Diagnosis and treatment experience of atypical hepatic cystic echinococcosis type 1 at a tertiary center in China

BACKGROUND Some hydatid cysts of cystic echinococcosis type 1(CE1)lack well-defined cyst walls or distinctive endocysts,making them difficult to differentiate from simple hepatic cysts.AIM To investigate the diagnostic methods for atypical hepatic CE1 and the clinical efficacy of laparoscopic surgeries.METHODS The clinical data of 93 patients who had a history of visiting endemic areas of CE and were diagnosed with cystic liver lesions for the first time at the People's Hospital of Xinjiang Uygur Autonomous Region(China)from January 2018 to September 2023 were retrospectively analyzed.Clinical diagnoses were made based on findings from serum immunoglobulin tests for echinococcosis,routine abdominal ultrasound,high-frequency ultrasound,abdominal computed tomography(CT)scan,and laparoscopy.Subsequent to the treatments,these patients underwent reexaminations at the outpatient clinic until October 2023.The evaluations included the diagnostic precision of diverse examinations,the efficacy of surgical approaches,and the incidence of CE recurrence.RESULTS All 93 patients were diagnosed with simple hepatic cysts by conventional abdominal ultrasound and abdominal CT scan.Among them,16 patients were preoperatively diagnosed with atypical CE1,and 77 were diagnosed with simple hepatic cysts by high-frequency ultrasound.All the 16 patients preoperatively diagnosed with atypical CE1 underwent laparoscopy,of whom 14 patients were intraoperatively confirmed to have CE1,which was consistent with the postoperative pathological diagnosis,one patient was diagnosed with a mesothelial cyst of the liver,and the other was diagnosed with a hepatic cyst combined with local infection.Among the 77 patients who were preoperatively diagnosed with simple hepatic cysts,4 received aspiration sclerotherapy of hepatic cysts,and 19 received laparoscopic fenestration.These patients were intraoperatively diagnosed with simple hepatic cysts.During the followup period,none of the 14 patients with CE1 experienced recurrence or implantation of hydatid scolices.One of the 77 patients was finally confirmed to have CE complicated with implantation to the right intercostal space.CONCLUSION Abdominal high-frequency ultrasound can detect CE1 hydatid cysts.The laparoscopic technique serves as a more effective diagnostic and therapeutic tool for CE.

Fifty-five cases of hepatic alveolar echinococcosis combined with lymph node metastasis:A retrospective study

BACKGROUND Lymph node metastasis is a specific type of metastasis in hepatic alveolar echinococcosis(AE).Currently,there is a scarcity of describing the clinical characteristics and lymph node metastasis rules of patients with hepatic AE combined with lymph node metastasis and its mechanism and management are still controversial.Radical hepatectomy combined with regional lymph node dissection is a better treatment.AIM To analyse the clinical features of hepatic AE combined with lymph node metastasis to explore its treatment and efficacy.METHODS A total of 623 patients with hepatic AE admitted to the First Affiliated Hospital of Xinjiang Medical University from 1 January 2012 to 1 January 2022 were retrospectively analysed.Fifty-five patients with combined lymph node metastasis were analysed for their clinical data,diagnosis and treatment methods,follow-up efficacy,and characteristics of lymph node metastasis.Finally,we comparatively analysed the lymph node metastasis rates at different sites.Categorical variables are expressed as frequencies and percentages,and the analysis of difference was performed using theχ2 test.The Bonferroni method was used for pairwise comparisons when statistical differences existed between multiple categorical variables.RESULTS A lymph node metastasis rate of 8.8%(55/623)was reported in patients with hepatic AE,with a female predilection(69.1%)and a statistically significant sex difference(χ2=8.018,P=0.005).Of the 55 patients with lymph node metastasis,72.7%had a parasite lesion,neighbouring organ invasion,and metastasis stage of P3N1M0 and above,of which 67.3%,78.2%,and 34.5%of hepatic AE lesions invaded the bile ducts,blood vessels,and distant metastases,respectively.Detection rates of lymph node metastasis of 16.4%,21.7%,and 34.2%were reported for a preoperative abdominal ultrasound,magnetic resonance imaging,and computed tomography examinations.All patients were intraoperatively suspected with enlarged lymph nodes and underwent radical hepatectomy combined with regional lymph node dissection.After surgery,a routine pathological examination was conducted on the resected lymph nodes.A total of 106 positive lymph nodes were detected in six groups at various sites,including 51 single-group metastasis cases and four multi-group metastasis cases.When the metastasis rates at different sites were statistically analysed,we observed that the metastasis rate in the para-hepatoduodenal ligament lymph nodes was significantly higher than that of the other sites(χ^(2)=128.089,P=0.000<0.05).No statistical difference was observed in the metastasis rate between the five other groups.Clavien-Dindo grade IIIa complication occurred in 14 cases,which improved after administering symptomatic treatment.Additionally,lymph node dissection-related complications were not observed.Recurrence after 2 years was observed in one patient.CONCLUSION Lymph node metastasis is a rare form of metastasis in hepatic AE,which is more frequent in women.Parahepatoduodenal ligament lymph nodes are commonly observed.Radical hepatectomy combined with regional lymph node dissection is a safe,effective,and feasible treatment for liver AE combined with lymph node metastasis.

