自体肝圆韧带血管重建在进展期肝泡型包虫病术中的应用

Application of autologous round ligament graft for vascular reconstruction in surgery for advanced hepatic alveolar echinococcosis

目的探讨自体肝圆韧带血管重建在累及肝后下腔静脉的进展期肝泡型包虫病术中应用的可行性及安全性。方法回顾性分析2018年1月至2019年7月青海省人民医院收治的8例进展期肝泡型包虫病患者临床资料。其中男5例,女3例;年龄18~56岁,中位年龄37岁。患者均签署知情同意书,符合医学伦理学规定。术前影像学检查诊断为肝泡型包虫病,病灶侵犯第一肝门及肝后下腔静脉。8例患者均为P4N0M0期,病灶主要分布于肝右叶。观察患者手术及恢复情况。结果8例患者均采用分步切除法顺利完成肝切除术,其中扩大右半肝切除2例,右半肝切除6例;术中同时重建肝后下腔静脉、第一肝门血管3例,仅重建肝后下腔静脉5例。无围手术期死亡。平均手术时间(518±140)min,术中出血量(746±212)ml,住院时间(16.1±2.5)d。2例术后出现较大量右侧胸腔积液,均经过超声引导下胸腔穿刺置管引流后治愈;1例腹腔包裹性积液,经超声引导下液腔置管引流后治愈;1例A级胆漏,经通畅引流及抗感染等治疗后治愈。术后所有患者均获随访,随访时间12~23个月,中位时间15个月。随访期间无发生吻合血管狭窄、栓塞及复发。结论对于累及肝后下腔静脉的进展期肝泡型包虫病患者,根治性肝切除术后利用自体肝圆韧带重建下腔静脉管道,是一种安全、简便、经济的手术方式。

Objective To investigate the feasibility and safety of autologous round ligament graft for vascular reconstruction in the treatment of advanced hepatic alveolar echinococcosis involving the posterior inferior vena cava.Methods Clinical data of 8 patients with advanced hepatic alveolar echinococcosis admitted to Qinghai Provincial People’s Hospital from January 2018 to July 2019 were retrospectively analyzed.Among them,5 patients were male and 3 female,aged from 18 to 56 years with a median age of 37 years.The informed consents of all patients were obtained and the local ethical committee approval was received.Preoperative imaging examination prompted the diagnosis of hepatic alveolar echinococcosis involving the first porta hepatis and posterior inferior vena cava.8 patients were classified as stage P4N0M0,and the lesions were mainly located in the right liver lobe.Surgical condition and postoperative recovery were observed.Results All 8 patients completed staged hepatectomy successfully,including 2 cases of extended right hemihepatectomy and 6 cases of right hemihepatectomy.Intraoperatively,3 cases received reconstruction of posterior inferior vena cava and the first porta hepatis,and 5 cases received reconstruction of posterior inferior vena cava.No perioperative death was reported.The average operation time was (518±140) min.Intraoperative blood loss was (746±212) ml.The length of hospital stay was (16.1±2.5) d.A large amount of right pleural effusion occurred in 2 cases after operation,who were cured with ultrasound-guided thoracic puncture and drainage.Abdominal encapsulated ascites was observed in 1 case,who was healed by ultrasound-guided catheter drainage.Grade A bile leakage occurred in 1 case,who was cured after drainage and anti-infection treatment.All patients were followed up for 12-23 months,with a median of 15 months.No anastomotic stenosis,embolism or recurrence occurred during postoperative follow-up.Conclusions For patients with advanced hepatic alveolar echinococcosis involving the posterior inferior vena cava,autologous round ligament graft is a safe,convenient and economical surgical approach for the inferior vena cava reconstruction after radical hepatectomy.