自体肝移植技术治疗晚期肝泡型包虫病16例临床疗效分析
|
摘要
目的探讨自体肝移植技术在治疗晚期肝泡型包虫病的疗效及安全性。方法回顾性分析本中心2017年8月至2018年11月收治的16例晚期肝泡型包虫病患者的临床资料,其中8例行半离体肝切除和8例行离体肝切除联合自体肝移植技术,分析患者的术中及术后随访情况。结果 16例患者手术时间(11. 5±3. 1) h,术中输血(8. 2±8) UU,术中失血(2253±842. 5) ml,术后住院时间(15±13) d。围手术期并发症6例,死亡1例;术后15例均随访,随访期间14例患者未见包虫复发及远处转移,1例术后5月死亡。结论自体肝移植是治疗晚期泡型包虫病的有效治疗方法,术中肝脏劈裂及个体化管道重建是手术的关键步骤,术前的精确评估、围手术期管理、手术方式非常重要。
Objective To explore the safety and efficacy of the autologous livertransplantation( ALT) for advanced hepatic alveolar echinococcosis( HAE).Methods The clinical data of 16 adancede HAE patients from August 2017 to November 2018 were retrospectively analyzed.Among the patients,8 patients received semi-deteched hepatectomy and other 8 patients received exhepatectomy combined ALT,respectively.The intra-and post-operative data of the patients were analyzed. Results The operation time was 11. 5 ±3. 1 hours,the intro-operative blood trasfusion was 8. 2 ± 8 U,the average blood loss during surgery was 2253 ± 842. 5 ml and post-operative hospital stay is 15 ± 13 days. The postoperative complications occured in 6 cases and 1 case died. After operation,15 patients were followed up.Of the patients,14 cases were found no recurrence or distant metastsis during follow-up time,and 1 case died after 5 months of operation.Conclusion ALT is effective for advanced HAE.Liver cleft palate and individual tube reconstruction is a critical step in surgery.Accurate evaluation before surgery,perioperative management and surgical options are significant for patient's prognosis.
Objective To explore the safety and efficacy of the autologous livertransplantation( ALT) for advanced hepatic alveolar echinococcosis( HAE).Methods The clinical data of 16 adancede HAE patients from August 2017 to November 2018 were retrospectively analyzed.Among the patients,8 patients received semi-deteched hepatectomy and other 8 patients received exhepatectomy combined ALT,respectively.The intra-and post-operative data of the patients were analyzed. Results The operation time was 11. 5 ±3. 1 hours,the intro-operative blood trasfusion was 8. 2 ± 8 U,the average blood loss during surgery was 2253 ± 842. 5 ml and post-operative hospital stay is 15 ± 13 days. The postoperative complications occured in 6 cases and 1 case died. After operation,15 patients were followed up.Of the patients,14 cases were found no recurrence or distant metastsis during follow-up time,and 1 case died after 5 months of operation.Conclusion ALT is effective for advanced HAE.Liver cleft palate and individual tube reconstruction is a critical step in surgery.Accurate evaluation before surgery,perioperative management and surgical options are significant for patient's prognosis.
引文
[1]Hao WEN,Tuerganaili AJI,Ying-Mei SHAO.Diagnosis and management against the complications of human cystic echinococcosis[J].Frontiers of Medicine in China,2010,4(4):394-398.
[2]Li Tiaoying,Qiu Jiamin,Yang Wenetal Echinococcosis in Tibetan Populations,Western Sichuan Province,China[J].Emerg Infect Dis,2005,11(12):1866-1873.
[3]四川省包虫病诊疗专家组.四川省肝包虫病诊治规范[J].中国普外基础与临床杂志,2017,24(7):789-803.
[4]Xianwei Yang,Yiwen Qiu,Wentao Wang,et al.Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis:A study of 31cases[J].American Journal of Transplantation,2018,18(7):1668-1679.
[5]Hai Wang,Qiaoyu Liu,Zhaoming Wang et al.Clinical Outcomes of Ex Vivo Liver Resection and Liver Autotransplantation for Hepatic Alveolar Echinococcosis[J].Journal of Huazhong Universityof Science and Technology(Medical Sciences),2012,32(4):598-600.
