Effect of partial liver preservation in situ for ex-vivo liver resection and auxiliatry autologous liver transplantation in end-stage hepatic alveolar echinococcosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHANG Yu ¹ , YANG Chong ¹ , WANG Yi ¹ , TANG Jichao ¹ , YANG Hongji ¹ , LIU Jun ² , ZHOU Guo ² , XIAN Di ¹ ,  DENG Shaoping ¹

1. Center of Organ Transplantation, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, P. R. China;
2. Department of Ultrasonography, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, P. R. China;

Corresponding?author：

ZHANG Yu, Email: 68532815@qq.com; DENG Shaoping, Email: Sdeng10@163.com

Keywords：

hepatic alveolar echinococcosis; auxiliary autologous liver transplantation; ex-vivo liver resection; hepatic vein reconstruction

DOI：

10.7507/1007-9424.201903023

Video：

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Objective To explore value of partial liver preservation in situ for ex-vivo liver resection and auxiliatry autologous liver transplantation in end-stage hepatic alveolar echinococcosis.Methods The clinical data of one patient with end-stage hepatic alveolar echinococcosis treated with auxiliatry autologous liver transplantation combined partial liver preservation in situ were analyzed retrospectively. This patient was admitted on January 2019. During the auxiliatry autologous liver transplantation procedure, the S1, S4-S8 segments of the liver were resected for mass dissection, whereas the S2 and S3 segments of left liver were preserved in situ.Results The preoperative evaluation and intraoperative exploration indicated that the mass located in the S4, S5, S8 segments, which was adjacent to the first hepatic portal and involved the anterior wall of posterior inferior vena cava, middle hepatic veins, the opening of right hepatic veins and the right wall of left hepatic veins. Based on the " in situ first” principle, the left lesion was slit using the anterior approach, the left hepatic vein was repaired and the S2 and S3 segments were preserved in situ. Then, the right lesion to involved hepatic vein was slit along the right interlobar fissure. The right hepatic artery, right portal vein and right bile duct were divided separately. The S1 and S4-S8 segments were removed completely. Next, the mass was resected, the out flow of the right liver was reconstructed using the allogeneic veins during the ex-vivo liver resection. Then, the auxiliatry autologous right liver transplantation was initiated by the wide-caliber hepatic vein-artificial inferior vena cava anastomosis. The surgical procedures lasted for 12 h, and the intraoperative bleeding was approximately 800 mL. The patient was routinely treated and smoothly recovered after the operation.Conclusions Procedure of auxiliatry autologous liver transplantation preserved part functional liver in situ during ex-vivo resection, which could maintain stability of systemic and portal vein circulation, hold part liver function during operation, preserve functional liver furthest, and reduce risk of hepatic failure, is an effective attempt for end stage hepatic alveolar echinococcosis.

Citation： ZHANG Yu, YANG Chong, WANG Yi, TANG Jichao, YANG Hongji, LIU Jun, ZHOU Guo, XIAN Di, DENG Shaoping. Effect of partial liver preservation in situ for ex-vivo liver resection and auxiliatry autologous liver transplantation in end-stage hepatic alveolar echinococcosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(8): 974-979. doi: 10.7507/1007-9424.201903023 Copy

