Surgical Treatment of Advanced Hepatic Alveolar Echinococcosis (Report of 36 Cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 WANGGuan ,  LUOLan-yun , ZOUHai-bo , LUOLe , XIANGGuang-ming , XUEHua , YAOYu-tong ,  HUANGXiao-lun

The Seventh Department of Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan Province, China;

Corresponding author：

HUANGXiao-lun, Email: huangxiaolun@med.uestc.edu.cn

Keywords：

Advanced hepatic alveolar echinococcosis; Surgical treatment; Multiple-disciplinary treatment

DOI：

10.7507/1007-9424.20160352

Video：

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Objective To investigate strategies and efficacy of surgical treatment of advanced hepatic alveolar echinococcosis. Methods Thirty-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. Results The 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. Conclusion Individualized treatment accompanied with multiple-disciplinary treatment and damage-control surgery concept could benefit optimally to patients with advanced hepatic alveolar echinococcosis.

Citation： WANGGuan, LUOLan-yun, ZOUHai-bo, LUOLe, XIANGGuang-ming, XUEHua, YAOYu-tong, HUANGXiao-lun. Surgical Treatment of Advanced Hepatic Alveolar Echinococcosis (Report of 36 Cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(11): 1379-1383. doi: 10.7507/1007-9424.20160352 Copy

1.	Grosso G, Gruttadauria S, Biondi A, et al. Worldwide epidemiology of liver hydatidosis including the Mediterranean area. World J Gastroenterol, 2012, 18(13):1425-1437.
2.	Kern P, Wen H, Sato N, et al. WHO classification of alveolar echino-coccosis:principles and application. Parasitol Int, 2006, 55 Suppl:S283-S287.
3.	中国医师协会外科医师分会包虫病外科专业委员会. 肝两型包虫病诊断与治疗专家共识(2015版). 中华消化外科杂志, 2015, 14(4):253-264.
4.	Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO Informal Working Group on Echinococcosis. Bull World Health Organ, 1996, 74(3):231-242.
5.	邵英梅, 蒋铁民, 吐尔干艾力·阿吉, 等. 根治性及准根治性手术治疗终末期肝泡型包虫病. 中华消化外科杂志, 2011, 10(4):296-298.
6.	Dindo D, Demartines N, Clavien PA. Classification of surgical comp-lications:A new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2):205-213.
7.	张瀚之, 陈哲宇, 严律南, 等. 肝包虫病外科治疗的单中心经验. 中国普外基础与临床杂志, 2015, 22(2):144-148.
8.	阿卜杜艾尼·啊卜力孜, 温浩. 难治性肝泡型包虫病的多学科个体化治疗. 临床肝胆病杂志, 2015, 31(4):639-641.
9.	张昀昊, 任利, 阳丹才让, 等. 肝泡型包虫病根治性切除163例回顾性分析. 中国普通外科杂志, 2016, 25(2):257-263.
10.	董家鸿, 郑树森, 陈孝平, 等. 肝切除术前肝脏储备功能评估的专家共识(2011版). 中华消化外科杂志, 2011, 10(1):20-25.
11.	马荣花, 郭亚民, 朱海宏, 等. 泡型肝包虫病患者肝切除术后肝储备功能的评价参数. 世界华人消化杂志, 2015, 23(2):308-312.
12.	罗兰云, 姚豫桐, 邹海波, 等. "掏核式肝切除法"治疗晚期巨大肝泡型包虫病9例临床分析. 实用医院临床杂志, 2015, 12(2):56-58.
13.	李作安, 吐尔干艾力·阿吉, 冉博, 等. "减体积式病灶肝切除"治疗晚期肝巨大泡型包虫病的临床应用. 中国普通外科杂志, 2012, 21(7):864-868.
14.	顾晋. 恶性肿瘤多学科综合治疗模式. 中国实用外科杂志, 2009, 29(1):21-22.
15.	Friedland PL, Bozic B, Dewar J, et al. Impact of disciplinary team management in head and neck cancer patients. Br J Cancer, 2011, 104(8):1246-1248.
16.	Bresson-Hadni S, Blagosklonov O, Knapp J, et al. Should possible recurrence of disease contraindicate liver transplantation in patients with end-stage alveolar echinococcosis? A 20-year follow-up study. Liver Transpl, 2011, 17(7):855-865.
17.	Wen H, Dong JH, Zhang JH, et al. Ex vivo liver resection and auto-transplantation for end-stage alveolar echinococcosis:a case series. Am J Transplant. 2016, 16(2):615-624.
18.	方丹, 陈哲宇, 曾勇, 等. 泡型肝包虫病的外科治疗. 中国普外基础与临床杂志, 2016, 23(5):521-525.
19.	Ulger S, Barut H, Tunc M, et al. Radiation therapy for resistant sternal hydatid disease. Strahlenther Onkol, 2013, 189(6):508-509.
20.	Schmid M, Pendl G, Samonigg H, et al. Gamma knife radiosurgery and albendazole for cerebral alveolar hydatid disease. Clin Infect Dis, 1998, 26(6):1379-1382.
21.	张永国, 张成武, 窦拉加. 高强度聚焦超声治疗巨大肝泡球蚴病一例. 中国寄生虫学与寄生虫病杂志, 2005, 23(4):256.
22.	La X, Zhang F, Li Y, et al. Upregulation of PD-1 on CD4⁺ CD25⁺ T cells is associated with immunosuppression in liver of mice infected with echinococcus multilocularis. Int Immunopharmacol, 2015, 26 (2):357-366.