[6]Pichlmayr R,Grosse H,Hauss J,Gubernatis G,et al.Technique and preliminary results of extracorporeal liver surgery(bench procedure)and of surgery on the in situ perfused liver[J].British Journal of Surgery,2010,77(1):21-26.
[7]吐尔洪江·吐逊,阿卜杜萨拉木·艾尼,李玉鹏,等.非原位肝切除技术安全性、可行性和有效性的系统评价[J].中华医学杂志,2016,96(28):2251-2257.
[8]温浩,董家鸿,张金辉,等.体外肝切除联合自体肝移植治疗肝泡型包虫病[J].中华消化外科杂志,2011,10(2):148-149.
[9]Wen H,Dong JH,Zhang JH,et al.ExVivo Liver Resection and Autotransplantation for End-Stage Alveolar Echinococcosis:A Case Series[J].AmericanJournal of Transplantation,2016,16(2):615-624.
[10]Shi ZR,Yan LN,Li B,et al.Evaluation of standard liver volume formulae for Chinese adults[J].World J Gastroenterol,2009,15(32):4062-4066.
[11]何翼彪,白磊,吐尔干艾力阿吉,等.数字化三维重建技术在肝泡型包虫病肝移植中的应用[J].中华肝脏外科手术学电子杂志,2015,4(5):279-283.
[12]He YB,Bai L,Jiang Y,et al.Application of a Three-Dimensional Reconstruction Technique in Liver Autotransplantation for End-Stage Hepatic Alveolar Echinococcosis[J].Journal of Gastrointestinal Surgery,2015,19(8):1-9.
[13]张宇,杨冲,王燚,等.离体肝切除和自体肝移植联合复杂肝静脉重建治疗终末期肝泡型包虫病[J].中国普外基础与临床杂志,2018,25(10):1236-1241.
[14]Chen CL,Concejero AM,Wang CC,et alRemodeled saphenous vein as interposition graft for portal vein reconstruction in living donor liver transplantation[J].Liver Transpl,2010,13(10):1472-1475.
[15]王海涛,陈强谱.门静脉肠系膜上静脉修复重建材料的研究进展[J].世界华人消化杂志,2012,20(26):2467-2473.
[16]Ribbe EB,Alm P,HallbergEt,et al.Evaluation of peritoneal tube grafts in the inferior vena cava of the pig[J].British Journal of Surgery,2010,75(4):357-360.
[17]Saiura A,Yamamoto J,Sakamoto Y,et al.Safety and efficacy of hepatic vein reconstruction for colorectal liver metastases[J].American Journal of Surgery,2011,202(4):449-454.
[18]Sato Y,Oya H,Yamamoto S,et al.Method for spontaneous constriction and closure of portocaval shunt using a ligamentum tereshepatis in small-for-size graft liver transplantation[J].Transplantation,2010,90(11):1200-1203.
[19]Sami Akbulut,Egemen Cicek,Mehmet Kolu,et al.Associating liver partition and portal vein ligation for staged hepatectomy for extensive alveolar echinococcosis:First case report in the literature[J].World Journal of Gastrointestinal Surgery,2018,10(1):1-5.
[20]方丹,杨康明,陈哲宇,等.分期切除治疗多发泡型肝包虫病的初步经验[J].中国普外基础与临床杂志,2017,24(7):804-807.
[21]陈哲宇.复杂肝包虫病的外科治疗[J].中国普外基础与临床杂志,2017,24(07):785-787.
[22]Brunetti E,Kern P,Vuitton DA.Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans.[J].Acta Tropica,2010,114(1):1-16.
[23]Ayifuhan A,Tuerganaili A,Ying-Mei S,et al.Surgical treatment for hepatic alveolar echinococcosis:report of 50 cases[J].Hepato-gastroenterology,2012,59(115):790.
[2]Li Tiaoying,Qiu Jiamin,Yang Wenetal Echinococcosis in Tibetan Populations,Western Sichuan Province,China[J].Emerg Infect Dis,2005,11(12):1866-1873.
[3]四川省包虫病诊疗专家组.四川省肝包虫病诊治规范[J].中国普外基础与临床杂志,2017,24(7):789-803.
