Surgical Treatment of Advanced Hepatic Alveolar Echinococcosis (Report of 36 Cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 WANGGuan ,  LUOLan-yun , ZOUHai-bo , LUOLe , XIANGGuang-ming , XUEHua , YAOYu-tong ,  HUANGXiao-lun

The Seventh Department of Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan Province, China;

Corresponding?author：

HUANGXiao-lun, Email: huangxiaolun@med.uestc.edu.cn

Keywords：

Advanced hepatic alveolar echinococcosis; Surgical treatment; Multiple-disciplinary treatment

DOI：

10.7507/1007-9424.20160352

Video：

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Objective To investigate strategies and efficacy of surgical treatment of advanced hepatic alveolar echinococcosis. Methods Thirty-six patients with advanced hepatic alveolar echinococcosis who underwent surgical treatment in our hospital from August 2014 to March 2016 were selected, who were divided into three groups:radical hepatectomy group (15 cases), quasi-radical hepatectomy group (17 cases), and palliative surgery group (4 cases). The operative time, intraoperative blood loss, postoperative complications, and metastasis were analyzed among these three groups. Results The operative time, intraoperative blood loss, and rate of postoperative complications had no significant differences between the radical hepatectomy group and the quasi-radical hepatectomy group. No patient had postoperative recurrence in the radical hepatectomy group. The hepatic portal residual lesion was enlarged for 1 case and the intrahepatic and extrahepatic lesions were stable for the other patients in the quasi-radical hepatectomy group. In the palliative surgery group,the retroperitoneal lesions enlargement was seen in 2 cases and the lesions around the abcess grew progressively in 1 case. Conclusion Individualized treatment accompanied with multiple-disciplinary treatment and damage-control surgery concept could benefit optimally to patients with advanced hepatic alveolar echinococcosis.

Citation： WANGGuan, LUOLan-yun, ZOUHai-bo, LUOLe, XIANGGuang-ming, XUEHua, YAOYu-tong, HUANGXiao-lun. Surgical Treatment of Advanced Hepatic Alveolar Echinococcosis (Report of 36 Cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(11): 1379-1383. doi: 10.7507/1007-9424.20160352 Copy

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2.	Kern P, Wen H, Sato N, et al. WHO classification of alveolar echino-coccosis:principles and application. Parasitol Int, 2006, 55 Suppl:S283-S287.
3.	中國醫師協會外科醫師分會包蟲病外科專業委員會. 肝兩型包蟲病診斷與治療專家共識(2015版). 中華消化外科雜志, 2015, 14(4):253-264.
4.	Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO Informal Working Group on Echinococcosis. Bull World Health Organ, 1996, 74(3):231-242.
5.	邵英梅, 蔣鐵民, 吐爾干艾力·阿吉, 等. 根治性及準根治性手術治療終末期肝泡型包蟲病. 中華消化外科雜志, 2011, 10(4):296-298.
6.	Dindo D, Demartines N, Clavien PA. Classification of surgical comp-lications:A new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2):205-213.
7.	張瀚之, 陳哲宇, 嚴律南, 等. 肝包蟲病外科治療的單中心經驗. 中國普外基礎與臨床雜志, 2015, 22(2):144-148.
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10.	董家鴻, 鄭樹森, 陳孝平, 等. 肝切除術前肝臟儲備功能評估的專家共識(2011版). 中華消化外科雜志, 2011, 10(1):20-25.
11.	馬榮花, 郭亞民, 朱海宏, 等. 泡型肝包蟲病患者肝切除術后肝儲備功能的評價參數. 世界華人消化雜志, 2015, 23(2):308-312.
12.	羅蘭云, 姚豫桐, 鄒海波, 等. "掏核式肝切除法"治療晚期巨大肝泡型包蟲病9例臨床分析. 實用醫院臨床雜志, 2015, 12(2):56-58.
13.	李作安, 吐爾干艾力·阿吉, 冉博, 等. "減體積式病灶肝切除"治療晚期肝巨大泡型包蟲病的臨床應用. 中國普通外科雜志, 2012, 21(7):864-868.
14.	顧晉. 惡性腫瘤多學科綜合治療模式. 中國實用外科雜志, 2009, 29(1):21-22.
15.	Friedland PL, Bozic B, Dewar J, et al. Impact of disciplinary team management in head and neck cancer patients. Br J Cancer, 2011, 104(8):1246-1248.
16.	Bresson-Hadni S, Blagosklonov O, Knapp J, et al. Should possible recurrence of disease contraindicate liver transplantation in patients with end-stage alveolar echinococcosis? A 20-year follow-up study. Liver Transpl, 2011, 17(7):855-865.
17.	Wen H, Dong JH, Zhang JH, et al. Ex vivo liver resection and auto-transplantation for end-stage alveolar echinococcosis:a case series. Am J Transplant. 2016, 16(2):615-624.
18.	方丹, 陳哲宇, 曾勇, 等. 泡型肝包蟲病的外科治療. 中國普外基礎與臨床雜志, 2016, 23(5):521-525.
19.	Ulger S, Barut H, Tunc M, et al. Radiation therapy for resistant sternal hydatid disease. Strahlenther Onkol, 2013, 189(6):508-509.
20.	Schmid M, Pendl G, Samonigg H, et al. Gamma knife radiosurgery and albendazole for cerebral alveolar hydatid disease. Clin Infect Dis, 1998, 26(6):1379-1382.
21.	張永國, 張成武, 竇拉加. 高強度聚焦超聲治療巨大肝泡球蚴病一例. 中國寄生蟲學與寄生蟲病雜志, 2005, 23(4):256.
22.	La X, Zhang F, Li Y, et al. Upregulation of PD-1 on CD4⁺ CD25⁺ T cells is associated with immunosuppression in liver of mice infected with echinococcus multilocularis. Int Immunopharmacol, 2015, 26 (2):357-366.

