The preliminary experience of two-stage hepatectomy for multiple hepatic alveolar echinococcosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

FANG Dan ¹ , YANG Kangming ² ,  CHEN Zheyu ¹ , CHEN Kefei ¹ , HUANG Xiang ² , YAN Lünan ¹ , LI Bo ¹ , WEN Tianfu ¹ , WANG Wentao ¹ , CHEN Ying ² , WU Hong ¹ , XU Mingqing ¹ , MA Zhi ² , YANG Jiayin ¹ , LI Zhihong ² , WEI Yonggang ¹ , WEI Gengfu ² , HUANG Jiwei ¹ , TANG Youyin ¹ , FENG Xi ¹

1. Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R.China;
2. Hepatobiliary Department, The people's Hospital of Ganzi Tibetan Autonomous Prefecture of Sichuan Province, Kangding, Sichuan 626000, P.R.China;

Corresponding?author：

CHEN Zheyu, Email: chenzheyu71@163.com

Keywords：

hepatic alveolar echinococcosis; two-stage hepatectomy

DOI：

10.7507/1007-9424.201706001

Video：

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Objective To discuss the clinical application of two-stage hepatectomy for multiple and huge hepatic alveolar echinococcosis. Methods The clinical data of 7 patients with multiple hepatic alveolar echinococcosis treated with two-staged hepatectomy in West China Hospital of Sichuan University and The people's Hospital of Ganzi Tibetan Autonomous Prefecture of Sichuan Province from August, 2013 to June, 2016 were analyzed retrospectively. The preoperative diagnose was definite according to CT and (or) MRI, serological and life in the epidemic area. The patients, which the future liver remnant was less than 30% according to CT, received two-staged hepatectomy. Epigastric enhancement CT, liver function and blood routine examination were reviewed monthly after the first surgery, the second surgery was operated after 3 monthes, epigastric ultrasound, enhancement CT or MRI, liver function, blood routine examination and serological were adopted in 1, 6, and 12 months and each year after the second operation. Results The liver function was normal in 7 days after two operations and no complications after the first suegery, one patient developd with biliary fistula after the second surgery, no recurrence or death occurred during the followed-up period. Conclusion The two-stage hepatectomy can be operated in multiple and huge alveolar echinococcosis to reduce surgery risk and cost, shorten hospital stays and improve quality of life.

Citation： FANG Dan, YANG Kangming, CHEN Zheyu, CHEN Kefei, HUANG Xiang, YAN Lünan, LI Bo, WEN Tianfu, WANG Wentao, CHEN Ying, WU Hong, XU Mingqing, MA Zhi, YANG Jiayin, LI Zhihong, WEI Yonggang, WEI Gengfu, HUANG Jiwei, TANG Youyin, FENG Xi. The preliminary experience of two-stage hepatectomy for multiple hepatic alveolar echinococcosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(7): 804-807. doi: 10.7507/1007-9424.201706001 Copy

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2.	陳哲宇. 肝包蟲病的治療. 中國普外基礎與臨床雜志, 2015, 22(2): 129-130.
3.	陳哲宇. 肝包蟲病的治療方法選擇. 中華臨床醫師雜志(電子版), 2015, 9(18): 3329-3331.
4.	陳穎, 楊康明, 黃詳, 等. 肝脾多發巨大泡型包蟲病分期切除 1 例報道. 中國普外基礎與臨床雜志, 2016, 23(5): 544-546.
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6.	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.
7.	Koch S, Bresson-Hadni S, Miguet JP, et al. Experience of liver transplantation for incurable alveolar echinococcosis: a 45-case European collaborative report. Transplantation, 2003, 75(6): 856-863.
8.	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.
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10.	Schreckenbach T, Liese J, Bechstein WO, et al. Post hepatectomy liver failure. Dig Surg, 2012, 29(1): 79-85.
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12.	Maydeo A, Soehendra N, Reddy N, et al. Endotherapy for chronic pancreatitis with intracanalar stones. Endoscopy, 2007, 39(7): 653-658.
13.	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, 32(2): 308-312.
14.	Mullin EJ, Metcalfe MS, Maddern GJ. How much liver resection is too much? Am J Surg, 2005, 190(1): 87-97.
15.	Schindl MJ, Redhead DN, Fearon KC, et al. The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut, 2005, 54(2): 289-296.
16.	Yigitler C, Farges O, Kianmanesh R, et al . The small remnant liver after major liver resection: How common and how relevant? Liver Transpl, 2003, 9(9): S18-S25.
17.	Shoup M, Gonen M, D’Angelica M, et al. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection. J Gastrointest Surg, 2003, 7(3): 325-330.
18.	Ferrero A, Viganò L, Polastri R, et al . Postoperative liver dysfunction and future remnant liver: where is the limit? Results of a prospective study. World J Surg, 2007, 31(8): 1643-1651.
19.	Abdalla EK, Barnett CC, Doherty D, et al. Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg, 2002, 137(6): 675-680.
20.	Truant S, Oberlin O, Sergent G, et al . Remnant liver volume to body weight ratio≥0.5%: A new cut‐off to estimate postoperative risks after extended resection in noncirrhotic liver. J Am Coll Surg, 2007, 204(1): 22-33.
21.	Varadarajulu S, Christein JD, Tamhane A, et al. Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos). Gastrointest Endosc, 2008, 68(6): 1102-1111.
22.	Hshieh TT, Sundaram V. Liver transplantation for hepatocellular carcinoma: are international guidelines possible? Hepatobiliary Surg Nutr, 2013, 2(2): 113-116.
23.	Le Roy B, Perrey A, Fontarensky M, et al . Combined preoperative portal and hepatic vein embolization (Biembolization) to improve liver regeneration before major liver resection: a preliminary report. World J Surg, 2017, Apr 17. [Epub ahead of print].
24.	唐群科, 張瑛, 曲艷玲. 晚期泡型包蟲病的治療. 寄生蟲病與感染性疾病, 2015, 13(3): 123-126.
25.	Chen ZY, Yan LN, Zeng Y, et al. Transdiaphragmatic exposure for direct atrioatrial anastomosis in liver transplantation. Chin Med J, 2010, 123(24): 3515-3518.
26.	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.
27.	陳哲宇. 泡型肝包蟲病的外科治療現狀. 中國普外基礎與臨床雜志, 2016, 23(5): 513-516.