Application of 3D reconstruction for surgical treatment of hepatic alveolar echinococcosis

AIM: To evaluate the reliability and accuracy of threedimensional(3D) reconstruction for liver resection in patients with hepatic alveolar echinococcosis(HAE).METHODS: One-hundred and six consecutive patients with HAE underwent hepatectomy at our hospital between May 2011 and January 2015. Fifty-nine patients underwent preoperative 3D reconstruction and "virtual" 3D liver resection before surgery(Group A). Another 47 patients used conventional imaging methods for preoperative assessment(Group B). Outcomes of hepatectomy were compared between the two groups.RESULTS: There was no significant difference in preoperative data between the two groups. Compared with patients in Group B, those in Group A had a significantly shorter operation time(227.1 ± 51.4 vs 304.6 ± 88.1 min; P < 0.05), less intraoperative blood loss(308.1 ± 135.4 vs 458.1 ± 175.4 m L; P < 0.05), and lower requirement for intraoperative blood transfusion(186.4 ± 169.6 vs 289.4 ± 199.2 m L; P < 0.05). Estimated resection liver volumes in bothgroups had good correlation with actual graft weight(Group A: r = 0.978; Group B: r = 0.960). There was a significant higher serum level of albumin in Group A(26.3 ± 5.9 vs 22.6 ± 4.3 g/L, P < 0.05). Other postoperative laboratory parameters(serum levels of aminotransferase and bilirubin; prothrombin time) and duration of postoperative hospital stay were similar. Sixteen complications occurred in Group A and 19 in Group B. All patients were followed for 3-46(mean, 17.3) mo. There was no recurrence of lesions in Group A, but two recurrences in Group B. There were three deaths: two from cerebrovascular accident, and one from car accident.CONCLUSION: 3D reconstruction provides comprehensive and precise anatomical information for the liver. It also improves the chance of success and reduces the risk of hepatectomy in HAE.

Historical changes in surgical strategy and complication management for hepatic cystic echinococcosis

Echinococcosis is a zoonotic parasitic disease caused by Escherichia larvae.It frequently involves the liver(70%-75%),followed by the lungs(15%-20%),and occasionally the brain,heart,spleen,bone,and other organs.The main pathogenic forms of human echinococcosis currently include cystic echinococcosis(CE)and alveolar echinococcosis(AE).CE is globally distributed,while the distribution of AE is generally restricted to the northern hemisphere.In China,CE accounts for 75%of all echinococcosis cases.With rapid advances in surgical techniques in recent decades,the surgical strategy for CE has changed,especially with the continuous improvement of surgical methods and the expansion of surgical contraindications.To further understand the changes in surgical treatment strategies for hepatic CE,we interpreted and analyzed the existing literature addressing the surgical treatment of hepatic CE both domestically and abroad and briefly summarized them in chronological order.This review aims to provide a deeper understanding of the progress in the surgical treatment of hepatic CE to provide clearer avenues for its clinical diagnosis and treatment.

