ObjectiveTo investigate strategies and efficacy of surgical treatment of advanced hepatic alveolar echinococcosis. MethodsThirty-six patients with advanced hepatic alveolar echinococcosis who underwent surgical treatment in our hospital from August 2014 to March 2016 were selected, who were divided into three groups:radical hepatectomy group (15 cases), quasi-radical hepatectomy group (17 cases), and palliative surgery group (4 cases). The operative time, intraoperative blood loss, postoperative complications, and metastasis were analyzed among these three groups. ResultsThe operative time, intraoperative blood loss, and rate of postoperative complications had no significant differences between the radical hepatectomy group and the quasi-radical hepatectomy group. No patient had postoperative recurrence in the radical hepatectomy group. The hepatic portal residual lesion was enlarged for 1 case and the intrahepatic and extrahepatic lesions were stable for the other patients in the quasi-radical hepatectomy group. In the palliative surgery group,the retroperitoneal lesions enlargement was seen in 2 cases and the lesions around the abcess grew progressively in 1 case. ConclusionIndividualized treatment accompanied with multiple-disciplinary treatment and damage-control surgery concept could benefit optimally to patients with advanced hepatic alveolar echinococcosis.
ObjectiveTo discuss the clinical application of two-step hepatectomy for hepatic alveolar echinococcosis which invaded the second and the third porta hepatis.MethodsThe clinical data of 60 patients with hepatic alveolar echinococcosis invaded the second and the third porta hepatis who treated with two-step hepatectomy in West China Hospital of Sichuan University and The People’s Hospital of Ganzi Tibetan Autonomous Prefecture of Sichuan Province from Jan. 2013 to Jun. 2017 were analyzed retrospectively.ResultsSixty patients had underwent radical hepatectomy successfully and no death happened during perioperative period. The average operative time was 309.17 min (150–475 min) and intraoperative blood loss was 586.67 mL (100–3 000 mL). Forty-eight patients blocked the blood flowing into the liver, the average blocking time was 25.85 min (15–50 min); 24 patients suffered red blood cell suspension, the average amount was 3.79 U (2–8 U), and 9 patients were infused with fresh frozen plasma, the average amount was 527.78 mL (350–850 mL). The average of hospital stays was 17.5 days (7–39 days) and average of hospitalization cost was 49 323.43 yuan (28 045.32–61 243.15 yuan). The liver function indicators returned to normal within 7 days after operation. After operation, 3 patients suffered from biliary fistula, 3 patients suffered from pleural effusion, 3 patients suffered from peritoneal effusion, 10 patients suffered from effusion. According to the rank of complication: 10 patients were defined as grade Ⅰ, 3 patients were defined as grade Ⅱ, 6 patients were defined as grade Ⅲa. The average follow-up time of 60 patients was 14.47 months (1–31 months). No recurrence and death occurred during follow-up period.ConclusionThe two-step hepatectomy in treatment of hepatic alveolar echinococcosis invaded the second and the third porta hepatis can avoid the large flucyuations of intraoperative blood pressure and other vital signs, can increase the safety of surgery and reduce the difficulty and risk of surgery.
Objective To discuss the clinical application of two-stage hepatectomy for multiple and huge hepatic alveolar echinococcosis. Methods The clinical data of 7 patients with multiple hepatic alveolar echinococcosis treated with two-staged hepatectomy in West China Hospital of Sichuan University and The people's Hospital of Ganzi Tibetan Autonomous Prefecture of Sichuan Province from August, 2013 to June, 2016 were analyzed retrospectively. The preoperative diagnose was definite according to CT and (or) MRI, serological and life in the epidemic area. The patients, which the future liver remnant was less than 30% according to CT, received two-staged hepatectomy. Epigastric enhancement CT, liver function and blood routine examination were reviewed monthly after the first surgery, the second surgery was operated after 3 monthes, epigastric ultrasound, enhancement CT or MRI, liver function, blood routine examination and serological were adopted in 1, 6, and 12 months and each year after the second operation. Results The liver function was normal in 7 days after two operations and no complications after the first suegery, one patient developd with biliary fistula after the second surgery, no recurrence or death occurred during the followed-up period. Conclusion The two-stage hepatectomy can be operated in multiple and huge alveolar echinococcosis to reduce surgery risk and cost, shorten hospital stays and improve quality of life.
