保留肝后下腔静脉的在体肝切除术治疗侵犯下腔静脉的复杂泡型肝包虫病  

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

作　　者：李航 滕飞 孔庆研 陈哲宇[1] LI Hang;TENG Fei;KONG Qingyan;CHEN Zheyu(Department of Liver Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西医院肝脏外科,成都610041

出　　处：《中国普外基础与临床杂志》2022年第10期1279-1283,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：成都市科技项目技术创新研发项目(项目编号:2021-YF05-01827-SN)。

摘　　要：目的 探讨保留肝后下腔静脉的在体肝切除术治疗侵犯下腔静脉的复杂泡型肝包虫病的临床应用价值。方法 回顾性收集2021年12月四川大学华西医院肝脏外科收治的1例病灶大(最大横截面12.6 cm×9.6 cm)且呈浸润性生长、与周围组织分界不清、侵犯膈肌和下腔静脉(侵犯长度达4.6 cm)的复杂泡型肝包虫病患者的临床病理资料。术前进行三维重建肝脏模型,对右肝病灶所侵犯下腔静脉进行测量并模拟切除范围,术中采用钳夹法逐步分离病灶与受累下腔静脉,逐步去除残留病灶。结果 完整切除了右肝泡型包虫病灶,保证了下腔静脉的完整性,切除范围与术前三维重建规划的方案基本一致。手术时间275 min,出血量约500 mL。患者于术后第1天行血生化检查提示丙氨酸氨基转移酶及天门冬氨酸氨基转移酶升高,血浆白蛋白、胆红素等均未见明显异常,于术后第7天康复出院。术后无并发症发生,随访期间未见包虫复发或转移。结论 从本例患者的结果看,保留肝后下腔静脉的在体肝切除术治疗侵犯下腔静脉的复杂泡型肝包虫病安全、可行,术后规律服用阿苯达唑可维持无病生存状态。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 December2021 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 threedimensional 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.

关 键 词：泡型肝包虫病 肝后下腔静脉 在体肝切除术 

分 类 号：R657.3[医药卫生—外科学]