. 離體肝切除和自體肝移植聯合復雜肝靜脈重建治療終末期肝泡型包蟲病. 中國普外基礎與臨床雜志, 2018, 25(10): 1236-1241.
12. Li FG, Yan LN, Li B, et al. Estimation of standard liver volume in Chinese adult living donors. Transplant Proc, 2009, 41(10): 4052-4056.
13. 智明, 邱逸聞, 楊先偉, 等. 基于血管侵犯情況的晚期肝泡型包蟲病分型84例應用體會. 中國普外基礎與臨床雜志, 2022: 優先出版.
14. 何翼彪, 白磊, 吐爾干艾力·阿吉, 等. 數字化三維重建技術在肝泡型包蟲病肝移植中的應用. 中華肝臟外科手術學電子雜志, 2015, 4(5): 279-283.
15. Ikegami T, Soejima Y, Taketomi A, et al. Explanted portal vein grafts for middle hepatic vein tributaries in living-donor liver transplantation. Transplantation, 2007, 84(7): 836-841.
16. Wu H, Yan LN, Li B, et al. Hepatic venous outflow reconstruction in right lobe graft without middle hepatic vein. Hepatol Res, 2007, 37(12): 1044-1051.
17. Ikegami T, Shirabe K, Yoshiya S, et al. One-step reconstruction of the right inferior hepatic veins using auto-venous grafts in living-donor liver transplantation. Surg Today, 2013, 43(7): 769-776.
18. 任章勇, 呂少誠, 賀強. 同種異體血管在肝膽胰手術中的應用現狀. 解放軍醫學院學報, 2020, 41(7): 724-727.
19. Kilic M, Aydin U, Sozbilen M, et al. Comparison between allogenic and autologous vascular conduits in the drainage of anterior sector in right living donor liver transplantation. Transpl Int, 2007, 20(8): 697-701.
20. 李曉鋒, 何菊. 同種異體血管在血管外科的應用現狀. 實用器官移植電子雜志, 2019, 7(4): 305-307.
21. Jashari R, Van Hoeck B, Ngakam R, et al. Banking of cryopreserved arterial allografts in Europe: 20 years of operation in the European Homograft Bank (EHB) in Brussels. Cell Tissue Bank, 2013, 14(4): 589-599.
22. Gómez-Caro A, Martinez E, Rodríguez A, et al. Cryopreserved arterial allograft reconstruction after excision of thoracic malignancies. Ann Thorac Surg, 2008, 86(6): 1753-1761.
23. Boulland LM, Naper C, Skauby MH. Presensitization revisited: pitfalls of vascular allografts in transplant candidates. Clin Kidney J, 2014, 7(1): 65-67.
24. Ribbe EB, Alm P, Hallberg E, et al. Evaluation of peritoneal tube grafts in the inferior vena cava of the pig. Br J Surg, 1988, 75(4): 357-360.
25. Ikegami T, Wang H, Imai D, et al. Pathological analysis of opened round ligaments as venous patch grafts in living donor liver transplantation. Liver Transpl, 2013, 19(11): 1245-1251.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of hepatic vein reconstruction with various vascular materials in treatment of end-stage hepatic alveolar echinococcosis by ex-vivo liver resection and autologous liver transplantation

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