Objective To explore the effect of “in situ first” ex vivo liver resection and autologous liver transplantation (ELRA) for end stage hepatic alveolar echinococcosis (HAE). Methods The clinicopathologic data of 85 end stage HAE cases were initially scheduled underwent ELRA from June 2019 to May 2022 in the Sichuan Provincial People’s Hospital were collected retrospectively. The included cases were operated under “in situ first” ERLA principle. The analyzed data included the final surgical style, operative time, time of anhepatic phase and intraoperative blood transfusion volume for ELRA cases. Results All the included 85 cases underwent radical HAE lesions resection and without perioperative death occurred. According to the principle of “in situ first”, 57 cases underwent HAE lesions resection combined vascular reconstruction without ex vivo liver resection (in situ resection group); 1 case underwent auxiliary partial autologous liver transplantation, and 27 cases underwent ERLA procedures (ELRA group). In the in situ resection group, the operative time was 210–750 min, （380±134）min, and the intraoperative blood transfusion was 0–3 250 mL with a median of 0 mL. In the ELRA group, the operative time was 450–1 445 min, (852±203) min, and the intraoperative blood transfusion was 0–6 800 mL with a median of 1 960 mL. The operative time and the amount of blood transfusion in the ELRA group were longer or more than those in the in situ resection group. The time of anhepatic phase for the ELRA group was 60–480 min, (231±83) min. On the 5th day after operation, except that the total bilirubin and direct bilirubin in the ELRA group were higher than those in the in situ resection group, the other indexes of liver function were similar between the two groups. The postoperative stay in ICU and the total postoperative hospital stay in the ELRA group were longer than those in the in situ resection group. Conclusions The advantage of “in situ first” ERLA principle for end stage HAE patients include resecting the HAE lesions radically without ex vivo liver resection and alleviating the hepatic ischemia and reperfusion injury. For the inevasible ELRA cases, “in situ first” principle could shorten the anhepatic phase and reduce intraoperative blood loss, and turn some cases to auxiliary partial autologous liver transplantation, which will reduce the risk of postoperative hepatic failure.
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.
ObjectiveTo summarize and analyze the application of ex vivo liver resection and autotransplantation (ELRA) in the treatment of hepatobiliary diseases. MethodThe related literature about ELRA used to treat various hepatobiliary space-occupyingdiseases at home and abroad in recent years was comprehensively searched and summarized. ResultsELRA had overcome the limitations of limited operational space in traditional surgery for the treatment of hepatobiliary space-occupying diseases reduced dependence on donor livers, and avoided post-transplant rejection. It had been applied in the treatment of hepatic alveolar echinococcosis, liver cancer, cholangiocarcinoma, and rare liver space-occupying diseases. ConclusionsWith the maturation of ELRA techniques and the continuous improvement of ex vivo liver perfusion technology, along with rigorous preoperative evaluation and meticulous postoperative management, postoperative complications of ELRA have significantly decreased compared to the initial stages of its application. By strictly adhering to surgical indications, this procedure is expected to be used treatment in an increasing number of hepatobiliary space-occupying diseases.
Hepatic alveolar echinococcosis (HAE) is a severe zoonotic disease caused by Echinococcus multilocularis, primarily affecting the liver. Due to its insidious nature, the patients are often diagnosed at advanced stage, posing significant treatment challenges. We comprehensively examines the progress in surgical techniques for HAE management, focusing on various strategies across different disease stages. For the patients with early-stage HAE, ablation therapy has emerged as an effective treatment option. In the moderate to advanced cases, numerous surgical techniques and innovative approaches have been introduced, including laparoscopic surgery and liver transplantation, with particular emphasis on ex vivo liver resection and autotransplantation. These advancements offer more effective treatment options for the patients with advanced HAE. However, significant challenges persist, notably the preservation of adequate liver function while achieving complete lesion removal. Future research should prioritize the exploration and optimization of existing surgical methods, especially for advanced HAE cases. This includes refining surgical techniques through precise preoperative evaluation and staging, as well as developing novel surgical approaches to enhance safety and efficacy. Furthermore, multicenter and long-term follow-up prospective studies are crucial for validating the effectiveness of new surgical techniques and strategies. Through these concerted efforts, it is anticipated that the survival rates and quality of life for HAE patients will significantly be improved, marking a new era in the management of this complex disease.
