Surgical Treatment of Hepatic Alveolar Echinococcosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 FANGDan ,  CHENZhe-yu , ZENGYong , LIBo , WENTian-fu , WANGWen-tao , WUHong , XUMing-qing , YANGJia-yin , WEIYong-gang , HUANGJi-wei , CHENKe-fei , LIJia-xin , ZHANGHan-zhi , FENGXi , YANLü-nan

Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding author：

CHENZhe-yu, Email: chenzheyu71@163.com

Keywords：

Hepatic alveolar echinococcosis; Palliative surgery; Hepatectomy; Liver transplantation

DOI：

10.7507/1007-9424.20160138

Video：

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Objective To discuss various surgical methods for hepatic alveolar echinococcosis. Methods The clinical data of 98 patients with hepatic alveolar echinococcosis treated in West China Hospital of Sichuan University from 2004 to 2015 were analyzed retrospectively. Palliative surgeries were performed in 9 cases, radical hepatectomies were performed in 69 cases, liver transplantations were performed in 20 cases, in which 12 cases were performed by liver allotransplantation, and 8 cases were performed by liver autotransplantation. Results There was no death case during perioperative period. The rate of postoperative complications of the radical hepatectomy (11.6%, 8/69) was significantly lower than that of the palliative surgery (44.4%, 4/9), which had statistically significant difference (P<0.05). The followup time was from 4 months to 6 years, the average time was 36 months. The postoperative recurrence rate in the radical hepatectomy (1.4%, 1/69) was significantly lower than that in the palliative surgery (55.6%, 5/9), which had statistically significant difference (P<0.05). During follow-up period, the mortality of the palliative surgery (33.33%, 3/9) was also significantly higher than that of the radical hepatectomy (0, 0/69), which had statistically significant difference (P<0.05). Four patients underwent liver transplantation were death within 3 months (20.0%). Conclusions Radical hepatectomy should be the first choice for alveolar echinococcosis. In this research, although the rates of postoperative complications and recurrence in palliative surgery are higher than those in radical hepatectomy, palliative surgery, for the patients who had lose the opportunity to perform radical hepatectomy, could be used to alleviate symptoms and physical signs, improve quality of life, delay progression of this disease. Although risk of liver transplantation is high, this might be an alternative for advanced hepatic alveolar echinococcosis.

Citation： FANGDan, CHENZhe-yu, ZENGYong, LIBo, WENTian-fu, WANGWen-tao, WUHong, XUMing-qing, YANGJia-yin, WEIYong-gang, HUANGJi-wei, CHENKe-fei, LIJia-xin, ZHANGHan-zhi, FENGXi, YANLü-nan. Surgical Treatment of Hepatic Alveolar Echinococcosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(5): 521-525. doi: 10.7507/1007-9424.20160138 Copy

1.	吴观陵. 人体寄生虫学. 第4版. 北京:人民卫生出版社, 2013:491-495.
2.	Hatipoglu S, Bulbuloglu B, Piskin T, et al. Living donor liver transplantation for alveolar echinococcus is a difficult procedure. Transplant Proc, 2013, 45(3):1028-1030.
3.	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.
4.	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.
5.	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.
6.	Koch S, Bresson-Hadni S, Miguet JP, et al. Experience of liver transplantation for incurable alveolar echinococcosis:a 45-case European collaborative report. Transplantation, 2003, 75(6):856-863.
7.	Parsak CK, Demiryurek HH, Inal M, et al. Alveolar hydatid disease:imaging findings and surgical approach. Acta Chir Belg, 2007, 107(5):572-577.
8.	Polat KY, Balik AA, Celebi F. Hepatic alveolar echinococcosis:clinical report from an endemic region. Can J Surg, 2002, 45(6):415-419.
9.	Ayifuhan A, Tuerganaili A, Jun C, et al. Surgical treatment for hepatic alveolar echinococcosis:report of 50 cases. Hepatogastroenterology, 2012, 59(115):790-793.
10.	张瀚之, 陈哲宇, 严律南, 等. 肝包虫病外科治疗的单中心经验. 中国普外基础与临床杂志, 2015, 22(2):144-148.
11.	Brunetti E, Kern P, Vuitton DA; Writing Panel for the WHO-IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop, 2010, 114(1):1-16.
12.	Atanasov G, Benckert C, Thelen A, et al. Alveolar echinococcosisspreading disease challenging clinicians:a case report and literature review. World J Gastroenterol, 2013, 19(26):4257-4261.
13.	Buttenschoen K, Gruener B, Carli Buttenschoen D, et al. Palliative operation for the treatment of alveolar echinococcosis. Langenbecks Arch Surg, 2009, 394(1):199-204.
14.	Nunnari G, Pinzone MR, Gruttadauria S, et al. Hepatic echinococcosis:clinical and therapeutic aspects. World J Gastroenterol, 2012, 18(13):1448-1458.
15.	Buttenschoen K, Gruener B, Carli Buttenschoen D, et al. Palliative operation for the treatment of alveolar echinococcosis. Langenbecks Arch Surg, 2009, 394(1):199-204.
16.	Li FQ, Yang M, Li B, et al. Initial clinical results of orthotopic liver transplantation for hepatic alveolar echinococcosis. Liver Transpl, 2007, 13(6):924-926.
17.	He YB, Bai L, Jiang Y, et al. Application of a three-dimensional reconstruction technique in liver autotransplantation for end-stage hepatic alveolar echinococcosis. J Gastrointest Surg, 2015, 19(8):1457-1465.
18.	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.
19.	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.
20.	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.

