肝泡型棘球蚴病的外科治疗策略  

Surgical treatment strategies for hepatic alveolar echinococcosis

作　　者：邱逸闻 庞华胜 沈舒[1] 王焘 杨屹 王文涛[1] QIU Yiwen;PANG Huasheng;SHEN Shu;WANG Tao;YANG Yi;WANG Wentao(Division of Liver Surgery,Department of General Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;NHC Key Laboratory of Echinococcosis Prevention and Control,Tibet Center of Disease Control and Prevention,Tibet Autonomous Region,Lhasa 850000,P.R.China)

机构地区：[1]四川大学华西医院普通外科肝脏外科病房,成都610041 [2]国家卫生健康委包虫病防治研究重点实验室,西藏自治区疾病预防控制中心,拉萨850000

出　　处：《中国普外基础与临床杂志》2024年第10期1153-1159,共7页Chinese Journal of Bases and Clinics In General Surgery

基　　金：国家自然科学基金面上项目(项目编号:82170543);国家自然科学基金青年科学基金项目(项目编号:8240034324);国家卫生健康委包虫病防治研究重点实验室资助(项目编号:2021WZK1004);西藏自治区卫生健康委员会资助横向科研项目(项目编号:311220432);四川省科技厅重点研发项目(项目编号:2023YFS0229)。

摘　　要：肝泡型棘球蚴病(hepatic alveolar echinococcosis,HAE,亦称“肝泡型包虫病”)是由多房棘球绦虫引起的一种严重的人畜共患疾病,主要侵犯肝脏。由于疾病的隐匿性,患者往往在晚期才被确诊,给治疗带来极大挑战。笔者回顾了HAE的外科治疗技术进展,重点关注了从早期到晚期HAE的手术策略。早期HAE采用消融治疗是有效手段;对于中晚期HAE,在众多研究中通过改进手术技术和引入具有挑战性的方法如腹腔镜手术和肝移植,特别是离体肝切除联合自体肝移植,为晚期HAE患者提供了更为有效的治疗选择,但仍面临许多挑战,比如如何在切除病灶的同时保留足够的剩余肝脏功能等。未来的研究应继续探索和优化现有的外科治疗方法,特别是针对晚期HAE患者的治疗策略,包括改进手术技术通过精确术前评估和分期以及开发新的外科技术,以提高手术的安全性和有效性;同时,多中心、前瞻性及长期随访的临床研究将是验证新手术技术和策略有效性的关键。通过这些努力,期望能够显著提高HAE患者的生存率和改善其生活质量。Hepatic alveolar echinococcosis(HAE)is a severe zoonotic disease caused by Echinococcus multilocularis,primarily affecting the liver.Due to its insidious nature,the patients are often diagnosed at advanced stage,posing significant treatment challenges.We comprehensively examines the progress in surgical techniques for HAE management,focusing on various strategies across different disease stages.For the patients with early-stage HAE,ablation therapy has emerged as an effective treatment option.In the moderate to advanced cases,numerous surgical techniques and innovative approaches have been introduced,including laparoscopic surgery and liver transplantation,with particular emphasis on ex vivo liver resection and autotransplantation.These advancements offer more effective treatment options for the patients with advanced HAE.However,significant challenges persist,notably the preservation of adequate liver function while achieving complete lesion removal.Future research should prioritize the exploration and optimization of existing surgical methods,especially for advanced HAE cases.This includes refining surgical techniques through precise preoperative evaluation and staging,as well as developing novel surgical approaches to enhance safety and efficacy.Furthermore,multicenter and long-term follow-up prospective studies are crucial for validating the effectiveness of new surgical techniques and strategies.Through these concerted efforts,it is anticipated that the survival rates and quality of life for HAE patients will significantly be improved,marking a new era in the management of this complex disease.

关 键 词：肝泡型棘球蚴病 肝泡型包虫病 外科治疗 肝切除 腹腔镜 消融治疗 肝移植 

分 类 号：R657.3[医药卫生—外科学]