高原地区体外肝切除联合自体肝移植术治疗晚期肝泡型包虫病的术后并发症及其防治策略  

Postoperative complications of ex vivo liver resection combined with autologous liver transplantation in treatment of advanced hepatic alveolar echinococcosis at high altitude and related prevention and treatment strategies

作　　者：田青山[1] 冯少培 郭亚民[1] 韩秀敏[1] 赵顺云[1] 叶成杰[1] 安永德[1] 吴世乐[1] 王向前 郑海波 朱文君 阿吉德 高伟 潘洪帅 TIAN Qingshan;FENG Shaopei;GUO Yamin;HAN Xiumin;ZHAO Shunyun;YE Chengjie;AN Yongde;WU Shile;WANG Xiangqian;ZHENG Haibo;ZHU Wenjun;A Jide;GAO Wei;PAN Hongshuai(Department of General Surgery,Qinghai Provincial People’s Hospital,Xining 810000,China;Graduate School of Qinghai University,Xining 810000,China)

机构地区：[1]青海省人民医院普外科,西宁810000 [2]青海大学研究生院,西宁810000

出　　处：《临床肝胆病杂志》2021年第9期2153-2160,共8页Journal of Clinical Hepatology

基　　金：青海省2020年重大公共卫生专项资金包虫病防治项目(2305999901-1073)。

摘　　要：目的探讨高原地区体外肝切除联合自体肝移植术治疗终末期肝泡型包虫病的术后并发症并探讨防治策略。方法收集青海省人民医院2013年1月—2019年3月接受自体肝移植术的11例终末期肝泡型包虫病患者的手术资料及随访资料,对术中及术后情况进行分析。结果11例患者均成功行自体肝移植术,无术中死亡,其中2例(18.18%)行半离体肝切除,9例(81.82%)行全离体肝切除。肝后下腔静脉重建方式中,采用自体大隐静脉进行重建者2例(18.18%),采用人造血管重建者4例(36.36%),5例(45.45%)保留自体肝后下腔静脉。胆道重建方式中,8例(72.73%)行胆肠吻合术,3例(27.27%)行胆管端端吻合术。11例患者的术后并发症主要有出血2例(18.18%);胆汁漏、腹腔感染4例(36.36%),胆肠吻合口狭窄1例(9.09%),血栓2例(18.18%),肺部感染、胸腔积液2例(18.18%);包虫复发1例(9.09%)。11例患者发生围术期死亡2例(18.18%),其余9例(81.82%)患者均好转出院。结论出血、胆道并发症和感染是造成高原地区自体肝移植患者死亡的主要原因,精准把握手术适应证、术前仔细多学科评估、术中精湛的操作、外科技术流程的标准化及精细的围术期管理是降低自体肝移植术围术期病死率、避免和减少术后并发症以及使患者获得长期良好生存的关键。Objective To investigate the postoperative complications of ex vivo liver resection combined with autologous liver transplantation in the treatment of end-stage hepatic alveolar echinococcosis at high altitude and related prevention and treatment strategies.Methods Surgical data and follow-up data were collected from 11 patients with end-stage hepatic alveolar echinococcosis who underwent autologous liver transplantation in Qinghai People’s Hospital from January 2013 to March 2019,and intraoperative and postoperative conditions were analyzed.Results All 11 patients underwent autologous liver transplantation successfully,without intraoperative death,among whom 2(18.18%)underwent hemi-extracorporeal hepatectomy and 9(81.82%)underwent total extracorporeal hepatectomy.For the reconstruction of the retrohepatic inferior vena cava,2 patients(18.18%)underwent reconstruction with the autologous great saphenous vein,4 patients(36.36%)underwent reconstruction with artificial vessels,and the autologous retrohepatic inferior vena cava was preserved in 5 patients(45.45%).For biliary reconstruction,8 patients(72.73%)underwent choledochoenterostomy and 3(27.27%)underwent choledochocholedochostomy.The main postoperative complications of the 11 patients included bleeding in 2 patients(18.18%),bile leakage and abdominal infection in 4 patients(36.36%),bilioenteric anastomotic stenosis in 1 patient(9.09%),thrombus in 2 patients(18.18%),pulmonary infection and pleural effusion in 2 patients(18.18%),and echinococcosis recurrence in 1 patient(9.09%).Of all 11 patients,2(18.18%)died during the perioperative period,and the other 9 patients(81.82%)were improved and discharged.ConclusionBleeding,biliary complications,and infection are the main causes of death in patients undergoing autologous liver transplantation at high altitude.An accurate understanding of surgical indication,careful multidisciplinary evaluation before surgery,superb operation during surgery,standardized surgical procedures,and fine perioperative management are the k

关 键 词：棘球蚴病 肝 体外肝切除联合自体肝移植术 手术后并发症 

分 类 号：R532.32[医药卫生—内科学] R617[医药卫生—临床医学]