1. Craig P. Echinococcus multilocularis. Curr Opin Infect Dis, 2003, 16(5): 437-444.
2. 陳哲宇. 肝包蟲病的治療. 中國普外基礎與臨床雜志, 2015, 22(2): 129-130.
3. 陳哲宇. 肝包蟲病的治療方法選擇. 中華臨床醫師雜志(電子版), 2015, 9(18): 3329-3331.
4. 陳穎, 楊康明, 黃詳, 等. 肝脾多發巨大泡型包蟲病分期切除 1 例報道. 中國普外基礎與臨床雜志, 2016, 23(5): 544-546.
5. Mullen JT, Ribero D, Reddy SK, et al. Hepatic insufficiency and mortality in 1 059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg, 2007, 204(5): 854-862.
6. 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.
7. Koch S, Bresson-Hadni S, Miguet JP, et al. Experience of liver transplantation for incurable alveolar echinococcosis: a 45-case European collaborative report. Transplantation, 2003, 75(6): 856-863.
8. 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.
9. Bruix J, Sherman M, Practice Guidelines Committee, et al. Management of hepatocellular carcinoma. Hepatology, 2005, 42(5): 1208-1236.
10. Schreckenbach T, Liese J, Bechstein WO, et al. Post hepatectomy liver failure. Dig Surg, 2012, 29(1): 79-85.
11. Miyagawa S, Makuuchi M, Kawasaki S, et al. Criteria for safe hepatic resection. Am J Surg, 1995, 169(6): 589-594.
12. Maydeo A, Soehendra N, Reddy N, et al. Endotherapy for chronic pancreatitis with intracanalar stones. Endoscopy, 2007, 39(7): 653-658.
13. 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, 32(2): 308-312.
14. Mullin EJ, Metcalfe MS, Maddern GJ. How much liver resection is too much? Am J Surg, 2005, 190(1): 87-97.
15. Schindl MJ, Redhead DN, Fearon KC, et al. The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut, 2005, 54(2): 289-296.
16. Yigitler C, Farges O, Kianmanesh R, et al . The small remnant liver after major liver resection: How common and how relevant? Liver Transpl, 2003, 9(9): S18-S25.
17. Shoup M, Gonen M, D’Angelica M, et al. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection. J Gastrointest Surg, 2003, 7(3): 325-330.
18. Ferrero A, Viganò L, Polastri R, et al . Postoperative liver dysfunction and future remnant liver: where is the limit? Results of a prospective study. World J Surg, 2007, 31(8): 1643-1651.
19. Abdalla EK, Barnett CC, Doherty D, et al. Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg, 2002, 137(6): 675-680.
20. Truant S, Oberlin O, Sergent G, et al . Remnant liver volume to body weight ratio≥0.5%: A new cut‐off to estimate postoperative risks after extended resection in noncirrhotic liver. J Am Coll Surg, 2007, 204(1): 22-33.
21. Varadarajulu S, Christein JD, Tamhane A, et al. Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos). Gastrointest Endosc, 2008, 68(6): 1102-1111.
22. Hshieh TT, Sundaram V. Liver transplantation for hepatocellular carcinoma: are international guidelines possible? Hepatobiliary Surg Nutr, 2013, 2(2): 113-116.
23. Le Roy B, Perrey A, Fontarensky M, et al . Combined preoperative portal and hepatic vein embolization (Biembolization) to improve liver regeneration before major liver resection: a preliminary report. World J Surg, 2017, Apr 17. [Epub ahead of print].
24. 唐群科, 張瑛, 曲艷玲. 晚期泡型包蟲病的治療. 寄生蟲病與感染性疾病, 2015, 13(3): 123-126.
25. Chen ZY, Yan LN, Zeng Y, et al. Transdiaphragmatic exposure for direct atrioatrial anastomosis in liver transplantation. Chin Med J, 2010, 123(24): 3515-3518.
26. 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.
27. 陳哲宇. 泡型肝包蟲病的外科治療現狀. 中國普外基礎與臨床雜志, 2016, 23(5): 513-516.

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The preliminary experience of two-stage hepatectomy for multiple hepatic alveolar echinococcosis

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