中国普外基础与临床杂志

中国普外基础与临床杂志

离体肝切除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

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目的 总结离体肝切除自体肝移植术联合复杂肝静脉重建在治疗终末期肝泡型包虫病中的效果。 方法 回顾性分析四川省人民医院于 2017 年 12 月收治的 1 例行离体肝切除、自体肝移植联合复杂肝静脉重建术的泡型肝包虫患者的临床资料。 结果 经术前评估及术中探查发现,患者的腔静脉及肝静脉广泛受侵,故于在体包虫切除结合离体包虫切除后,重建门静脉,切取自体大隐静脉重建肝右静脉、肝短静脉及右后下静脉肝静脉流出道为一完整广口流出道,将重建之流出道大补片与腔静脉人工血管行侧侧吻合,残余肝行“背驮式”自体肝移植。患者的手术时间为 16 h,术中出血量约 1 000 mL。术后行肝切除术后常规治疗,24 h 后以低分子肝素抗凝,无胆汁漏、出血、感染、肝功能衰竭等并发症发生,于术后 14 d 顺利出院。术后随访 6 个月,一般情况良好。 结论 离体肝切除自体肝移植术是治疗终末期包虫病的有效手术方式,术中肝脏劈裂及个体化的管道重建尤其是流出道重建是手术的难点及关键步骤。

Objective To explore the effect of ex-vivo liver resection and autologous liver transplantation (ERAT) combined with complicated hepatic venous reconstruction for end stage hepatic alveolar echinococcosis (AE). Methods The clinical data of one case with hepatic AE who treated in Organ Transplantation Center of Sichuan Provincial People’s Hospital in December 2017 was analyzed retrospectively. Results Pre-operative examination and intraoperative exploration revealed the hepatic vein (HV) and retrohepatic inferior vena cava (RHIVC) were invaded widely. We successfully initiated operation through vivo and ex-vivo hepatic AE resection, portal vein reconstruction, right/short/right inferior HV reconstruction into a wide mouth outflow with the assist of autogenous saphenous vein, and then piggyback autologous liver transplantation by wide mouth outflow-artificial inferior vena cava anastomosis (side to side). The operative time was 16 hours, and blood loss was 1 000 mL approximately. The patient was admitted routine treatment after hepatectomy. The inject low-molecular-weight heparin sodium was admitted for anticoagulant therapy 24 hours after operation. This patient recovered smoothly without bile leakage, bleeding, infection and liver failure, and so on. The patient was discharged uneventfully 14 days after operation, and there were no special situation during the 6 months follow-up period. Conclusions ERAT is an ideal surgical method for end stage hepatic AE. Hepatic parenchymal transection and individual duct reconstruction, especially hepatic outflow reconstruction, are the key steps for ERAT.

关键词: 肝泡型包虫病; 自体肝移植; 离体肝切除; 肝静脉重建

Key words: liver alveolar echinococcosis; autologous liver transplantation; ex-vivo liver resection; hepatic vein reconstruction

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