<i>In vivo</i> hepatectomy with preservation of retrohepatic inferior vena cava for hepatic alveolar echinococcosis with invasion of inferior vena cava_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Hang , TENG Fei , KONG Qingyan ,  CHEN Zheyu

Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

CHEN Zheyu, Email: chenzheyu71@163.com

Keywords：

hepatic alveolar echinococcosis; retrohepatic inferior vena cava; in vivo hepatectomy

DOI：

10.7507/1007-9424.202207070

Video：

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Objective To explore the clinical application of in vivo hepatectomy with preservation of retrohepatic inferior vena cava (IVC) for hepatic alveolar echinococcosis (HAE) with the invasion of IVC. Methods The clinicopathologic data of a complicated HAE patient with large lesion (maximum cross-section 12.6 cm×9.6 cm), infiltrative growth, unclear boundary with surrounding tissues, and invasions of diaphragm and IVC (invasion length up to 4.6 cm) admitted to the Department of Liver Surgery in the West China Hospital of Sichuan University in December 2021 was retrospectively collected. The three-dimensional reconstruction of the liver model was performed by Mimics Medical 21.0 software before operation. The invading IVC of the right liver lesion was measured and the resection was simulated. During the operation, the HAE lesion and the affected IVC were gradually separated from IVC by the hemostatic forceps, and the residual lesions were gradually removed. Results In this patient, the HAE lesion of right liver was resected, the IVC was entirely preserved, and the resection of liver was consistent with the preoperative three-dimensional reconstruction plan. The operation time was 275 min, the bleeding was approximately 500 mL. On the first day after the operation, the alanine aminotransferase and aspartate aminotransferase were increased, no obvious abnormalities were observed in the plasma albumin and bilirubin, the patient recovered and was discharged on the seventh day after the operation. No complications occurred after the operation, and no recurrence or metastasis of HAE was observed during follow-up period. Conclusions Hepatectomy with preservation of retrohepatic IVC for HAE with invasion of IVC is safe and effective. Taking albendazole regularly after surgery will help maintain disease-free survival.

Citation： LI Hang, TENG Fei, KONG Qingyan, CHEN Zheyu. In vivo hepatectomy with preservation of retrohepatic inferior vena cava for hepatic alveolar echinococcosis with invasion of inferior vena cava. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(10): 1279-1283. doi: 10.7507/1007-9424.202207070 Copy