1. Grosso G, Gruttadauria S, Biondi A, et al. Worldwide epidemiology of liver hydatidosis including the Mediterranean area. World J Gastroenterol, 2012, 18(13):1425-1437.
2. Kern P, Wen H, Sato N, et al. WHO classification of alveolar echino-coccosis:principles and application. Parasitol Int, 2006, 55 Suppl:S283-S287.
3. 中国医师协会外科医师分会包虫病外科专业委员会. 肝两型包虫病诊断与治疗专家共识(2015版). 中华消化外科杂志, 2015, 14(4):253-264.
4. Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO Informal Working Group on Echinococcosis. Bull World Health Organ, 1996, 74(3):231-242.
5. 邵英梅, 蒋铁民, 吐尔干艾力·阿吉, 等. 根治性及准根治性手术治疗终末期肝泡型包虫病. 中华消化外科杂志, 2011, 10(4):296-298.
6. Dindo D, Demartines N, Clavien PA. Classification of surgical comp-lications:A new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2):205-213.
7. 张瀚之, 陈哲宇, 严律南, 等. 肝包虫病外科治疗的单中心经验. 中国普外基础与临床杂志, 2015, 22(2):144-148.
8. 阿卜杜艾尼·啊卜力孜, 温浩. 难治性肝泡型包虫病的多学科个体化治疗. 临床肝胆病杂志, 2015, 31(4):639-641.
9. 张昀昊, 任利, 阳丹才让, 等. 肝泡型包虫病根治性切除163例回顾性分析. 中国普通外科杂志, 2016, 25(2):257-263.
10. 董家鸿, 郑树森, 陈孝平, 等. 肝切除术前肝脏储备功能评估的专家共识(2011版). 中华消化外科杂志, 2011, 10(1):20-25.
11. 马荣花, 郭亚民, 朱海宏, 等. 泡型肝包虫病患者肝切除术后肝储备功能的评价参数. 世界华人消化杂志, 2015, 23(2):308-312.
12. 罗兰云, 姚豫桐, 邹海波, 等. "掏核式肝切除法"治疗晚期巨大肝泡型包虫病9例临床分析. 实用医院临床杂志, 2015, 12(2):56-58.
13. 李作安, 吐尔干艾力·阿吉, 冉博, 等. "减体积式病灶肝切除"治疗晚期肝巨大泡型包虫病的临床应用. 中国普通外科杂志, 2012, 21(7):864-868.
14. 顾晋. 恶性肿瘤多学科综合治疗模式. 中国实用外科杂志, 2009, 29(1):21-22.
15. Friedland PL, Bozic B, Dewar J, et al. Impact of disciplinary team management in head and neck cancer patients. Br J Cancer, 2011, 104(8):1246-1248.
16. Bresson-Hadni S, Blagosklonov O, Knapp J, et al. Should possible recurrence of disease contraindicate liver transplantation in patients with end-stage alveolar echinococcosis? A 20-year follow-up study. Liver Transpl, 2011, 17(7):855-865.
17. Wen H, Dong JH, Zhang JH, et al. Ex vivo liver resection and auto-transplantation for end-stage alveolar echinococcosis:a case series. Am J Transplant. 2016, 16(2):615-624.
18. 方丹, 陈哲宇, 曾勇, 等. 泡型肝包虫病的外科治疗. 中国普外基础与临床杂志, 2016, 23(5):521-525.
19. Ulger S, Barut H, Tunc M, et al. Radiation therapy for resistant sternal hydatid disease. Strahlenther Onkol, 2013, 189(6):508-509.
20. Schmid M, Pendl G, Samonigg H, et al. Gamma knife radiosurgery and albendazole for cerebral alveolar hydatid disease. Clin Infect Dis, 1998, 26(6):1379-1382.
21. 张永国, 张成武, 窦拉加. 高强度聚焦超声治疗巨大肝泡球蚴病一例. 中国寄生虫学与寄生虫病杂志, 2005, 23(4):256.
22. La X, Zhang F, Li Y, et al. Upregulation of PD-1 on CD4⁺ CD25⁺ T cells is associated with immunosuppression in liver of mice infected with echinococcus multilocularis. Int Immunopharmacol, 2015, 26 (2):357-366.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Surgical Treatment of Advanced Hepatic Alveolar Echinococcosis (Report of 36 Cases)

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