ObjectivesTo evaluate the learning curve of radical hepatectomy combined with vascular and/or bile duct reconstruction (RHVBR) in the treatment of hepatic alveolar echinococcosis (HAE), and to explore the feasibility and safety of RHVBR. MethodsThe clinical data of 203 patients who received RHVBR treatment for HAE complicated with vascular invasion in West China Hospital from 2010 to 2018 were analyzed retrospectively. Cumulative sum (CUSUM) and risk-adjusted cumulative sum (RA-CUSUM) were used to analyze the learning curve of RHVBR, determine the learning stage, and compare the differences of intraoperative and postoperative outcome indexes in different learning stages. ResultsThe average operative time was (537.9±207.6) minutes, with blood loss amounted to 617.3 (138.9, 1 094.2) mL. Postoperative complications occurred in 65 cases, and the incidence of complications was 32.0%. Among them, 29 cases (14.3%) had serious complications. Three cases (1.5%) died within 90 days after operation. The results of RA-CUSUM analysis showed that 54 cases of surgery were the cut-off point of learning curve for serious postoperative complications. According to the results of CUSUM analysis, the whole queue was divided into the first stage (n=53) and the second stage (n=150) based on the completion of 53 operations. Compared with the first stage, the operative time and total postoperative hospital stay in the second stage was shortened, the incidence of serious complications was reduced, and the number of resected liver segments was increased. The differences were statistically significant (P<0.05). ConclusionIt is feasible and safe to treat HAE with RHVBR, and the incidence of serious complications is obviously reduced after 54 cases of operation.
Objective To evaluate effects of three-dimensional (3D) visualized reconstruction technology on short-term benefits of different extent of resection in treating hepatic alveolar echinococcosis (HAE) as well as some disadvantages. Methods One hundred and fifty-two patients with HAE from January 2014 to December 2016 in the Department Liver Surgery, West China Hospital of Sichuan University were collected, there were 80 patients with ≥4 segments and 72 patients with ≤3 segments of liver resection among these patients, which were designed to 3D reconstruction group and non-3D reconstruction group according to the preference of patients. The imaging data, intraoperative and postoperative indicators were recorded and compared. Results The 3D visualized reconstructions were performed in the 79 patients with HAE, the average time of 3D visualized reconstruction was 19 min, of which 13 cases took more than 30 min and the longest reached 150 min. The preoperative predicted liver resection volume of the 79 patients underwent the 3D visualized reconstruction was (583.6±374.7) mL, the volume of intraoperative actual liver resection was (573.8±406.3) mL, the comparison of preoperative and intraoperative data indicated that both agreed reasonably well (P=0.640). Forty-one cases and 38 cases in the 80 patients with ≥4 segments and 72 patients with ≤3 segments of liverresection respectively were selected for the 3D visualized reconstruction. For the patients with ≥4 segments of liver resection, the operative time was shorter (P=0.021) and the blood loss was less (P=0.047) in the 3D reconstruction group as compared with the non-3D reconstruction group, the status of intraoperative blood transfusion had no significant difference between the 3D reconstruction group and the non-3D reconstruction group (P=0.766). For the patients with ≤3 segments of liver resection, the operative time, the blood loss, and the status of intraoperative blood transfusion had no significant differences between the 3D reconstruction group and the non-3D reconstruction group (P>0.05). For the patients with ≥4 segments or ≤3 segments of liver resection, the laboratory examination results within postoperative 3 d, complications within postoperative 90 d, and the postoperative hospitalization time had no significant differences between the 3D reconstruction group and the non-3D reconstruction group (P>0.05). Conclusion 3D visualized reconstruction technology contributes to patients with HAE ≥4 segments of liver resection, it could reduce intraoperative blood loss and shorten operation time, but it displays no remarkable benefits for ≤3 segments of liver resection.
Objective To detect and analize the expressions and it’s clinical significance of apoptosis factors in hepatic alveolar echinococcosis tissues by using antibody chip technology. Methods The liver tissue specimens (including the edge of lesions and normal liver tissues) of surgical resection of 6 patients with hepatic alveolar echinococcosis in Affiliated Hospital of Qinghai University were collected. The tissue protein was extracted and the level of apoptosis was detected by antibody chip technology. The data were analyzed by AAH-APO-G1 software. Results The expression levels of 5 kinds of apoptosis factors (Bad, Fas, IGFBP-3, P21 and XIAP) in the liver tissues of the marginal zone of hepatic alveolar echinococcosis were compared with that of the normal liver tissues, and the difference was statistically significant (P<0.05). The expression levels of Bad, Fas, IGFBP-3 and P21 were up-regulated, and the expression level of XIAP was down regulated. Conclusions Apoptosis-related factors play a role in the progression of the hepatic alveolar echinococcosis, there may be contact with the immune escape mechanisms, while promote apoptosis factor and inhibitory apoptosis factor that may exist the function imbalance, so more in-depth exploration the mechanism of apoptosis factors on hepatic alveolar echinococcosis in diagnosis and treatment have important significance.