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2.	Carmena D, Cardona GA. Echinococcosis in wild carnivorous species: epidemiology, genotypic diversity, and implications for veterinary public health. Vet Parasitol, 2014, 202(3-4): 69-94.
3.	陳哲宇. 泡型肝包蟲病的外科治療現狀. 中國普外基礎與臨床雜志, 2016, 23(5): 513-516.
4.	四川省包蟲病診療專家組. 四川省肝包蟲病診治規范. 中國普外基礎與臨床雜志, 2017, 24(7): 798-803.
5.	Ni ZK, Lin D, Wang ZQ, et al. Precision liver resection: three-dimensional reconstruction combined with fluorescence laparoscopic imaging. Surg Innov, 2021, 28(1): 71-78.
6.	楊曉菲, 鮑海華, 曹佳媛, 等. 肝泡型包蟲病“嗜靜脈血管”特點研究. 實用放射學雜志, 2018, 34(4): 541-544,567.
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9.	玉蘇甫卡迪爾·麥麥提尼加提, 吐爾干艾力·阿吉, 冉博, 等. 不同下腔靜脈重建方式在離體肝切除和自體肝移植治療肝AE中的應用. 中華器官移植雜志, 2020, 41(3): 180-184.
10.	阿吉德, 柴金萍, 趙順云, 等. 保留肝后下腔靜脈的離體肝切除、自體肝移植術在治療終末期肝泡型包蟲病中的臨床應用. 中華肝膽外科雜志, 2019, 25(11): 860-862.
11.	Ha TY, Hwang S, Jung DH, et al. Complications analysis of polytetrafluoroethylene grafts used for middle hepatic vein reconstruction in living-donor liver transplantation. Transplant Proc, 2014, 46(3): 845-849.
12.	Song HG, Rumma RT, Ozaki CK, et al. Vascular tissue engineering: progress, challenges, and clinical promise. Cell Stem Cell, 2018, 22(3): 340-354.
13.	Adipurnama I, Yang MC, Ciach T, et al. Surface modification and endothelialization of polyurethane for vascular tissue engineering applications: a review. Biomater Sci, 2016, 5(1): 22-37.
14.	Lee SH, Na GH, Choi HJ, et al. Impact of the reconstruction material on the patency of middle hepatic vein in living donor liver transplantation using the right liver. Transplant Proc, 2019, 51(8): 2745-2749.
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.	王強, 康瑩麗, 王虎, 等. 晚期肝泡型包蟲病PTCD聯合阿苯達唑治療前后肝功能及ADC值變化的研究. 磁共振成像, 2019, 10(4): 254-257.
17.	Siles-Lucas M, Casulli A, Cirilli R, et al. Progress in the pharmacological treatment of human cystic and alveolar echinococcosis: compounds and therapeutic targets. PLoS Negl Trop Dis, 2018, 12(4): e0006422. doi: 10.1371/journal.pntd.0006422.
18.	陳哲宇. 肝包蟲病的治療方法選擇. 中華臨床醫師雜志(電子版), 2015, 9(18): 3329-3331.
19.	張烈, 李延茂, 叢山. 泡型肝包蟲病患者肝切除術后肝衰竭風險的預測因素研究. 肝臟, 2021, 26(3): 302-304, 308.
20.	張勝龍, 楊先偉, 王文濤. 泡型肝包蟲病肝切除術后膽漏發生危險因素分析. 中華普通外科雜志, 2020, 35(1): 26-29.
21.	楊先偉, 黃斌, 邱逸聞, 等. 離體肝切除聯合自體肝移植治療晚期肝泡型包蟲病21例報道. 中國普外基礎與臨床雜志, 2017, 24(6): 685-690.
22.	陳克霏, 唐友銀, 賈貴清, 等. 復雜泡型肝包蟲根治性肝切除的MDT討論. 中國普外基礎與臨床雜志, 2018, 25(1): 77-82.
23.	方丹, 陳哲宇, 曾勇, 等. 泡型肝包蟲病的外科治療. 中國普外基礎與臨床雜志, 2016, 23(5): 521-525.
24.	張蒙召, 周瀛, 張靈強, 等. 肝泡型包蟲病灶邊緣組織病理特點及臨床意義的研究現狀. 中國現代普通外科進展, 2020, 23(6): 502-504.
25.	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.
26.	陳哲宇. 復雜肝包蟲病的外科治療. 中國普外基礎與臨床雜志, 2017, 24(7): 785-787.

