高海拔地区17例晚期肝泡型包虫病行自体肝移植的临床研究  

Clinical study of 17 patients with ex vivo liver resection followed by autotransplantation for advanced hepatic alveolar echinococcosis in high altitude area

作　　者：魏耕富 杨康明[1,2] 史屹洋 马智 陈颖[1,2] 李志宏 权力[1] 智明 周明亮 陈雪林 樊谦 常秀萍 杨先伟 黄斌 陈哲宇[2,3] 王文涛[2,3] WEI Gengfu;YANG Kangming;SHI Yiyang;MA Zhi;CHEN Ying;LI Zhihong;QUAN Li;ZHI Ming;ZHOU Mingliang;CHEN Xuelin;FAN Qian;CHANG Xiuping;YANG Xianwei;HUANG Bin;CHEN Zheyu;WANG Wentao(Department of Hepatobiliary Surgery&Hydatid Treatment Center,Ganzi Tibetan Autonomous Prefecture People’s Hospital,Kangding,Sichuan 626000,P.R.China;Sichuan Clinical Research Center for Hydatidosis,Kangding,Sichuan 626000,P.R.China;Department of Liver Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Department of Vascular Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]甘孜藏族自治州人民医院肝胆外科包虫治疗中心,四川康定626000 [2]四川省包虫病临床医学研究中心,四川康定626000 [3]四川大学华西医院肝脏外科,成都610041 [4]四川大学华西医院血管外科,成都610041

出　　处：《中国普外基础与临床杂志》2020年第1期24-29,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省卫生厅科研课题(项目编号：169151);四川省科技厅重点研发项目(项目编号：2019YFS0029);四川省科技计划项目(项目编号：2019YFS0529)

摘　　要：目的总结离体肝切除联合自体肝移植(简称"自体肝移植")治疗晚期肝泡型包虫病(HAE)的近远期疗效。方法回顾性分析甘孜藏族自治州人民医院2016年11月至2019年7月期间接受自体肝移植的17例晚期HAE患者的临床资料及随访结果。结果 17例晚期HAE患者的自体肝移植术均成功,下腔静脉重建方式中有10例采用自体大隐静脉重建,5例采用人造血管重建,1例采用原下腔静脉断端直接吻合,1例因腹膜后侧支循环丰富而未重建。移植肝质量365~1 350 g,平均681.3 g;手术时间9~16 h,平均11.5 h;无肝期175~450 min,中位无肝期312 min;术中失血量950~4 500 mL,中位失血量2 000 mL;输入红细胞悬液1~20 U,平均6.4 U;输入新鲜冰冻血浆0.8~2.0 L,平均1.1 L。术后住院时间为5~45 d,平均25.6 d。4例患者术后出现肝区包裹性积液、1例胆汁漏和1例胆管狭窄,均予以相应干预并治愈,无围术期死亡发生。17例患者随访时间为3~35个月,平均9.5个月,均未见HAE复发及远处转移。结论在高原地区对晚期HAE患者行自体肝移植治疗的临床疗效较满意,但该手术仍存在风险高、难度大,术中重建材料的选择、后腹膜侧支循环的判断、下腔静脉端端吻合口有无张力等问题需精准考虑,同时术后抗凝治疗、并发症管理复杂,仅适合在有丰富经验的高原医疗单位开展。Objective To 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).Method The 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. Results The 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. Conclusions In 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

关 键 词：肝泡型包虫病 离体肝切除联合自体肝移植 下腔静脉重建 

分 类 号：R657.3[医药卫生—外科学]