二步肝切除治疗晚期肝泡型棘球蚴病的安全性和疗效  

Two-step liver resection in treatment of advanced hepatic alveolar echinococcosis:Safety and efficacy

作　　者：邢洪铭 黄建花 游欣雨 廖玉波 张宇[1,2] XING Hongming;HUANG Jianhua;YOU Xinyu;LIAO Yubo;ZHANG Yu(Department of Hepatobiliary and Pancreatic Surgery,Sichuan Provincial People’s Hospital,University of Electronic Science and Technology of China,Chengdu 610072,P.R.China;Medical School of University of Electronic Science and Technology of China,Chengdu 610054,P.R.China;Southwest Medical University,Luzhou,Sichuan 646000,P.R.China;Department of Hepatobiliary and Pancreatic Surgery,The First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,P.R.China)

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]电子科技大学医学院,成都610054 [3]西南医科大学,四川泸州646000 [4]成都医学院第一附属医院肝胆胰外科,成都610500

出　　处：《中国普外基础与临床杂志》2024年第10期1202-1209,共8页Chinese Journal of Bases and Clinics In General Surgery

基　　金：2022年第一批省级科技计划项目-重点研发计划(重大科技专项)项目(项目编号:2022YFS0596)。

摘　　要：目的探讨对于预计肝切除术后剩余肝体积不足的晚期肝泡型棘球蚴病(hepatic alveolar echinococcosis,HAE,又称“肝泡型包虫病”)患者术前予以促进剩余肝脏增生后再二期行肝切除的安全性和疗效。方法回顾性收集四川省人民医院2016年12月至2022年12月期间对预计肝切除术后剩余肝体积不足且采用二步肝切除治疗的晚期HAE患者,对其临床资料进行分析并总结。结果共收集到11例经术后病理证实的晚期HAE患者,11例患者中一期有2例采用门静脉栓塞、2例采用肝静脉剥夺术及7例采用肝脏分隔联合门静脉结扎的二步肝切除术促进剩余肝脏增生后,剩余肝体积/标准肝体积均达到超过40%的手术要求标准;二期再行半离体肝切除术或离体肝切除+自体肝移植术或直接行根治性肝切除治疗后均恢复良好,其中有1例患者因术中大量出血(约4000 mL),于术后第3天行手术取出填塞纱布。术后中位随访时间(95%可信区间)为36(15,75)个月,仅1例在术后第3年时发现复发而再次行手术切除,其余患者未发生复发、远期并发症及死亡。结论从本组病例结果看,门静脉栓塞、肝静脉剥夺术及肝脏分隔联合门静脉结扎的二步肝切除术应用于预计肝切除术后剩余肝体积不足的晚期HAE有助于残肝增生,为晚期HAE患者的二期根治性治疗创造了条件;二期在“在体优先”理念下采用包括半离体肝切除术或离体肝切除+自体肝移植或直接肝切除治疗,效果良好,安全可行,为以往被认定为无法行根治性切除的晚期HAE患者带来了生存希望,但该种治疗策略费用仍高昂,未来仍需进一步优化。Objective To explore the safety and efficacy of preoperative liver regeneration and then two-stage liver resection for advanced hepatic alveolar echinococcosis(HAE)patients pre-evaluating insufficient future liver remnant(FLR)after resection.Method The clinical data of the advanced HAE patients who were expected to have insufficient FLR after liver resection and underwent two-step liver resection in the Sichuan Provincial People’s Hospital from December 2016 to December 2022 were retrospectively collected and summarized.Results A total of 11 patients with advanced HAE pathologically confirmed were collected.Among them,2 cases underwent portal vein embolization(PVE),2 cases underwent liver vein deprivation(LVD),and 7 cases underwent associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)to promote residual liver regeneration in the first stage.The FLR/standard liver volume(SLV)exceeded the surgical requirement standard of 40%.Then the ex-vivo liver resection and autotransplantation,or directly radical liver resection was performed in the second stage.Only one patient underwent surgery to remove packed gauze on day 3 postoperatively due to massive intraoperative bleeding(approximately 4000 mL).The median(P25,P75)follow-up time after surgery was 36(15,75)months,only one case was found to relapse at the third year after surgery and underwent surgical resection again,and the rest patients had no recurrence,long-term complications,or death.Conclusions Based on the results from these cases,applying PVE,LVD,or ALPPS in the patients with advanced HAE who were expected to have insufficient FLR after resection aids to residual liver regeneration,creating conditions for the second stage radical resection.The second stage treatment including ex-vivo liver resection and autotransplantation or directly radical liver resection could achieve good results and is feasible and safe,which brings a hope of survival for the advanced HAE patients who could not previously undergo curative resection.However,th

关 键 词：肝棘球蚴病 肝包虫病 门静脉栓塞 肝静脉剥夺术 肝脏分隔联合门静脉结扎的二步肝切除 ALPPS 肝脏再生 二步手术 

分 类 号：R657.3[医药卫生—外科学] R532.32[医药卫生—临床医学]