[4]Xianwei Yang,Yiwen Qiu,Wentao Wang,et al.Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis:A study of 31cases[J].American Journal of Transplantation,2018,18(7):1668-1679.
[5]Hai Wang,Qiaoyu Liu,Zhaoming Wang et al.Clinical Outcomes of Ex Vivo Liver Resection and Liver Autotransplantation for Hepatic Alveolar Echinococcosis[J].Journal of Huazhong Universityof Science and Technology(Medical Sciences),2012,32(4):598-600.
[6]Pichlmayr R,Grosse H,Hauss J,Gubernatis G,et al.Technique and preliminary results of extracorporeal liver surgery(bench procedure)and of surgery on the in situ perfused liver[J].British Journal of Surgery,2010,77(1):21-26.
[7]吐尔洪江·吐逊,阿卜杜萨拉木·艾尼,李玉鹏,等.非原位肝切除技术安全性、可行性和有效性的系统评价[J].中华医学杂志,2016,96(28):2251-2257.
[8]温浩,董家鸿,张金辉,等.体外肝切除联合自体肝移植治疗肝泡型包虫病[J].中华消化外科杂志,2011,10(2):148-149.
[9]Wen H,Dong JH,Zhang JH,et al.ExVivo Liver Resection and Autotransplantation for End-Stage Alveolar Echinococcosis:A Case Series[J].AmericanJournal of Transplantation,2016,16(2):615-624.
[10]Shi ZR,Yan LN,Li B,et al.Evaluation of standard liver volume formulae for Chinese adults[J].World J Gastroenterol,2009,15(32):4062-4066.
[11]何翼彪,白磊,吐尔干艾力阿吉,等.数字化三维重建技术在肝泡型包虫病肝移植中的应用[J].中华肝脏外科手术学电子杂志,2015,4(5):279-283.
[12]He YB,Bai L,Jiang Y,et al.Application of a Three-Dimensional Reconstruction Technique in Liver Autotransplantation for End-Stage Hepatic Alveolar Echinococcosis[J].Journal of Gastrointestinal Surgery,2015,19(8):1-9.
[13]张宇,杨冲,王燚,等.离体肝切除和自体肝移植联合复杂肝静脉重建治疗终末期肝泡型包虫病[J].中国普外基础与临床杂志,2018,25(10):1236-1241.
[14]Chen CL,Concejero AM,Wang CC,et alRemodeled saphenous vein as interposition graft for portal vein reconstruction in living donor liver transplantation[J].Liver Transpl,2010,13(10):1472-1475.
[15]王海涛,陈强谱.门静脉肠系膜上静脉修复重建材料的研究进展[J].世界华人消化杂志,2012,20(26):2467-2473.
[16]Ribbe EB,Alm P,HallbergEt,et al.Evaluation of peritoneal tube grafts in the inferior vena cava of the pig[J].British Journal of Surgery,2010,75(4):357-360.
[17]Saiura A,Yamamoto J,Sakamoto Y,et al.Safety and efficacy of hepatic vein reconstruction for colorectal liver metastases[J].American Journal of Surgery,2011,202(4):449-454.
[18]Sato Y,Oya H,Yamamoto S,et al.Method for spontaneous constriction and closure of portocaval shunt using a ligamentum tereshepatis in small-for-size graft liver transplantation[J].Transplantation,2010,90(11):1200-1203.
[19]Sami Akbulut,Egemen Cicek,Mehmet Kolu,et al.Associating liver partition and portal vein ligation for staged hepatectomy for extensive alveolar echinococcosis:First case report in the literature[J].World Journal of Gastrointestinal Surgery,2018,10(1):1-5.
[20]方丹,杨康明,陈哲宇,等.分期切除治疗多发泡型肝包虫病的初步经验[J].中国普外基础与临床杂志,2017,24(7):804-807.
[21]陈哲宇.复杂肝包虫病的外科治疗[J].中国普外基础与临床杂志,2017,24(07):785-787.
[22]Brunetti E,Kern P,Vuitton DA.Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans.[J].Acta Tropica,2010,114(1):1-16.
[23]Ayifuhan A,Tuerganaili A,Ying-Mei S,et al.Surgical treatment for hepatic alveolar echinococcosis:report of 50 cases[J].Hepato-gastroenterology,2012,59(115):790.