ObjectiveTo 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).MethodThe 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.ResultsThe 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.ConclusionsIn 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.
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.