The preliminary experience of two-stage hepatectomy for multiple hepatic alveolar echinococcosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

FANG Dan ¹ , YANG Kangming ² ,  CHEN Zheyu ¹ , CHEN Kefei ¹ , HUANG Xiang ² , YAN Lünan ¹ , LI Bo ¹ , WEN Tianfu ¹ , WANG Wentao ¹ , CHEN Ying ² , WU Hong ¹ , XU Mingqing ¹ , MA Zhi ² , YANG Jiayin ¹ , LI Zhihong ² , WEI Yonggang ¹ , WEI Gengfu ² , HUANG Jiwei ¹ , TANG Youyin ¹ , FENG Xi ¹

1. Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R.China;
2. Hepatobiliary Department, The people's Hospital of Ganzi Tibetan Autonomous Prefecture of Sichuan Province, Kangding, Sichuan 626000, P.R.China;

Corresponding author：

CHEN Zheyu, Email: chenzheyu71@163.com

Keywords：

hepatic alveolar echinococcosis; two-stage hepatectomy

DOI：

10.7507/1007-9424.201706001

Video：

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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.

Citation： FANG Dan, YANG Kangming, CHEN Zheyu, CHEN Kefei, HUANG Xiang, YAN Lünan, LI Bo, WEN Tianfu, WANG Wentao, CHEN Ying, WU Hong, XU Mingqing, MA Zhi, YANG Jiayin, LI Zhihong, WEI Yonggang, WEI Gengfu, HUANG Jiwei, TANG Youyin, FENG Xi. The preliminary experience of two-stage hepatectomy for multiple hepatic alveolar echinococcosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(7): 804-807. doi: 10.7507/1007-9424.201706001 Copy

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2.	陈哲宇. 肝包虫病的治疗. 中国普外基础与临床杂志, 2015, 22(2): 129-130.
3.	陈哲宇. 肝包虫病的治疗方法选择. 中华临床医师杂志(电子版), 2015, 9(18): 3329-3331.
4.	陈颖, 杨康明, 黄详, 等. 肝脾多发巨大泡型包虫病分期切除 1 例报道. 中国普外基础与临床杂志, 2016, 23(5): 544-546.
5.	Mullen JT, Ribero D, Reddy SK, et al. Hepatic insufficiency and mortality in 1 059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg, 2007, 204(5): 854-862.
6.	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.
7.	Koch S, Bresson-Hadni S, Miguet JP, et al. Experience of liver transplantation for incurable alveolar echinococcosis: a 45-case European collaborative report. Transplantation, 2003, 75(6): 856-863.
8.	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.
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11.	Miyagawa S, Makuuchi M, Kawasaki S, et al. Criteria for safe hepatic resection. Am J Surg, 1995, 169(6): 589-594.
12.	Maydeo A, Soehendra N, Reddy N, et al. Endotherapy for chronic pancreatitis with intracanalar stones. Endoscopy, 2007, 39(7): 653-658.
13.	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, 32(2): 308-312.
14.	Mullin EJ, Metcalfe MS, Maddern GJ. How much liver resection is too much? Am J Surg, 2005, 190(1): 87-97.
15.	Schindl MJ, Redhead DN, Fearon KC, et al. The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut, 2005, 54(2): 289-296.
16.	Yigitler C, Farges O, Kianmanesh R, et al . The small remnant liver after major liver resection: How common and how relevant? Liver Transpl, 2003, 9(9): S18-S25.
17.	Shoup M, Gonen M, D’Angelica M, et al. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection. J Gastrointest Surg, 2003, 7(3): 325-330.
18.	Ferrero A, Viganò L, Polastri R, et al . Postoperative liver dysfunction and future remnant liver: where is the limit? Results of a prospective study. World J Surg, 2007, 31(8): 1643-1651.
19.	Abdalla EK, Barnett CC, Doherty D, et al. Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg, 2002, 137(6): 675-680.
20.	Truant S, Oberlin O, Sergent G, et al . Remnant liver volume to body weight ratio≥0.5%: A new cut‐off to estimate postoperative risks after extended resection in noncirrhotic liver. J Am Coll Surg, 2007, 204(1): 22-33.
21.	Varadarajulu S, Christein JD, Tamhane A, et al. Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos). Gastrointest Endosc, 2008, 68(6): 1102-1111.
22.	Hshieh TT, Sundaram V. Liver transplantation for hepatocellular carcinoma: are international guidelines possible? Hepatobiliary Surg Nutr, 2013, 2(2): 113-116.
23.	Le Roy B, Perrey A, Fontarensky M, et al . Combined preoperative portal and hepatic vein embolization (Biembolization) to improve liver regeneration before major liver resection: a preliminary report. World J Surg, 2017, Apr 17. [Epub ahead of print].
24.	唐群科, 张瑛, 曲艳玲. 晚期泡型包虫病的治疗. 寄生虫病与感染性疾病, 2015, 13(3): 123-126.
25.	Chen ZY, Yan LN, Zeng Y, et al. Transdiaphragmatic exposure for direct atrioatrial anastomosis in liver transplantation. Chin Med J, 2010, 123(24): 3515-3518.
26.	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.
27.	陈哲宇. 泡型肝包虫病的外科治疗现状. 中国普外基础与临床杂志, 2016, 23(5): 513-516.