1. Grosso G, Gruttadauria S, Biondi A, et al. Worldwide epidemiology of liver hydatidosis including the Mediterranean area. World J Gastroenterol, 2012, 18(13):1425-1437.
2. Kern P, Wen H, Sato N, et al. WHO classification of alveolar echino-coccosis:principles and application. Parasitol Int, 2006, 55 Suppl:S283-S287.
3. 中國醫師協會外科醫師分會包蟲病外科專業委員會. 肝兩型包蟲病診斷與治療專家共識(2015版). 中華消化外科雜志, 2015, 14(4):253-264.
4. Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO Informal Working Group on Echinococcosis. Bull World Health Organ, 1996, 74(3):231-242.
5. 邵英梅, 蔣鐵民, 吐爾干艾力·阿吉, 等. 根治性及準根治性手術治療終末期肝泡型包蟲病. 中華消化外科雜志, 2011, 10(4):296-298.
6. Dindo D, Demartines N, Clavien PA. Classification of surgical comp-lications:A new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2):205-213.
7. 張瀚之, 陳哲宇, 嚴律南, 等. 肝包蟲病外科治療的單中心經驗. 中國普外基礎與臨床雜志, 2015, 22(2):144-148.
8. 阿卜杜艾尼·啊卜力孜, 溫浩. 難治性肝泡型包蟲病的多學科個體化治療. 臨床肝膽病雜志, 2015, 31(4):639-641.
9. 張昀昊, 任利, 陽丹才讓, 等. 肝泡型包蟲病根治性切除163例回顧性分析. 中國普通外科雜志, 2016, 25(2):257-263.
10. 董家鴻, 鄭樹森, 陳孝平, 等. 肝切除術前肝臟儲備功能評估的專家共識(2011版). 中華消化外科雜志, 2011, 10(1):20-25.
11. 馬榮花, 郭亞民, 朱海宏, 等. 泡型肝包蟲病患者肝切除術后肝儲備功能的評價參數. 世界華人消化雜志, 2015, 23(2):308-312.
12. 羅蘭云, 姚豫桐, 鄒海波, 等. "掏核式肝切除法"治療晚期巨大肝泡型包蟲病9例臨床分析. 實用醫院臨床雜志, 2015, 12(2):56-58.
13. 李作安, 吐爾干艾力·阿吉, 冉博, 等. "減體積式病灶肝切除"治療晚期肝巨大泡型包蟲病的臨床應用. 中國普通外科雜志, 2012, 21(7):864-868.
14. 顧晉. 惡性腫瘤多學科綜合治療模式. 中國實用外科雜志, 2009, 29(1):21-22.
15. Friedland PL, Bozic B, Dewar J, et al. Impact of disciplinary team management in head and neck cancer patients. Br J Cancer, 2011, 104(8):1246-1248.
16. Bresson-Hadni S, Blagosklonov O, Knapp J, et al. Should possible recurrence of disease contraindicate liver transplantation in patients with end-stage alveolar echinococcosis? A 20-year follow-up study. Liver Transpl, 2011, 17(7):855-865.
17. Wen H, Dong JH, Zhang JH, et al. Ex vivo liver resection and auto-transplantation for end-stage alveolar echinococcosis:a case series. Am J Transplant. 2016, 16(2):615-624.
18. 方丹, 陳哲宇, 曾勇, 等. 泡型肝包蟲病的外科治療. 中國普外基礎與臨床雜志, 2016, 23(5):521-525.
19. Ulger S, Barut H, Tunc M, et al. Radiation therapy for resistant sternal hydatid disease. Strahlenther Onkol, 2013, 189(6):508-509.
20. Schmid M, Pendl G, Samonigg H, et al. Gamma knife radiosurgery and albendazole for cerebral alveolar hydatid disease. Clin Infect Dis, 1998, 26(6):1379-1382.
21. 張永國, 張成武, 竇拉加. 高強度聚焦超聲治療巨大肝泡球蚴病一例. 中國寄生蟲學與寄生蟲病雜志, 2005, 23(4):256.
22. La X, Zhang F, Li Y, et al. Upregulation of PD-1 on CD4⁺ CD25⁺ T cells is associated with immunosuppression in liver of mice infected with echinococcus multilocularis. Int Immunopharmacol, 2015, 26 (2):357-366.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Surgical Treatment of Advanced Hepatic Alveolar Echinococcosis (Report of 36 Cases)

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