ObjectiveTo explore the efficiency of two-stage hepatectomy applicated in complex alveolar echinococcosis. MethodThe clinical data of one case who suffered from complicated alveolar echinococcosis with multiple lesions and then treated with two-stage hepatectomy were analyzed retrospectively. ResultsPreoperative 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. ConclusionTwo-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.