1. Craig P. Echinococcus multilocularis. Curr Opin Infect Dis, 2003, 16(5): 437-444.
2. 陈哲宇. 肝包虫病的治疗. 中国普外基础与临床杂志, 2015, 22(2): 129-130.
3. 陈哲宇. 肝包虫病的治疗方法选择. 中华临床医师杂志(电子版), 2015, 9(18): 3329-3331.
4. 陈颖, 杨康明, 黄详, 等. 肝脾多发巨大泡型包虫病分期切除 1 例报道. 中国普外基础与临床杂志, 2016, 23(5): 544-546.
5. Mullen JT, Ribero D, Reddy SK, et al. Hepatic insufficiency and mortality in 1 059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg, 2007, 204(5): 854-862.
6. 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.
7. Koch S, Bresson-Hadni S, Miguet JP, et al. Experience of liver transplantation for incurable alveolar echinococcosis: a 45-case European collaborative report. Transplantation, 2003, 75(6): 856-863.
8. 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.
9. Bruix J, Sherman M, Practice Guidelines Committee, et al. Management of hepatocellular carcinoma. Hepatology, 2005, 42(5): 1208-1236.
10. Schreckenbach T, Liese J, Bechstein WO, et al. Post hepatectomy liver failure. Dig Surg, 2012, 29(1): 79-85.
11. Miyagawa S, Makuuchi M, Kawasaki S, et al. Criteria for safe hepatic resection. Am J Surg, 1995, 169(6): 589-594.
12. Maydeo A, Soehendra N, Reddy N, et al. Endotherapy for chronic pancreatitis with intracanalar stones. Endoscopy, 2007, 39(7): 653-658.
13. 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, 32(2): 308-312.
14. Mullin EJ, Metcalfe MS, Maddern GJ. How much liver resection is too much? Am J Surg, 2005, 190(1): 87-97.
15. Schindl MJ, Redhead DN, Fearon KC, et al. The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut, 2005, 54(2): 289-296.
16. Yigitler C, Farges O, Kianmanesh R, et al . The small remnant liver after major liver resection: How common and how relevant? Liver Transpl, 2003, 9(9): S18-S25.
17. Shoup M, Gonen M, D’Angelica M, et al. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection. J Gastrointest Surg, 2003, 7(3): 325-330.
18. Ferrero A, Viganò L, Polastri R, et al . Postoperative liver dysfunction and future remnant liver: where is the limit? Results of a prospective study. World J Surg, 2007, 31(8): 1643-1651.
19. Abdalla EK, Barnett CC, Doherty D, et al. Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg, 2002, 137(6): 675-680.
20. Truant S, Oberlin O, Sergent G, et al . Remnant liver volume to body weight ratio≥0.5%: A new cut‐off to estimate postoperative risks after extended resection in noncirrhotic liver. J Am Coll Surg, 2007, 204(1): 22-33.
21. Varadarajulu S, Christein JD, Tamhane A, et al. Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos). Gastrointest Endosc, 2008, 68(6): 1102-1111.
22. Hshieh TT, Sundaram V. Liver transplantation for hepatocellular carcinoma: are international guidelines possible? Hepatobiliary Surg Nutr, 2013, 2(2): 113-116.
23. Le Roy B, Perrey A, Fontarensky M, et al . Combined preoperative portal and hepatic vein embolization (Biembolization) to improve liver regeneration before major liver resection: a preliminary report. World J Surg, 2017, Apr 17. [Epub ahead of print].
24. 唐群科, 张瑛, 曲艳玲. 晚期泡型包虫病的治疗. 寄生虫病与感染性疾病, 2015, 13(3): 123-126.
25. Chen ZY, Yan LN, Zeng Y, et al. Transdiaphragmatic exposure for direct atrioatrial anastomosis in liver transplantation. Chin Med J, 2010, 123(24): 3515-3518.
26. 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.
27. 陈哲宇. 泡型肝包虫病的外科治疗现状. 中国普外基础与临床杂志, 2016, 23(5): 513-516.

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The preliminary experience of two-stage hepatectomy for multiple hepatic alveolar echinococcosis

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