分期切除术治疗多病灶复杂肝泡型包虫病

Two-stage hepatectomy for complicated hepatic alveolar echinococcosis with multiple lesions

目的探讨分期切除术在多病灶复杂肝泡型包虫病治疗中的临床应用效果。方法回顾性分析四川大学华西医院2021年12月收治的1例行分期切除术的多病灶复杂肝泡型包虫病患者的临床资料。结果患者术前增强CT检查提示肝内不规则包虫病灶,约14.1 cm×9.2 cm大,侵及肝左内叶及肝右前叶多个肝段,包绕肝中静脉,门静脉右支受侵。完善术前检查后行手术探查,见中肝2个较大病灶,分别约6 cm×5 cm×4 cm及5 cm×4 cm×4 cm大;右肝及左肝3个较小病灶,右肝2个病灶约2 cm×2 cm×1 cm大,左肝病灶约3 cm×2 cm×1 cm大。一期手术行中肝切除术,切除位于中肝的病灶及被包绕的门静脉右前支。术后恢复佳,未观察到胆汁漏、出血等并发症发生。术后3个月行二期手术,术前CT增强扫描评估患者右肝剩余病灶无明显进展、左肝外叶有明显增生。术中切除右肝前叶及部分右肝后叶。患者术后7 d出院,随访7个月,期间患者恢复佳,生存良好,无复发及其他并发症发生。结论分期切除术应用于治疗多病灶复杂肝泡型包虫病的安全性及可行性高。该术式为患者提供了一种相比异体肝移植术创伤更小、手术花费更低、并发症更少的治疗选择。

Objective To explore the efficiency of two-stage hepatectomy applicated in complex alveolar echinococcosis.Method The clinical data of one case who suffered from complicated alveolar echinococcosis with multiple lesions and then treated with two-stage hepatectomy were analyzed retrospectively.Results Preoperative enhanced CT revealed that the hydatid lesion with irregular shape,measuring 14.1 cm×9.2 cm,invaded several segments including left medial lobe and right anterior lobe of liver and the right branch of portal vein and medium hepatic vein were entirely surrounded by it.After preoperative examination surgical exploration was performed,two larger lesions measuring 6 cm×5 cm×4 cm and 5 cm×4 cm×4 cm respectively were found in caudate lobe of liver,three smaller lesions were found in the right and left lobe of liver,among which two measured 2 cm×2 cm×1 cm in the right lobe and one measured 3 cm×2 cm×1 cm in the left lobe.Mesohepatectomy was performed in the first stage,the lesion in left medial lobe and right anterior lobe of liver and the right anterior branch of portal vein were resected during the procedure.The patient recovered well after the operation without complications such as bile leakage or hemorrhage observed.The second stage surgery was performed at three months after operation,the computed tomograph before the surgery revealed that the remained lesions in the right lobe of liver did not proceed obviously and the left lateral external lobe of liver regenerated significantly.In the second stage,the right anterior lobe and part of the right posterior lobe of liver were resected.The patient was discharged on 7 days after operation,and there was no complication and relapse during the 7months of follow-up period.Conclusion Two-stage hepatectomy applicated in treating complicated alveolar echinococcosis with multiple lesions is safe and feasible,offering a choice with smaller trauma,lower expense and less complications for patients compared with liver transplantation.