<i>In vivo</i> hepatectomy with preservation of retrohepatic inferior vena cava for hepatic alveolar echinococcosis with invasion of inferior vena cava_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Hang , TENG Fei , KONG Qingyan ,  CHEN Zheyu

Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

CHEN Zheyu, Email: chenzheyu71@163.com

Keywords：

hepatic alveolar echinococcosis; retrohepatic inferior vena cava; in vivo hepatectomy

DOI：

10.7507/1007-9424.202207070

Video：

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Objective To explore the clinical application of in vivo hepatectomy with preservation of retrohepatic inferior vena cava (IVC) for hepatic alveolar echinococcosis (HAE) with the invasion of IVC. Methods The clinicopathologic data of a complicated HAE patient with large lesion (maximum cross-section 12.6 cm×9.6 cm), infiltrative growth, unclear boundary with surrounding tissues, and invasions of diaphragm and IVC (invasion length up to 4.6 cm) admitted to the Department of Liver Surgery in the West China Hospital of Sichuan University in December 2021 was retrospectively collected. The three-dimensional reconstruction of the liver model was performed by Mimics Medical 21.0 software before operation. The invading IVC of the right liver lesion was measured and the resection was simulated. During the operation, the HAE lesion and the affected IVC were gradually separated from IVC by the hemostatic forceps, and the residual lesions were gradually removed. Results In this patient, the HAE lesion of right liver was resected, the IVC was entirely preserved, and the resection of liver was consistent with the preoperative three-dimensional reconstruction plan. The operation time was 275 min, the bleeding was approximately 500 mL. On the first day after the operation, the alanine aminotransferase and aspartate aminotransferase were increased, no obvious abnormalities were observed in the plasma albumin and bilirubin, the patient recovered and was discharged on the seventh day after the operation. No complications occurred after the operation, and no recurrence or metastasis of HAE was observed during follow-up period. Conclusions Hepatectomy with preservation of retrohepatic IVC for HAE with invasion of IVC is safe and effective. Taking albendazole regularly after surgery will help maintain disease-free survival.

Citation： LI Hang, TENG Fei, KONG Qingyan, CHEN Zheyu. In vivo hepatectomy with preservation of retrohepatic inferior vena cava for hepatic alveolar echinococcosis with invasion of inferior vena cava. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(10): 1279-1283. doi: 10.7507/1007-9424.202207070 Copy

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13.	Adipurnama I, Yang MC, Ciach T, et al. Surface modification and endothelialization of polyurethane for vascular tissue engineering applications: a review. Biomater Sci, 2016, 5(1): 22-37.
14.	Lee SH, Na GH, Choi HJ, et al. Impact of the reconstruction material on the patency of middle hepatic vein in living donor liver transplantation using the right liver. Transplant Proc, 2019, 51(8): 2745-2749.
15.	Joliat GR, Melloul E, Petermann D, et al. Outcomes after liver resection for hepatic alveolar echinococcosis: a single-center cohort study. World J Surg, 2015, 39(10): 2529-2534.
16.	王强, 康莹丽, 王虎, 等. 晚期肝泡型包虫病PTCD联合阿苯达唑治疗前后肝功能及ADC值变化的研究. 磁共振成像, 2019, 10(4): 254-257.
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18.	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.
19.	张烈, 李延茂, 丛山. 泡型肝包虫病患者肝切除术后肝衰竭风险的预测因素研究. 肝脏, 2021, 26(3): 302-304, 308.
20.	张胜龙, 杨先伟, 王文涛. 泡型肝包虫病肝切除术后胆漏发生危险因素分析. 中华普通外科杂志, 2020, 35(1): 26-29.
21.	杨先伟, 黄斌, 邱逸闻, 等. 离体肝切除联合自体肝移植治疗晚期肝泡型包虫病21例报道. 中国普外基础与临床杂志, 2017, 24(6): 685-690.
22.	陈克霏, 唐友银, 贾贵清, 等. 复杂泡型肝包虫根治性肝切除的MDT讨论. 中国普外基础与临床杂志, 2018, 25(1): 77-82.
23.	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.
24.	张蒙召, 周瀛, 张灵强, 等. 肝泡型包虫病灶边缘组织病理特点及临床意义的研究现状. 中国现代普通外科进展, 2020, 23(6): 502-504.
25.	Brunetti E, Kern P, Vuitton DA, et al. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop, 2010, 114(1): 1-16.
26.	陈哲宇. 复杂肝包虫病的外科治疗. 中国普外基础与临床杂志, 2017, 24(7): 785-787.

