ObjectiveTo explore the clinical application of variant associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) combined with inferior vena cava reconstruction for end stage hepatic alveolar echinococcosis (HAE).MethodThe clinical data of one case with HAE who treated in Organ Transplantation Center of Sichuan Provincial People’s Hospital in November 2017 was analyzed retrospectively.ResultsComputed tomography revealed that the three hepatic veins and retrohepatic inferior vena cava were invaded by multiple and giant hydatid lesions. Only the segment 6 retained the complete portal vein and hepatic vein return branch. Remnant liver volume/standard liver volume (RLV/SLV) of this patient was 24.9%. Surgical exploration was performed after preoperative examination. In the first stage, ligation of the left portal vein and the right anterior lobe portal vein were performed to increase portal blood supply at S6 while partial split of the liver. The patient recovered well after operation without complications such as bile leakage and infection. Six months after the first stage surgery, the second stage surgery was performed, and RLV/SLV measured before surgery was 48.3%. S1–5/S7–8 were completely removed and the hepatic inferior vena cava was reconstructed with artificial blood vessels. The patient was discharged on 10 days after operation, and there was no complications and relapses occurred during the 18 months follow-up period.ConclusionsVariant ALPPS combined with inferior vena cava reconstruction is an effective attempt to treat end stage HAE with multiple and giant hydatid lesions and insufficient RLV.
ObjectiveTo explore value of partial liver preservation in situ for ex-vivo liver resection and auxiliatry autologous liver transplantation in end-stage hepatic alveolar echinococcosis.MethodsThe clinical data of one patient with end-stage hepatic alveolar echinococcosis treated with auxiliatry autologous liver transplantation combined partial liver preservation in situ were analyzed retrospectively. This patient was admitted on January 2019. During the auxiliatry autologous liver transplantation procedure, the S1, S4-S8 segments of the liver were resected for mass dissection, whereas the S2 and S3 segments of left liver were preserved in situ.ResultsThe preoperative evaluation and intraoperative exploration indicated that the mass located in the S4, S5, S8 segments, which was adjacent to the first hepatic portal and involved the anterior wall of posterior inferior vena cava, middle hepatic veins, the opening of right hepatic veins and the right wall of left hepatic veins. Based on the " in situ first” principle, the left lesion was slit using the anterior approach, the left hepatic vein was repaired and the S2 and S3 segments were preserved in situ. Then, the right lesion to involved hepatic vein was slit along the right interlobar fissure. The right hepatic artery, right portal vein and right bile duct were divided separately. The S1 and S4-S8 segments were removed completely. Next, the mass was resected, the out flow of the right liver was reconstructed using the allogeneic veins during the ex-vivo liver resection. Then, the auxiliatry autologous right liver transplantation was initiated by the wide-caliber hepatic vein-artificial inferior vena cava anastomosis. The surgical procedures lasted for 12 h, and the intraoperative bleeding was approximately 800 mL. The patient was routinely treated and smoothly recovered after the operation.ConclusionsProcedure of auxiliatry autologous liver transplantation preserved part functional liver in situ during ex-vivo resection, which could maintain stability of systemic and portal vein circulation, hold part liver function during operation, preserve functional liver furthest, and reduce risk of hepatic failure, is an effective attempt for end stage hepatic alveolar echinococcosis.