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;
WANG Wentao, Email: wwt02@163.com
hepatic alveolar echinococcosis; ex vivo liver resection followed by autotransplantation; inferior vena cava reconstruction
10.7507/1007-9424.201911076
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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