Two-stage hepatectomy for complicated hepatic alveolar echinococcosis with multiple lesions_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Hang ^1,2 , TENG Fei ^1,2 , KONG Qingyan ^1,2 ,  CHEN Zheyu ²

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

Corresponding author：

CHEN Zheyu, Email: chenzheyu71@163.com

Keywords：

complicated hepatic alveolar echinococcosis; two-stage hepatectomy

DOI：

10.7507/1007-9424.202210058

Video：

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Objective To explore the efficiency of two-stage hepatectomy applicated in complex alveolar echinococcosis. Method The clinical data of one case who suffered from complicated alveolar echinococcosis with multiple lesions and then treated with two-stage hepatectomy were analyzed retrospectively. Results Preoperative enhanced CT revealed that the hydatid lesion with irregular shape, measuring 14.1 cm×9.2 cm, invaded several segments including left medial lobe and right anterior lobe of liver and the right branch of portal vein and medium hepatic vein were entirely surrounded by it. After preoperative examination surgical exploration was performed, two larger lesions measuring 6 cm×5 cm×4 cm and 5 cm×4 cm×4 cm respectively were found in caudate lobe of liver, three smaller lesions were found in the right and left lobe of liver, among which two measured 2 cm×2 cm×1 cm in the right lobe and one measured 3 cm×2 cm×1 cm in the left lobe. Mesohepatectomy was performed in the first stage, the lesion in left medial lobe and right anterior lobe of liver and the right anterior branch of portal vein were resected during the procedure. The patient recovered well after the operation without complications such as bile leakage or hemorrhage observed. The second stage surgery was performed at three months after operation, the computed tomograph before the surgery revealed that the remained lesions in the right lobe of liver did not proceed obviously and the left lateral external lobe of liver regenerated significantly. In the second stage, the right anterior lobe and part of the right posterior lobe of liver were resected. The patient was discharged on 7 days after operation, and there was no complication and relapse during the 7 months of follow-up period. Conclusion Two-stage hepatectomy applicated in treating complicated alveolar echinococcosis with multiple lesions is safe and feasible, offering a choice with smaller trauma, lower expense and less complications for patients compared with liver transplantation.

Citation： LI Hang, TENG Fei, KONG Qingyan, CHEN Zheyu. Two-stage hepatectomy for complicated hepatic alveolar echinococcosis with multiple lesions. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(1): 43-47. doi: 10.7507/1007-9424.202210058 Copy

1.	Wang X, Dai G, Li M, et al. Prevalence of human alveolar echinococcosis in China: a systematic review and meta-analysis. BMC Public Health, 2020, 20(1): 1105. doi: 10.1186/s12889-020-08989-8.
2.	Maddah G, Abdollahi A, Sharifi-Nooghabi R, et al. Difficulties in the diagnosis and management of alveolar hydatid disease: a case series. Caspian J Intern Med, 2016, 7(1): 52-56.
3.	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.
4.	杨晓菲, 鲍海华, 曹佳媛, 等. 肝泡型包虫病“嗜静脉血管”特点研究. 实用放射学杂志, 2018, 34(4): 541-544, 567.
5.	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.
6.	张烈, 李延茂, 丛山. 肝泡型包虫病患者肝切除术后肝衰竭风险的预测因素研究. 肝脏, 2021, 26(3): 302-304, 308.
7.	Søreide JA, Deshpande R. Post hepatectomy liver failure (PHLF)—Recent advances in prevention and clinical management. Eur J Surg Oncol. 2021, 47(2): 216-224.
8.	Zavoikin VD, Zelya OP, Tumolskaya NI. Clinical tolerance and efficacy of anti-parasitic treatment with albendazole in patients with alveolar echinococcosis: long-term follow-up observation in 117 patients. Parasitol Res, 2021, 120(10): 3603-3610.
9.	Bresson-hadni S, Spahr L, Chappuis F. Hepatic alveolar echinococcosis. Semin Liver Dis, 2021, 41(3): 393-408.
10.	Aliakbarian M, Tohidinezhad F, Eslami S, et al. Liver transplantation for hepatic alveolar echinococcosis: literature review and three new cases. Infect Dis (Lond), 2018, 50(6): 452-459.
11.	Ran B, Maimaitinijiati Y, Yasen A, et al. Feasibility of retrohepatic inferior vena cava resection without reconstruction for hepatic alveolar echinococcosis. Am Surg, 2021, 87(3): 443-449.
12.	Shen HD, Chen KF, Li B, et al. Two-stage hepatectomy for multiple giant alveolar echinococcosis. Medicine (Baltimore), 2017, 96(33): e7819. doi: 10.1097/MD. 0000000000007819.
13.	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.
14.	Ricken FJ, Nell J, Gruner B, et al. Albendazole increases the inflammatory response and the amount of Em2-positive small particles of Echinococcus multilocularis (spems) in human hepatic alveolar echinococcosis lesions. PLoS Negl Trop Dis, 2017, 11(5): e0005636. doi: 10.1371/journal.pntd.0005636.
15.	Yagi S, Hirata M, Miyachi Y, et al. Liver regeneration after hepatectomy and partial liver transplantation. Int J Mol Sci, 2020, 21(21): 8414. doi: 10.3390/ijms21218414.
16.	方丹, 杨康明, 陈哲宇, 等. 分期切除治疗多发肝泡型包虫病的初步经验. 中国普外基础与临床杂志, 2017, 24(7): 804-807.
17.	方丹, 陈哲宇, 杨康明, 等. 侵犯第二、三肝门的肝泡型包虫病行分步切除的初步经验. 中国普外基础与临床杂志, 2017, 24(9): 1066-1070.
18.	Sun T, He Y, Shen S, et al. Two-stage hepatectomy combined with middle hepatic vein reconstruction in a patient with complicated hepatic alveolar echinococcosis. Asian J Surg, 2021, 44(11): 1405-1406.
19.	陈颖, 杨康明, 黄详, 等. 肝脾多发巨大泡型包虫病分期切除1例报道. 中国普外基础与临床杂志, 2016, 23(5): 544-546.
20.	王文涛, 杨闯, 严律南. 肝泡型包虫病外科根治性治疗的新理念与策略. 中华医学杂志, 2018, 98(38): 3049-3051.
21.	陈哲宇. 复杂肝包虫病的外科治疗. 中国普外基础与临床杂志, 2017, 24(7): 785-787.
22.	四川省包虫病诊疗专家组. 四川省肝包虫病诊治规范. 中国普外基础与临床杂志, 2017, 24(7): 798-803.

