Systematic sequential therapy for ex vivo liver resection and autotransplantation: A case report and review of literature

BACKGROUND Perihilar cholangiocarcinoma(pCCA)is a highly malignant tumor arising from the biliary tree.Radical surgery is the only treatment offering a chance of long-term survival.However,limited by the tumor’s anatomic location and peri-vascular invasion,most patients lose the chance for curative treatment.Therefore,more methods to increase the resectability of tumors as well as to improve outcomes are needed.CASE SUMMARY A 68-year-old female patient had a hepatic hilar mass without obvious symptoms.Laboratory results showed hepatitis B positivity.Magnetic resonance imaging indicated that the mass(maximum diameter:41 mm)invaded the left and right branches of the main portal vein,as well as the middle,left and right hepatic veins;enlarged lymph nodes were also detected in the hilum.The patient was diagnosed with pCCA,and the clinical stage was determined to be T4N1M0(stage IIIC).Considering the tumor’s anatomic location and vascular invasion,systematic conversion therapy followed by ex vivo liver resection and autotrans-plantation(ELRA)was determined as personalized treatment for this patient.Our original systemic sequential therapeutic strategy(lenvatinib and tislelizumab in combination with gemcitabine and cisplatin)was successfully adopted as conversion therapy because she achieved partial response after three cycles of treatment,without severe toxicity.ELRA,anastomotic reconstruction of the middle hepatic vein,right hepatic vein,root of portal vein,inferior vena cava and right hepatic artery,and lymph node dissection were performed at one month after systemic therapy.Pathological and immunohistochemical examination confirmed the diagnosis of pCCA with lymph node metastasis.Although the middle hepatic vein was partially obstructed four months later,hepatic vein stent implantation successfully addressed this problem.The patient has survived for 22 mo after the diagnosis,with no evidence of recurrence or metastasis.CONCLUSION An effective therapeutic strategy for conversion therapy greatly increases the feasibility and efficiency of ELRA.

Complex inferior vena cava reconstruction during ex vivo liver resection and autotransplantation:A case report

BACKGROUND Ex vivo liver resection and autotransplantation(ELRA)is an essential approach for treating patients with end-stage hepatic alveolar echinococcosis(AE),and its surgical indications involve severe invasion of important hepatic vessels,which makes in vivo resection impossible.Revascularization is a major step in the process of ELRA,which is extremely challenging when the invaded vessels have huge defects.CASE SUMMARY Herein,we have reported the case of a 26-year-old patient with hepatic AE in an autologous liver graft who underwent complex inferior vena cava(IVC)reconstruction using disease-free IVC,autologous portal vein fragments,and umbilical vein within the ligamentum teres hepatis.The patient showed good surgical recovery without vascular-related complications during the long-term follow-up.CONCLUSION We reviewed three studies that have reported complex revascularization of the IVC.This case report and systematic review showed that the use of autologous perihepatic vessels prevents donor-area trauma,immune rejection,and other adverse reactions.When the blood vessel is severely invaded and a single vascular material cannot repair and reconstruct the defect,ELRA may provide a safe and feasible surgical approach,which has good prospects for clinical application.

Approaches to reconstruction of inferior vena cava by ex vivo liver resection and autotransplantation in 114 patients with hepatic alveolar echinococcosis

BACKGROUND Hepatic alveolar echinococcosis(AE)is most commonly found in retrohepatic inferior vena cava(RHIVC).Ex vivo liver resection and autotransplantation(ELRA)can better realize the radical resection of end-stage hepatic AE with severely compromised hepatocaval confluences,and reconstruction of the affected vessels.Currently,there is a scarcity of information regarding RHIVC reconstruction in ELRA.AIM To propose reasonable RHICV reconstruction strategies for ex vivo liver resection and autotransplantation.METHODS We retrospectively summarized the clinical data of 114 patients diagnosed with hepatic AE who treated by ELRA in our department.A total of 114 patients were divided into three groups according to the different reconstruction methods of RHIVC:Group A with original RHIVC being repaired and reconstructed(n=64),group B with RHIVC being replaced(n=43),and group C with RHIVC being resected without reconstruction(n=7).The clinical data of patients,including the operation time,anhepatic phase,intraoperative blood loss,complications and postoperative hospital stay,were analyzed and the patients were routinely followed up.The normally distributed continuous variables were expressed as means±SD,whereas the abnormally distributed ones were expressed as median and analyzed by analysis of variance.Survival curve was plotted by the Kaplan-Meier method.RESULTS All patients were routinely followed up for a median duration of 52(range,12-125)mo.The 30 d mortality rate was 7.0%(8/114)and 7 patients died within 90 d.Among all subjects,the inferior vena cava(IVC)-related complication rates were 17.5%(11/63)in group A and 16.3%(7/43)in group B.IVC stenosis was found in 12 patients(10.5%),whereas thrombus was formed in 6 patients(5.3%).Twenty-two patients had grade III or higher complications,with the complication rates being 17.2%,16.3%,and 57.1%in the three groups.The average postoperative hospital stay in the three groups was 32.3±19.8,26.7±18.2,and 51.3±29.4 d(P=0.03),respectively.CONCLUSION ELRA can be considered a safe and feasible option for end-stage hepatic AE patients with RHIVC infiltration.The RHIVC reconstruction methods should be selected appropriately depending on the defect degree of AE lesions in IVC lumen.The RHIVC resection without any reconstruction method should be considered with caution.

