侵犯第二、三肝门的泡型肝包虫病行分步切除的初步经验

The preliminary experience of two-step hepatectomy in treatment of hepatic alveolar echinococcosis invaded the second and the third porta hepatis

目的探讨分步切除法治疗侵犯第二、三肝门的泡型肝包虫病的临床疗效。方法回顾性分析四川大学华西医院及甘孜藏族自治州人民医院于2013年1月至2017年6月期间收治的60例行分步切除术的侵犯第二、三肝门的泡型肝包虫病患者的临床资料。结果 60例患者的病灶均成功施行根治性切除,手术顺利,无围手术期死亡。平均手术时间为309.17 min(150~475 min);平均术中失血量为586.67 m L(100~3 000 m L);48例阻断了入肝血流,平均阻断时间为25.85 min(15~50 min);24例输入红细胞悬液,平均红细胞悬液输入量为3.79 U(2~8 U);9例输入新鲜冰冻血浆,平均新鲜冰冻血浆输入量为527.78 m L(350~850 m L);平均住院时间为17.5 d(7~39 d);平均住院费用为49 323.43元(28 045.32~61 243.15元)。术后7 d复查肝功能指标均恢复正常。术后3例出现轻微胆瘘,3例出现胸腔积液,3例出现腹腔积液,10例出现术区积液,无一例严重并发症发生。并发症分级为Ⅰ级10例,Ⅱ级3例,Ⅲa级6例。术后60例患者获访,平均随访时间为14.47个月(1~31个月)。随访期间,无一例患者死亡或复发。结论采用分步切除术治疗侵犯第二、三肝门的巨大泡型肝包虫病,术中可以避免患者血压等生命体征出现大范围波动,手术安全性高,手术难度和手术风险低。

Objective To discuss the clinical application of two-step hepatectomy for hepatic alveolar echinococcosis which invaded the second and the third porta hepatis. Methods The clinical data of 60 patients with hepatic alveolar echinococcosis invaded the second and the third porta hepatis who treated with two-step hepatectomy in West China Hospital of Sichuan University and The People＇s Hospital of Ganzi Tibetan Autonomous Prefecture of Sichuan Province from Jan. 2013 to Jun. 2017 were analyzed retrospectively. Results Sixty patients had underwent radical hepatectomy successfully and no death happened during perioperative period. The average operative time was 309.17 min （150-475 min） and intraoperative blood loss was 586.67 mL （100-3 000 mL）. Forty-eight patients blocked the blood flowing into the liver, the average blocking time was 25.85 min （15-50 min）; 24 patients suffered red blood cell suspension, the average amount was 3.79 U （2-8 U）, and 9 patients were infused with fresh frozen plasma, the average amount was 527.78 mL （350-850 mL）. The average of hospital stays was 17.S days （7-39 days） and average of hospitalization cost was 49 323.43 yuan （28 045.32-61 243.15 yuan）. The liver function indicators returned to normal within 7 days after operation. After operation, 3 patients suffered from biliary fistula, 3 patients suffered from pleural effusion, 3 patients suffered from peritoneal effusion, 10 patients suffered from effusion. According to the rank of complication： 10 patients were defined as grade Ⅰ , 3 patients were defined as grade Ⅱ, 6 patients were defined as grade Ⅲ a. The average follow-up time of 60 patients was 14.47 months （1-31 months）. No recurrence and death occurred during follow-up period. Conclusion The two-step hepatectomy in treatment of hepatic alveolar echinococcosis invaded the second and the third porta hepatis can avoid the large flucyuations of intraoperative blood pressure and other vital signs, can increase the safety of surgery and reduce the difficulty and risk of surgery.