1. Baumann S, Shi R, Liu W, et al. Worldwide literature on epidemiology of human alveolar echinococcosis: a systematic review of research published in the twenty-first century. Infection, 2019, 47(5): 703-727.
2. Carmena D, Cardona GA. Echinococcosis in wild carnivorous species: epidemiology, genotypic diversity, and implications for veterinary public health. Vet Parasitol, 2014, 202(3-4): 69-94.
3. 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.
4. 四川省包虫病诊疗专家组. 四川省肝包虫病诊治规范. 中国普外基础与临床杂志, 2017, 24(7): 798-803.
5. Ni ZK, Lin D, Wang ZQ, et al. Precision liver resection: three-dimensional reconstruction combined with fluorescence laparoscopic imaging. Surg Innov, 2021, 28(1): 71-78.
6. 杨晓菲, 鲍海华, 曹佳媛, 等. 肝泡型包虫病“嗜静脉血管”特点研究. 实用放射学杂志, 2018, 34(4): 541-544,567.
7. 李富贵, 严律南, 李波, 等. 中国成人标准肝体积评估公式的临床研究. 四川大学学报(医学版), 2009, 40(2): 302-306.
8. 李治宏, 杨康明, 谢德坤, 等. 肝脏泡型包虫病侵犯下腔静脉行人工血管置换手术效果的初步探讨(附5例报道). 中国普外基础与临床杂志, 2020, 27(1): 30-33.
9. 玉苏甫卡迪尔·麦麦提尼加提, 吐尔干艾力·阿吉, 冉博, 等. 不同下腔静脉重建方式在离体肝切除和自体肝移植治疗肝AE中的应用. 中华器官移植杂志, 2020, 41(3): 180-184.
10. 阿吉德, 柴金萍, 赵顺云, 等. 保留肝后下腔静脉的离体肝切除、自体肝移植术在治疗终末期肝泡型包虫病中的临床应用. 中华肝胆外科杂志, 2019, 25(11): 860-862.
11. Ha TY, Hwang S, Jung DH, et al. Complications analysis of polytetrafluoroethylene grafts used for middle hepatic vein reconstruction in living-donor liver transplantation. Transplant Proc, 2014, 46(3): 845-849.
12. Song HG, Rumma RT, Ozaki CK, et al. Vascular tissue engineering: progress, challenges, and clinical promise. Cell Stem Cell, 2018, 22(3): 340-354.
13. Adipurnama I, Yang MC, Ciach T, et al. Surface modification and endothelialization of polyurethane for vascular tissue engineering applications: a review. Biomater Sci, 2016, 5(1): 22-37.
14. Lee SH, Na GH, Choi HJ, et al. Impact of the reconstruction material on the patency of middle hepatic vein in living donor liver transplantation using the right liver. Transplant Proc, 2019, 51(8): 2745-2749.
15. Joliat GR, Melloul E, Petermann D, et al. Outcomes after liver resection for hepatic alveolar echinococcosis: a single-center cohort study. World J Surg, 2015, 39(10): 2529-2534.
16. 王强, 康莹丽, 王虎, 等. 晚期肝泡型包虫病PTCD联合阿苯达唑治疗前后肝功能及ADC值变化的研究. 磁共振成像, 2019, 10(4): 254-257.
17. Siles-Lucas M, Casulli A, Cirilli R, et al. Progress in the pharmacological treatment of human cystic and alveolar echinococcosis: compounds and therapeutic targets. PLoS Negl Trop Dis, 2018, 12(4): e0006422. doi: 10.1371/journal.pntd.0006422.
18. 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.
19. 张烈, 李延茂, 丛山. 泡型肝包虫病患者肝切除术后肝衰竭风险的预测因素研究. 肝脏, 2021, 26(3): 302-304, 308.
20. 张胜龙, 杨先伟, 王文涛. 泡型肝包虫病肝切除术后胆漏发生危险因素分析. 中华普通外科杂志, 2020, 35(1): 26-29.
21. 杨先伟, 黄斌, 邱逸闻, 等. 离体肝切除联合自体肝移植治疗晚期肝泡型包虫病21例报道. 中国普外基础与临床杂志, 2017, 24(6): 685-690.
22. 陈克霏, 唐友银, 贾贵清, 等. 复杂泡型肝包虫根治性肝切除的MDT讨论. 中国普外基础与临床杂志, 2018, 25(1): 77-82.
23. 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.
24. 张蒙召, 周瀛, 张灵强, 等. 肝泡型包虫病灶边缘组织病理特点及临床意义的研究现状. 中国现代普通外科进展, 2020, 23(6): 502-504.
25. Brunetti E, Kern P, Vuitton DA, et al. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop, 2010, 114(1): 1-16.
26. 陈哲宇. 复杂肝包虫病的外科治疗. 中国普外基础与临床杂志, 2017, 24(7): 785-787.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

In vivo hepatectomy with preservation of retrohepatic inferior vena cava for hepatic alveolar echinococcosis with invasion of inferior vena cava

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