终末期肝泡型包虫病的肝移植治疗  

Liver transplantation for end-stage hepatic alveolar echinococcosis

作　　者：庞北川 张娜 左邦佑 杨冲[1] 张宇[1] 邓绍平[2] Pang Beichuan;Zhang Na;Zuo Bangyou;Yang Chong;Zhang Yu;Deng Shaoping(Department of Hepatopancreatobiliary Surgery,Sichuan Academy of Medical Science&Sichuan Provincial People's Hospital(School of Medicine,University of Electronic Science and Technology of China),Chengdu 610072,China;不详)

机构地区：[1]四川省医学科学院·四川省人民医院(电子科技大学附属医院)肝胆胰外科,成都610072 [2]四川省医学科学院·四川省人民医院(电子科技大学附属医院)器官移植中心,成都610072 [3]西部战区总医院第五派驻门诊部

出　　处：《器官移植》2024年第2期163-170,共8页Organ Transplantation

基　　金：国家自然科学基金(82373189);四川省科技厅重大消化系统疾病诊治(2021YFS0375);四川省科技厅重点研发项目(2022YFS0596);吴阶平医学基金(2022HX017)。

摘　　要：肝泡型包虫病(HAE)是我国西部地区常见的人畜共患地方性寄生虫病,早期缺乏典型临床表现,症状明显时常已进入终末期,具有极高的致死率。在终末期HAE(es-HAE)治疗中,因残余肝体积不足、无法控制的出血、脉管在体重建困难等,同种异体原位肝移植几乎成为唯一根治的方式。但因供肝短缺、术后需长期使用免疫抑制药等因素限制了其应用,离体肝切除联合自体肝移植术(ELRA)的出现打破了这一窘境,极大拓宽了es-HAE手术指征。此外,我国多中心对ELRA进行了诸多优化与改良,进一步完善es-HAE的治疗体系。目前,es-HAE的肝移植(包括ELRA)治疗仍是临床医师研究的热点。本文对原位肝移植、ELRA、辅助性ELRA等多种手段在es-HAE的外科治疗进行综述,旨在进一步提升es-HAE的诊治水平,改善患者临床预后。Hepatic alveolar echinococcosis(HAE)is a common zoonotic endemic parasitic disease in western China.It lacks of typical clinical manifestations in the early stage,and symptoms become prominent during the end stage,with an alarmingly high mortality rate.Among the treatment of end-stage HAE(es-HAE),orthotopic liver transplantation is almost the only radical treatment due to insufficient remnant liver volume,uncontrollable bleeding and difficulty in vascular reconstruction in vivo.However,the shortage of donor liver and long-term postoperative use of immunosuppressants limit its application.The introduction of ex vivo liver resection and autotransplantation(ELRA)resolves this dilemma and significantly broadens the indications of es-HAE.In addition,multiple centers in China have optimized and modified ELRA to further improve the treatment system of es-HAE.At present,liver transplantation(including ELRA)of es-HAE remains a hot topic for clinicians.In this article,orthotopic liver transplantation,ELRA,auxiliary ELRA and other surgical treatment of es-HAE were reviewed,aiming to further enhance the diagnosis and treatment of es-HAE and improve clinical prognosis of the patients.

关 键 词：肝泡型包虫病 终末期 原位肝移植 离体肝切除 自体肝移植 残余肝体积 肝静脉支架 手术桥接 

分 类 号：R617[医药卫生—外科学] R53[医药卫生—临床医学]