1. 吴观陵. 人体寄生虫学. 第4版. 北京:人民卫生出版社, 2013:491-495.
2. Hatipoglu S, Bulbuloglu B, Piskin T, et al. Living donor liver transplantation for alveolar echinococcus is a difficult procedure. Transplant Proc, 2013, 45(3):1028-1030.
3. 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.
4. 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.
5. 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.
6. Koch S, Bresson-Hadni S, Miguet JP, et al. Experience of liver transplantation for incurable alveolar echinococcosis:a 45-case European collaborative report. Transplantation, 2003, 75(6):856-863.
7. Parsak CK, Demiryurek HH, Inal M, et al. Alveolar hydatid disease:imaging findings and surgical approach. Acta Chir Belg, 2007, 107(5):572-577.
8. Polat KY, Balik AA, Celebi F. Hepatic alveolar echinococcosis:clinical report from an endemic region. Can J Surg, 2002, 45(6):415-419.
9. Ayifuhan A, Tuerganaili A, Jun C, et al. Surgical treatment for hepatic alveolar echinococcosis:report of 50 cases. Hepatogastroenterology, 2012, 59(115):790-793.
10. 张瀚之, 陈哲宇, 严律南, 等. 肝包虫病外科治疗的单中心经验. 中国普外基础与临床杂志, 2015, 22(2):144-148.
11. Brunetti E, Kern P, Vuitton DA; Writing Panel for the WHO-IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop, 2010, 114(1):1-16.
12. Atanasov G, Benckert C, Thelen A, et al. Alveolar echinococcosisspreading disease challenging clinicians:a case report and literature review. World J Gastroenterol, 2013, 19(26):4257-4261.
13. Buttenschoen K, Gruener B, Carli Buttenschoen D, et al. Palliative operation for the treatment of alveolar echinococcosis. Langenbecks Arch Surg, 2009, 394(1):199-204.
14. Nunnari G, Pinzone MR, Gruttadauria S, et al. Hepatic echinococcosis:clinical and therapeutic aspects. World J Gastroenterol, 2012, 18(13):1448-1458.
15. Buttenschoen K, Gruener B, Carli Buttenschoen D, et al. Palliative operation for the treatment of alveolar echinococcosis. Langenbecks Arch Surg, 2009, 394(1):199-204.
16. Li FQ, Yang M, Li B, et al. Initial clinical results of orthotopic liver transplantation for hepatic alveolar echinococcosis. Liver Transpl, 2007, 13(6):924-926.
17. He YB, Bai L, Jiang Y, et al. Application of a three-dimensional reconstruction technique in liver autotransplantation for end-stage hepatic alveolar echinococcosis. J Gastrointest Surg, 2015, 19(8):1457-1465.
18. 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.
19. 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.
20. 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.

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Surgical Treatment of Hepatic Alveolar Echinococcosis

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