Proposal of a computed tomography classification for hepatic alveolar echinococcosis

AIM: To establish a computed tomography (CT)-morphological classification for hepatic alveolar echinococcosis was the aim of the study.METHODS: The CT morphology of hepatic lesions in 228 patients with confirmed alveolar echinococcosis (AE) drawn from the Echinococcus Databank of the University Hospital of Ulm was reviewed retrospectively. For this reason, CT datasets of combined positron emission tomography (PET)-CT examinations were evaluated. The diagnosis of AE was made in patients with unequivocal seropositivity; positive histological findings following diagnostic puncture or partial resection of the liver; and/or findings typical for AE at either ultrasonography, CT, magnetic resonance imaging or PET-CT. The CT-morphological findings were grouped into the new classification scheme.RESULTS: Within the classification a lesion was dedicated to one out of five &#x0201c;primary morphologies&#x0201d; as well as to one out of six &#x0201c;patterns of calcification&#x0201d;. &#x0201c;primary morphology&#x0201d; and &#x0201c;pattern of calcification&#x0201d; are primarily focussed on separately from each other and combined, whereas the &#x0201c;primary morphology&#x0201d; V is not further characterized by a &#x0201c;pattern of calcification&#x0201d;. Based on the five primary morphologies, further descriptive sub-criteria were appended to types&#x02005;I-III. An analysis of the calcification pattern in relation to the primary morphology revealed the exclusive association of the central calcification with type IV primary morphology. Similarly, certain calcification patterns exhibited a clear predominance for other primary morphologies, which underscores the delimitation of the individual primary morphological types from each other. These relationships in terms of calcification patterns extend into the primary morphological sub-criteria, demonstrating the clear subordination of those criteria.CONCLUSION: The proposed CT-morphological classification (EMUC-CT) is intended to facilitate the recognition and interpretation of lesions in hepatic alveolar echinococcosis. This could help to interpret different clinical courses better and shall assist in the context of scientific studies to improve the comparability of CT findings.

Proposal of an ultrasonographic classification for hepatic alveolar echinococcosis: Echinococcosis multilocularis Ulm classification-ultrasound

AIM: To establish an ultrasonographic classification based on a large sample of patients with confirmed hepatic alveolar echinococcosis(AE).METHODS: Clinical data and ultrasonography(US) findings of 185 patients(100 males; 85 females; mean age at diagnosis: 51.4 ± 17.6 years; mean age at time of US examination: 58.7 ± 18.2 years) were retrospectively reviewed with respect to the US morphology of hepatic AE lesions. The sonomorphological findings were grouped according to a five-part classification scheme.RESULTS: Application of the new classification resulted in the following distribution of sonomorphological patterns among the patients examined: hailstorm(54.1%); pseudocystic(13.5%); ossification(13.0%); hemangioma-like(8.1%); and metastasis-like(6.5%). Only 4.9% of lesions could not be assigned to a sonomorphological pattern.CONCLUSION: The sonomorphological classification proposed in the present study facilitates the diagnosis,interpretation and comparison of hepatic alveolar echinococcosis in routine practice and in the context of scientific studies.

Clinical Outcomes of Ex Vivo Liver Resection and Liver Autotransplantation for Hepatic Alveolar Echinococcosis

The effectiveness of liver autotransplantation for patients with partial hepatic alveolar echinococcosis was analyzed.We retrospectively studied 6 patients with hepatic alveolar echinococcosis who underwent liver autotransplantation in our hospital from 2008 to 2010.We also summarized the surgical indications of liver autotransplantation for hepatic alveolar echinococcosis and our experience in the management of postoperative complications of liver autotransplantation.Of 6 patients,5 achieved good curative results,and one died of multiple organ failure caused by portal vein thrombosis.Main complications included postoperative bleeding,bile leak and small-for-size liver graft syndrome.Liver autotransplantation offers a new approach to cure hepatic alveolar echinococcosis with non-resectable lesions.It could be the most effective method to cure intractable hepatic alveolar echinococcosis if correct handling in operation and proper prevention of complications are performed.But the long-term outcomes are still needed to be confirmed in longer follow-up.

Radical resection of hepatic polycystic echinococcosis complicated with hepatocellular carcinoma: A case report

BACKGROUND Hepatic cystic echinococcosis(CE)is an infectious zoonotic parasitic disease,and the insidious onset and slow progression of hepatic CE usually contributes to delayed diagnosis and treatment.Hepatocellular carcinoma(HCC)is the fourth most common malignant tumor.Co-existence of CE and HCC is fairly rare in clinical settings and the association between the two is still not well recognized.We report a case of hepatic CE complicated with HCC which are radically resected and raise some questions worth thinking about.CASE SUMMARY A 70-year-old man presented with upper abdominal pain.On admission,laboratory data showed that,except for hepatitis B surface antigen positivity,other indicators were normal,including alpha-fetoprotein.Computed tomography of the abdomen revealed a huge polycystic lesion in left liver lobe,without reinforcement after enhanced scanning and sized about 16.9 cm×12.2 cm,which was considered a type II hydatid cyst.Multiple small solid lesions were also found adjacent to it,and thus it was highly suspected as a malignant tumor.After a multidisciplinary team discussion,the diagnosis of co-occurrence of hepatic CE and HCC was made.According to Romic classification,the case belongs to type IIb,and radical left hemi-hepatectomy was performed.Postoperative pathological examination revealed CE co-existence with welldifferentiated HCC,consistent with the preoperative diagnosis.CONCLUSION With the combination of hepatitis B and obvious extrusion by large hydatid,the HCC risk of a patient might be higher.