1.	四川省包蟲病診療專家組. 四川省肝包蟲病診治規范. 中國普外基礎與臨床雜志, 2017, 24(7): 798-803.
2.	Craig PS, Li T, Qiu J, et al. Echinococcosis and Tibetan communities. Emerg Infect Dis, 2008, 14(10): 1674-1675.
3.	陳哲宇. 復雜肝包蟲病的外科治療. 中國普外基礎與臨床雜志, 2017, 24(7): 785-787.
4.	趙海平. 復雜肝包蟲病的診治. 中國普外基礎與臨床雜志, 2017, 24(7): 788-791.
5.	McManus DP, Zhang W, Li J, et al. Echinococcosis. Lancet, 2003, 362(9392): 1295-1304.
6.	Li F, Yang M, Li B, et al. Initial clinical results of orthotopic liver transplantation for hepatic alveolar echinococcosis. Liver Transpl, 2007, 13(6): 924-926.
7.	Haider HH, Nishidas, Selvaggi G, et al. Alveolar echinococcosis induced liver falure: salvage by liver transplantation in an otherwise uniformly fatal disease. Clin Transplant, 2008, 22(4): 664-667.
8.	Gruttadauria S, Marsh JW, Bartlett DL, et al. Ex situ resection technique and liver autotransplantation: last resource for otherwise unresectable malignancy. Dig Dis Sci, 2005, 50(10): 1829-1835.
9.	沈中陽. 中國肝移植10年成就與展望. 華夏醫藥, 2009, 4(6): 419-420.
10.	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.
11.	吐爾洪江·吐遜, 李玉鵬, 張皓, 等. 非原位肝切除技術安全性、可行性和有效性的系統評價. 中華醫學雜志, 2016, 96(28): 2251-2257.
12.	張宇, 楊沖, 王燚, 等. 離體肝切除和自體肝移植聯合復雜肝靜脈重建治療終末期肝泡型包蟲病. 中國普外基礎與臨床雜志, 2018, 25(10): 1236-1241.
13.	Li FG, Yan LN, Li B, et al. Estimation of standard liver volume in Chinese adult living donors. Transplant Proc, 2009, 41(10): 4052-4056.
14.	Wen H, Dong JH, Zhang JH, et al. Ex vivo liver resection followed by autotransplantation for end-stage hepatic alveolar echinococcosis. Chin Med J (Engl), 2011, 124(18): 2813-2817.
15.	Wen H, Dong JH, Zhang JH, et al. Ex vivo liver resection and autotransplantation for end-stage alveolar echinococcosis: A Case Series. Am J Transplant, 2016, 16(2): 615-624.
16.	Wang H, Liu Q, Wang Z, et al. Clinical outcomes of ex vivo liver resection and liver autotransplantation for hepatic alveolar echinococcosis. J Huazhong Univ Sci Technolog Med Sci, 2012, 32(4): 598-600.
17.	楊先偉, 黃斌, 邱逸聞, 等. 離體肝切除聯合自體肝移植治療晚期肝泡型包蟲病21例報道. 中國普外基礎與臨床雜志, 2017, 24(6): 685-690.
18.	Yang X, Qiu Y, Huang B, et al. Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: A study of 31 cases. Am J Transplant, 2018, 18(7): 1668-1679.
19.	吐爾洪江·吐遜, 邵英梅, 趙晉明, 等. 肝泡型包蟲病自體肝移植中提升功能肝" 量與質”的臨床實踐: 附12例臨床病例分析. 中華醫學雜志, 2017, 97(4): 270-275.
20.	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 Gastrointest Surg, 2015, 19(8): 1457-1465.
21.	何翼彪, 白磊, 吐爾干艾力·阿吉, 等. 數字化三維重建技術在肝泡型包蟲病肝移植中的應用. 中華肝臟外科手術學電子雜志, 2015, 4(5): 279-283.
22.	何翼彪, 白磊, 李濤, 等. 三維可視化技術在肝泡型包蟲病外科治療中的應用. 中華外科雜志, 2016, 54(9): 704-709.
23.	Hu H, Huang B, Zhao J, et al. Liver autotransplantation and retrohepatic vena cava reconstruction for alveolar echinococcosis. J Surg Res, 2017, 210: 169-176.
24.	方丹, 楊康明, 陳哲宇, 等. 分期切除治療多發泡型肝包蟲病的初步經驗. 中國普外基礎與臨床雜志, 2017, 24(7): 804-807.
25.	Lei JY, Hao JC, Wang WT, et al. Ex vivo liver resection followed by autotransplantation to a patient with advanced alveolar echinococcosis with a replacement of the retrohepatic inferior vena cava using autogenous vein grafting: a case report and literature review. Medicine (Baltimore), 2015, 94(7): e514.
26.	Cheng F, Yang Z, Zeng J, et al. Anesthesia management of modified ex vivo liver resection and autotransplantation. Ann Transplant, 2018, 23: 274-284.
27.	Ito T, Kiuchi T, Yamamoto H, et al. Changes in portal venous pressure in the early phase after living donor liver transplantation: pathogenesis and clinical implications. Transplantation, 2003, 75(8): 1313-1317.
28.	Ogura Y, Hori T, El Moghazy WM, et al. Portal pressure <15 mm Hg is a key for successful adult living donor liver transplantation utilizing smaller grafts than before. Liver Transpl, 2010, 16(6): 718-728.
29.	Ikegami T, Soejima Y, Taketomi A, et al. Explanted portal vein grafts for middle hepatic vein tributaries in living-donor liver transplantation. Transplantation, 2007, 84(7): 836-841.
30.	Wu H, Yan LN, Li B, et al. Hepatic venous outflow reconstruction in right lobe graft without middle hepatic vein. Hepatol Res, 2007, 37(12): 1044-1051.
31.	Ikegami T, Shirabe K, Yoshiya S, et al. One-step reconstruction of the right inferior hepatic veins using auto-venous grafts in living-donor liver transplantation. Surg Today, 2013, 43(7): 769-776.