1. Wang X, Dai G, Li M, et al. Prevalence of human alveolar echinococcosis in China: a systematic review and meta-analysis. BMC Public Health, 2020, 20(1): 1105. doi: 10.1186/s12889-020-08989-8.
2. Maddah G, Abdollahi A, Sharifi-Nooghabi R, et al. Difficulties in the diagnosis and management of alveolar hydatid disease: a case series. Caspian J Intern Med, 2016, 7(1): 52-56.
3. 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.
4. 杨晓菲, 鲍海华, 曹佳媛, 等. 肝泡型包虫病“嗜静脉血管”特点研究. 实用放射学杂志, 2018, 34(4): 541-544, 567.
5. 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.
6. 张烈, 李延茂, 丛山. 肝泡型包虫病患者肝切除术后肝衰竭风险的预测因素研究. 肝脏, 2021, 26(3): 302-304, 308.
7. Søreide JA, Deshpande R. Post hepatectomy liver failure (PHLF)—Recent advances in prevention and clinical management. Eur J Surg Oncol. 2021, 47(2): 216-224.
8. Zavoikin VD, Zelya OP, Tumolskaya NI. Clinical tolerance and efficacy of anti-parasitic treatment with albendazole in patients with alveolar echinococcosis: long-term follow-up observation in 117 patients. Parasitol Res, 2021, 120(10): 3603-3610.
9. Bresson-hadni S, Spahr L, Chappuis F. Hepatic alveolar echinococcosis. Semin Liver Dis, 2021, 41(3): 393-408.
10. Aliakbarian M, Tohidinezhad F, Eslami S, et al. Liver transplantation for hepatic alveolar echinococcosis: literature review and three new cases. Infect Dis (Lond), 2018, 50(6): 452-459.
11. Ran B, Maimaitinijiati Y, Yasen A, et al. Feasibility of retrohepatic inferior vena cava resection without reconstruction for hepatic alveolar echinococcosis. Am Surg, 2021, 87(3): 443-449.
12. Shen HD, Chen KF, Li B, et al. Two-stage hepatectomy for multiple giant alveolar echinococcosis. Medicine (Baltimore), 2017, 96(33): e7819. doi: 10.1097/MD. 0000000000007819.
13. 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.
14. Ricken FJ, Nell J, Gruner B, et al. Albendazole increases the inflammatory response and the amount of Em2-positive small particles of Echinococcus multilocularis (spems) in human hepatic alveolar echinococcosis lesions. PLoS Negl Trop Dis, 2017, 11(5): e0005636. doi: 10.1371/journal.pntd.0005636.
15. Yagi S, Hirata M, Miyachi Y, et al. Liver regeneration after hepatectomy and partial liver transplantation. Int J Mol Sci, 2020, 21(21): 8414. doi: 10.3390/ijms21218414.
16. 方丹, 杨康明, 陈哲宇, 等. 分期切除治疗多发肝泡型包虫病的初步经验. 中国普外基础与临床杂志, 2017, 24(7): 804-807.
17. 方丹, 陈哲宇, 杨康明, 等. 侵犯第二、三肝门的肝泡型包虫病行分步切除的初步经验. 中国普外基础与临床杂志, 2017, 24(9): 1066-1070.
18. Sun T, He Y, Shen S, et al. Two-stage hepatectomy combined with middle hepatic vein reconstruction in a patient with complicated hepatic alveolar echinococcosis. Asian J Surg, 2021, 44(11): 1405-1406.
19. 陈颖, 杨康明, 黄详, 等. 肝脾多发巨大泡型包虫病分期切除1例报道. 中国普外基础与临床杂志, 2016, 23(5): 544-546.
20. 王文涛, 杨闯, 严律南. 肝泡型包虫病外科根治性治疗的新理念与策略. 中华医学杂志, 2018, 98(38): 3049-3051.
21. 陈哲宇. 复杂肝包虫病的外科治疗. 中国普外基础与临床杂志, 2017, 24(7): 785-787.
22. 四川省包虫病诊疗专家组. 四川省肝包虫病诊治规范. 中国普外基础与临床杂志, 2017, 24(7): 798-803.

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Two-stage hepatectomy for complicated hepatic alveolar echinococcosis with multiple lesions

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