Effect and mechanism of reactive oxygen species-mediated NOD-like receptor family pyrin domain-containing 3 inflammasome activation in hepatic alveolar echinococcosis

BACKGROUND The NOD-like receptor family pyrin domain-containing 3(NLRP3)inflammasome is a significant component of the innate immune system that plays a vital role in the development of various parasitic diseases.However,its role in hepatic alveolar echinococcosis(HAE)remains unclear.AIM To investigate the NLRP3 inflammasome and its mechanism of activation in HAE.METHODS We assessed the expression of NLRP3,caspase-1,interleukin(IL)-1β,and IL-18 in the marginal zone and corresponding normal liver of 60 patients with HAE.A rat model of HAE was employed to investigate the role of the NLRP3 inflammasome in the marginal zone of HAE.Transwell experiments were conducted to investigate the effect of Echinococcus multilocularis(E.multilocularis)in stimulating Kupffer cells and hepatocytes.Furthermore,immunohistochemistry,Western blotting,and enzyme-linked immunosorbent assay were used to evaluate NLRP3,caspase-1,IL-1β,and IL-18 expression;flow cytometry was used to detect apoptosis and reactive oxygen species(ROS).RESULTS NLRP3 inflammasome activation was significantly associated with ROS.Inhibition of ROS production decreased NLRP3-caspase-1-IL-1βpathway activation and mitigated hepatocyte damage and inflammation.CONCLUSION E.multilocularis induces hepatocyte damage and inflammation by activating the ROS-mediated NLRP3-caspase-1-IL-1βpathway in Kupffer cells,indicating that ROS may serve as a potential target for the treatment of HAE.

Evaluation of Hepatic Cystic Echinococcosis’ CT image in Xinjiang Uygur Autonomous Region based on Kolmogorov Complexity Model

Designing and developing computer-assisted image processing techniques to help doctors improve their diagnosis has received considerable interests over the past years. In this paper, we used the kolmogorov complexity model to analyze the CT images of the healthy liver and multiple daughter hydatid cysts. Before the complexity characteristic calculating, the image preprocessing methods had been used for image standardization. From the kolmogorov complexity model, complexity characteristic were calculated in order to quantify the complexity, between healthy liver and multiple daughter hydatid cysts. Then we use statistical method to analyze the complexity characteristic of those two types of images. Our preliminary results show that the complexity characteristic has statistically significant (p<0.05) to analyze these two types CT images, between the healthy liver and the multiple daughter hydatid cysts. Furthermore, the result leads us to the conclusion that the kolmogorov complexity model could use for analyze the hydatid disease and will also extend the analysis the other lesions of liver.

Cystic echinococcosis of the liver and lung treated by radiofrequency thermal ablation:An ex-vivo pilot experimental study in animal models

AIM： To evaluate radiofrequency thermal ablation （RTA） for treatment of cystic echinococcosis in animal models （explanted organs）. METHODS： Infected livers and lungs from slaughtered animals, 10 bovine and two ovine, were collected. Cysts were photographed, and their volume, cyst content, germinal layer adhesion status, wall calcification and presence of daughter or adjacent cysts were evaluated by ultrasound. Some cysts were treated with RTA at 150 W, 80℃, 7 min. Temperature was monitored inside and outside the cyst. A second needle was placed inside the cyst for pressure stabilization. After treatment, all cysts were sectioned and examined by histology. Cysts were defined as alive if a preserved germinal layer at histology was evident, and as successfully treated if the germinal layer was necrotic. RESULTS： The subjects of the study were 17 cysts （nine hepatic and eight pulmonary）, who were treated with RTA. Pathology showed 100% success rate in both hepatic （919） and lung cysts （8/8）; immediate volume reduction of at least 65%; layer of host tissue necrosis outside the cyst, with average extension of 0.64 cm for liver and 1.57 cm for lung; and endocyst attached to the pericystium both in hepatic and lung cysts with small and focal de novo endocyst detachment in just 3/9 hepatic cysts. CONCLUSION： RTA appears to be very effective in killing hydatid cysts of explanted liver and lung. Bile duct and bronchial wall necrosis, persistence of endocyst attached to pericystium, should help avoid or greatly decrease in v/vo post-treatment fistula occurrence and consequent overlapping complications that are common after surgery or percutaneous aspiration, injection and reaspiration. In vivo studies are required to confirm and validate this new therapeutic approach.