1. Baumann S, Shi R, Liu W, et al. Worldwide literature on epidemiology of human alveolar echinococcosis: a systematic review of research published in the twenty-first century. Infection, 2019, 47(5): 703-727.
2. Carmena D, Cardona GA. Echinococcosis in wild carnivorous species: epidemiology, genotypic diversity, and implications for veterinary public health. Vet Parasitol, 2014, 202(3-4): 69-94.
3. 陳哲宇. 泡型肝包蟲病的外科治療現狀. 中國普外基礎與臨床雜志, 2016, 23(5): 513-516.
4. 四川省包蟲病診療專家組. 四川省肝包蟲病診治規范. 中國普外基礎與臨床雜志, 2017, 24(7): 798-803.
5. Ni ZK, Lin D, Wang ZQ, et al. Precision liver resection: three-dimensional reconstruction combined with fluorescence laparoscopic imaging. Surg Innov, 2021, 28(1): 71-78.
6. 楊曉菲, 鮑海華, 曹佳媛, 等. 肝泡型包蟲病“嗜靜脈血管”特點研究. 實用放射學雜志, 2018, 34(4): 541-544,567.
7. 李富貴, 嚴律南, 李波, 等. 中國成人標準肝體積評估公式的臨床研究. 四川大學學報(醫學版), 2009, 40(2): 302-306.
8. 李治宏, 楊康明, 謝德坤, 等. 肝臟泡型包蟲病侵犯下腔靜脈行人工血管置換手術效果的初步探討(附5例報道). 中國普外基礎與臨床雜志, 2020, 27(1): 30-33.
9. 玉蘇甫卡迪爾·麥麥提尼加提, 吐爾干艾力·阿吉, 冉博, 等. 不同下腔靜脈重建方式在離體肝切除和自體肝移植治療肝AE中的應用. 中華器官移植雜志, 2020, 41(3): 180-184.
10. 阿吉德, 柴金萍, 趙順云, 等. 保留肝后下腔靜脈的離體肝切除、自體肝移植術在治療終末期肝泡型包蟲病中的臨床應用. 中華肝膽外科雜志, 2019, 25(11): 860-862.
11. Ha TY, Hwang S, Jung DH, et al. Complications analysis of polytetrafluoroethylene grafts used for middle hepatic vein reconstruction in living-donor liver transplantation. Transplant Proc, 2014, 46(3): 845-849.
12. Song HG, Rumma RT, Ozaki CK, et al. Vascular tissue engineering: progress, challenges, and clinical promise. Cell Stem Cell, 2018, 22(3): 340-354.
13. Adipurnama I, Yang MC, Ciach T, et al. Surface modification and endothelialization of polyurethane for vascular tissue engineering applications: a review. Biomater Sci, 2016, 5(1): 22-37.
14. Lee SH, Na GH, Choi HJ, et al. Impact of the reconstruction material on the patency of middle hepatic vein in living donor liver transplantation using the right liver. Transplant Proc, 2019, 51(8): 2745-2749.
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. 王強, 康瑩麗, 王虎, 等. 晚期肝泡型包蟲病PTCD聯合阿苯達唑治療前后肝功能及ADC值變化的研究. 磁共振成像, 2019, 10(4): 254-257.
17. Siles-Lucas M, Casulli A, Cirilli R, et al. Progress in the pharmacological treatment of human cystic and alveolar echinococcosis: compounds and therapeutic targets. PLoS Negl Trop Dis, 2018, 12(4): e0006422. doi: 10.1371/journal.pntd.0006422.
18. 陳哲宇. 肝包蟲病的治療方法選擇. 中華臨床醫師雜志(電子版), 2015, 9(18): 3329-3331.
19. 張烈, 李延茂, 叢山. 泡型肝包蟲病患者肝切除術后肝衰竭風險的預測因素研究. 肝臟, 2021, 26(3): 302-304, 308.
20. 張勝龍, 楊先偉, 王文濤. 泡型肝包蟲病肝切除術后膽漏發生危險因素分析. 中華普通外科雜志, 2020, 35(1): 26-29.
21. 楊先偉, 黃斌, 邱逸聞, 等. 離體肝切除聯合自體肝移植治療晚期肝泡型包蟲病21例報道. 中國普外基礎與臨床雜志, 2017, 24(6): 685-690.
22. 陳克霏, 唐友銀, 賈貴清, 等. 復雜泡型肝包蟲根治性肝切除的MDT討論. 中國普外基礎與臨床雜志, 2018, 25(1): 77-82.
23. 方丹, 陳哲宇, 曾勇, 等. 泡型肝包蟲病的外科治療. 中國普外基礎與臨床雜志, 2016, 23(5): 521-525.
24. 張蒙召, 周瀛, 張靈強, 等. 肝泡型包蟲病灶邊緣組織病理特點及臨床意義的研究現狀. 中國現代普通外科進展, 2020, 23(6): 502-504.
25. 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.
26. 陳哲宇. 復雜肝包蟲病的外科治療. 中國普外基礎與臨床雜志, 2017, 24(7): 785-787.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

In vivo hepatectomy with preservation of retrohepatic inferior vena cava for hepatic alveolar echinococcosis with invasion of inferior vena cava

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