1. 四川省包蟲病診療專家組. 四川省肝包蟲病診治規范. 中國普外基礎與臨床雜志, 2017, 24(7): 798-803.
2. Craig PS, Li T, Qiu J, et al. Echinococcosis and Tibetan communities. Emerg Infect Dis, 2008, 14(10): 1674-1675.
3. 陳哲宇. 復雜肝包蟲病的外科治療. 中國普外基礎與臨床雜志, 2017, 24(7): 785-787.
4. 趙海平. 復雜肝包蟲病的診治. 中國普外基礎與臨床雜志, 2017, 24(7): 788-791.
5. McManus DP, Zhang W, Li J, et al. Echinococcosis. Lancet, 2003, 362(9392): 1295-1304.
6. Li F, Yang M, Li B, et al. Initial clinical results of orthotopic liver transplantation for hepatic alveolar echinococcosis. Liver Transpl, 2007, 13(6): 924-926.
7. Haider HH, Nishidas, Selvaggi G, et al. Alveolar echinococcosis induced liver falure: salvage by liver transplantation in an otherwise uniformly fatal disease. Clin Transplant, 2008, 22(4): 664-667.
8. Gruttadauria S, Marsh JW, Bartlett DL, et al. Ex situ resection technique and liver autotransplantation: last resource for otherwise unresectable malignancy. Dig Dis Sci, 2005, 50(10): 1829-1835.
9. 沈中陽. 中國肝移植10年成就與展望. 華夏醫藥, 2009, 4(6): 419-420.
10. 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.
11. 吐爾洪江·吐遜, 李玉鵬, 張皓, 等. 非原位肝切除技術安全性、可行性和有效性的系統評價. 中華醫學雜志, 2016, 96(28): 2251-2257.
12. 張宇, 楊沖, 王燚, 等. 離體肝切除和自體肝移植聯合復雜肝靜脈重建治療終末期肝泡型包蟲病. 中國普外基礎與臨床雜志, 2018, 25(10): 1236-1241.
13. Li FG, Yan LN, Li B, et al. Estimation of standard liver volume in Chinese adult living donors. Transplant Proc, 2009, 41(10): 4052-4056.
14. Wen H, Dong JH, Zhang JH, et al. Ex vivo liver resection followed by autotransplantation for end-stage hepatic alveolar echinococcosis. Chin Med J (Engl), 2011, 124(18): 2813-2817.
15. Wen H, Dong JH, Zhang JH, et al. Ex vivo liver resection and autotransplantation for end-stage alveolar echinococcosis: A Case Series. Am J Transplant, 2016, 16(2): 615-624.
16. Wang H, Liu Q, Wang Z, et al. Clinical outcomes of ex vivo liver resection and liver autotransplantation for hepatic alveolar echinococcosis. J Huazhong Univ Sci Technolog Med Sci, 2012, 32(4): 598-600.
17. 楊先偉, 黃斌, 邱逸聞, 等. 離體肝切除聯合自體肝移植治療晚期肝泡型包蟲病21例報道. 中國普外基礎與臨床雜志, 2017, 24(6): 685-690.
18. Yang X, Qiu Y, Huang B, et al. Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: A study of 31 cases. Am J Transplant, 2018, 18(7): 1668-1679.
19. 吐爾洪江·吐遜, 邵英梅, 趙晉明, 等. 肝泡型包蟲病自體肝移植中提升功能肝" 量與質”的臨床實踐: 附12例臨床病例分析. 中華醫學雜志, 2017, 97(4): 270-275.
20. 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 Gastrointest Surg, 2015, 19(8): 1457-1465.
21. 何翼彪, 白磊, 吐爾干艾力·阿吉, 等. 數字化三維重建技術在肝泡型包蟲病肝移植中的應用. 中華肝臟外科手術學電子雜志, 2015, 4(5): 279-283.
22. 何翼彪, 白磊, 李濤, 等. 三維可視化技術在肝泡型包蟲病外科治療中的應用. 中華外科雜志, 2016, 54(9): 704-709.
23. Hu H, Huang B, Zhao J, et al. Liver autotransplantation and retrohepatic vena cava reconstruction for alveolar echinococcosis. J Surg Res, 2017, 210: 169-176.
24. 方丹, 楊康明, 陳哲宇, 等. 分期切除治療多發泡型肝包蟲病的初步經驗. 中國普外基礎與臨床雜志, 2017, 24(7): 804-807.
25. Lei JY, Hao JC, Wang WT, et al. Ex vivo liver resection followed by autotransplantation to a patient with advanced alveolar echinococcosis with a replacement of the retrohepatic inferior vena cava using autogenous vein grafting: a case report and literature review. Medicine (Baltimore), 2015, 94(7): e514.
26. Cheng F, Yang Z, Zeng J, et al. Anesthesia management of modified ex vivo liver resection and autotransplantation. Ann Transplant, 2018, 23: 274-284.
27. Ito T, Kiuchi T, Yamamoto H, et al. Changes in portal venous pressure in the early phase after living donor liver transplantation: pathogenesis and clinical implications. Transplantation, 2003, 75(8): 1313-1317.
28. Ogura Y, Hori T, El Moghazy WM, et al. Portal pressure <15 mm Hg is a key for successful adult living donor liver transplantation utilizing smaller grafts than before. Liver Transpl, 2010, 16(6): 718-728.
29. Ikegami T, Soejima Y, Taketomi A, et al. Explanted portal vein grafts for middle hepatic vein tributaries in living-donor liver transplantation. Transplantation, 2007, 84(7): 836-841.
30. Wu H, Yan LN, Li B, et al. Hepatic venous outflow reconstruction in right lobe graft without middle hepatic vein. Hepatol Res, 2007, 37(12): 1044-1051.
31. Ikegami T, Shirabe K, Yoshiya S, et al. One-step reconstruction of the right inferior hepatic veins using auto-venous grafts in living-donor liver transplantation. Surg Today, 2013, 43(7): 769-776.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of partial liver preservation in situ for ex-vivo liver resection and auxiliatry autologous liver transplantation in end-stage hepatic alveolar echinococcosis

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