Survey data analysis of the related risk factors of echinococcosis in Inner Mongolia of China and Mongolia

Objective:The aim of the study is to analyze the risk factors of hepatic echinococcosis in mass epidemiological studies in Inner Mongolia of China and Mongolia and provide a basis for related authorities to make appropriate preventive measures.Methods:Eight areas in Inner Mongolia and Zamyn-Üüd region of Mongolia were selected as epidemiological fields.By distributing epidemiological questionnaires to local residents and performing serological examinations and abdominal ultrasound examinations,the data results were collected and analyzed to obtain the risk factors.Results:In this research,there were 7,373 cases of valid data in the area of Inner Mongolia and 1,500 cases in the area of Mongolia.The mean age of the whole survey samples was 52.86±13.90,and the ratio of the female(58.35%)was much higher than that of the male(41.65%).Both univariate analysis and multivariate analysis in this study showed that the female(14.7%)had a higher risk of hepatic echinococcosis than the male(10.9%).From the perspective of profession,children,educators and medical personnel had a lower incidence,herdsmen had the highest positive rate of the disease(15.8%).Living in pastoral areas,having been to pastoral areas,eating uncooked food and drinking unboiled water,raising dogs and surrounding activities of foxes and voles can also increase the risk of positivity.Conclusions:Our findings demonstrate that the most important risk factor of hepatic echinoccosis is unhealthy lifestyles and customs in farmers and herdsmen.It is possible to provide a basis for related authorities to make effective protective measures aiming at hepatic echinococcosis.

Follow-up in hepatic alveolar echinococcosis under benzimidazole therapy using computed tomography

To the Editor:Alveolar echinococcosis(AE),caused by infection with Echinococcus multilocularis,is regarded as the most dangerous parasitic zoonosis in the temperate climate zones of the northern hemisphere,particularly across Central Europe and large parts of North-/Central Asia.Left untreated,AE has a very high mortality rate.The liver is the organ most commonly affected showing complex,often infiltrative lesions.When lesions cannot be resected in curative intention,long-term parasitostatic pharmacotherapy with benzimidazoles is indicated to inhibit further extension.[1]

肝泡型包虫病的诊治进展

肝包虫病为慢性寄生虫病,由多房棘球蚴的幼虫引发,此病具有相当高的致残率和死亡风险,又被称作“虫癌”。临床上将肝包虫病分为肝泡型包虫病和肝囊型包虫病,肝包虫病在世界各地广泛流行,我国主要在西部农牧区居民群体中发生,对该地区居民的生存质量构成了巨大的威胁。目前临床上治疗肝包虫病以手术治疗方式为主,伴随着外科诊治技术的迅速发展和对肝包虫病研究不断深入,其诊治方案也不断完善。本文将主要综述肝泡型包虫病的诊断和治疗进展,旨在为临床医务人员提供参考,以尽早发现和治疗,降低疾病对患者产生的不良影响,改善患者预后。

西藏地区93例小儿肝囊型包虫病的手术治疗

目的探讨小儿肝囊型包虫病的临床特点及手术治疗的效果。方法回顾性分析西藏自治区人民医院普通外科2014年1月至2019年12月手术治疗小儿肝囊型包虫病患者的临床资料,包括临床表现、囊肿特点、手术方式及术后并发症。结果共纳入93例患儿,其中男性53例,女性40例。58例(62.3%)无症状体检发现就诊,29例(31.1%)表现为腹痛。62例(66.6%)囊肿位于肝右叶,12例(12.9%)位于肝左叶,左右肝均有19例(20.4%),肝内多发囊肿34例(36.55%);囊肿直径(9.14±3.16)cm;43例(46.2%)行内囊摘除术,39例(41.9%)行外囊次全切除术,11例(11.8%)行外囊完整摘除术;术后并发残腔胆漏5例,胸腔积液11例,残腔感染1例,肺部感染2例,死亡1例。术后随诊1~4年,复发4例,均经口服阿苯达唑治疗,定期B超随诊。结论小儿肝囊型包虫病无症状感染体检发现居多,囊肿多位于肝右叶且具有多发囊肿占比大、外囊壁薄的特点,手术是主要的的治疗方法,术式应遵循个体化的方案。

超声影像组学在肝包虫病分型中的应用研究

目的 基于超声影像组学构建机器学习模型,探究其在鉴别囊型肝包虫病与泡型肝包虫病中的应用价值。方法 选取于我院及四川省甘孜藏族自治州石渠县经病理结果(金标准)或“四川省包虫病专家组”依据临床结果及专家共识(银标准)确诊的肝包虫病患者4976例,共纳入23 452张超声图像,其中囊型肝包虫病图像8557张,泡型肝包虫病图像14 895张。按病灶类型以8∶2比例将超声图像随机分为训练集18 762张与独立测试集4690张。使用Pyradiomics(3.1.0)提取超声图像的影像组学特征,对训练集及独立测试集超声图像均使用相同的提取器;使用极小化极大、标准分数及均值方法对影像组学特征进行特征缩放,使用主成分分析和Pearson相关系数进行特征降维,使用方差分析、递归特征消除、相关特征法及克鲁斯卡尔-沃利斯法筛选最佳影像组学特征。基于支持向量机(SVM)、自编码器(AE)、线性判别分析(LDA)、随机森林(RF)、逻辑回归(LR)、自适应增强(AB)、决策树(DT)、朴素贝叶斯(NB)8种分类器构建鉴别肝包虫病分型的最佳机器学习模型。训练集中,以十折交叉验证策略训练模型。绘制受试者工作特征(ROC)曲线分析不同分类器中最佳机器学习模型在训练集及独立测试集中鉴别肝包虫病分型的诊断效能。结果 从每张超声图像中共提取1130个影像组学特征,经特征选择动态筛选出1~40个最佳影像组学特征,并以此建立最佳机器学习模型。ROC曲线分析显示,RF模型在训练集及独立测试集中鉴别肝包虫病分型的曲线下面积分别为0.82、0.86,均高于SVM、AE、LDA、LR、AB、DT、NB模型,差异均有统计学意义(均P<0.05)。结论 基于超声影像组学的RF模型对鉴别肝包虫病分型的诊断效能最佳,有助于肝包虫病精准超声诊断。

加速康复外科理念在肝囊型包虫病手术病人护理中的应用

目的:探究加速康复外科理念在肝囊型包虫病病人围术期护理中的应用效果。方法:选取新疆医科大学第一附属医院消化血管外科中心2021年1月1日—12月31日行手术治疗的272例肝囊型包虫病病人,随机分为对照组135例和观察组137例,对照组给予常规护理,观察组于围术期护理融入加速康复外科理念进行护理,比较两组病人临床相关指标(手术时间、术中出血量、术后8 h疼痛评分、首次排气时间、满意度和住院时间)及并发症(肠梗阻、肺部感染、下肢深静脉血栓)发生率。结果:观察组住院时间、首次排气时间和术后8 h疼痛评分低于对照组,满意度高于对照组,并发症发生率低于对照组,差异均有统计学意义(P<0.05)。结论:加速康复外科理念应用于肝囊型包虫病病人围术期护理,有助于缩短住院时间,降低并发症发生率,提高病人满意度。

终末期肝泡型包虫病的肝移植治疗

肝泡型包虫病(HAE)是我国西部地区常见的人畜共患地方性寄生虫病,早期缺乏典型临床表现,症状明显时常已进入终末期,具有极高的致死率。在终末期HAE(es-HAE)治疗中,因残余肝体积不足、无法控制的出血、脉管在体重建困难等,同种异体原位肝移植几乎成为唯一根治的方式。但因供肝短缺、术后需长期使用免疫抑制药等因素限制了其应用,离体肝切除联合自体肝移植术(ELRA)的出现打破了这一窘境,极大拓宽了es-HAE手术指征。此外,我国多中心对ELRA进行了诸多优化与改良,进一步完善es-HAE的治疗体系。目前,es-HAE的肝移植(包括ELRA)治疗仍是临床医师研究的热点。本文对原位肝移植、ELRA、辅助性ELRA等多种手段在es-HAE的外科治疗进行综述,旨在进一步提升es-HAE的诊治水平,改善患者临床预后。