Ex vivo liver resection and auto-transplantation and special systemic therapy in perihilar cholangiocarcinoma treatment

This editorial contains comments on the article“Systematic sequential therapy for ex vivo liver resection and autotransplantation:A case report and review of li-terature”in the recent issue of World Journal of Gastrointestinal Surgery.It points out the actuality and importance of the article and focuses primarily on the role and place of ex vivo liver resection and autotransplantation(ELRAT)and systemic therapy,underlying molecular mechanisms for targeted therapy in perihilar cho-langiocarcinoma(pCCA)management.pCCA is a tough malignancy with a high proportion of advanced disease at the time of diagnosis.The only curative option is radical surgery.Surgical excision and reconstruction become extremely com-plicated and not always could be performed even in localized disease.On the other hand,ELRAT takes its place among surgical options for carefully selected pCCA patients.In advanced disease,systemic therapy becomes a viable option to prolong survival.This editorial describes current possibilities in chemotherapy and reveals underlying mechanisms and projections in targeted therapy with ki-nase inhibitors and immunotherapy in both palliative and adjuvant settings.Fi-broblast grow factor and fibroblast grow factor receptor,human epidermal grow-th factor receptor 2,isocitrate dehydrogenase,and protein kinase cAMP activated catalytic subunit alpha(PRKACA)and beta(PRKACB)pathways have been ac-tively investigated in CCA in last years.Several agents were introduced and approved by the Food and Drug Administration.They all demonstrated mean-ingful activity in CCA patients with no global change in outcomes.That is why every successfully treated patient counts,especially those with advanced disease.In conclusion,pCCA is still hard to treat due to late diagnosis and extremely complicated surgical options.ELRAT also brings some hope,but it could be performed in very carefully selected patients.Advanced disease requires systemic anticancer treatment,which is supposed to be individualized according to the genetic and molecular features of cancer cells.Targeted therapy in combination with chemo-immunotherapy could be effective in susceptible patients.

Ex vivo liver resection and auto-transplantation as an alternative for the treatment of liver malignancies: Progress and challenges

Hepatectomy is still the major curative treatment for patients with liver malignancies.However,it is still a big challenge to remove the tumors in the central posterior area,especially if their location involves the retrohepatic inferior vena cava and hepatic veins.Ex vivo liver resection and auto-transplantation(ELRA),a hybrid technique of the traditional liver resection and transplantation,has brought new hope to these patients and therefore becomes a valid alternative to liver transplantation.Due to its technical difficulty,ELRA is still concentrated in a few hepatobiliary centers that have experienced surgeons in both liver resection and liver transplantation.The efficacy and safety of this technique has already been demonstrated in the treatment of benign liver diseases,especially in the advanced alveolar echinococcosis.Recently,the application of ELRA for liver malignances has gained more attention.However,standardization of clinical practice norms and international consensus are still lacking.The prognostic impact in these oncologic patients also needs further evaluation.In this review,we summarized the principles and recent progresses on ELRA.

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.

Ex vivo liver resection followed by autotransplantation in radical resection of gastric cancer liver metastases:A case report

BACKGROUND Radical resection of gastric cancer liver metastases(GCLM)can increase the 5-year survival rate of GCLM patients.However,patients may lose the theoretical feasibility of surgery due to the critical location of liver metastasis in some cases.CASE SUMMARY A 29-year-old woman had a chief complaint of chronic abdominal pain for 1 year.Abdominal computed tomography and magnetic resonance imaging examinations suggested a mass of unknown pathological nature located between the first and second hila and the margin of the lower segment of the right lobe of the liver.The anterior wall of the gastric antrum was unevenly thickened.The diagnosis of(gastric antrum)intramucosal well-differentiated adenocarcinoma was histopathologically confirmed by puncture biopsy with gastroscopy guidance.She underwent radical resection(excision of both gastric tumors and ex vivo liver resection followed by autotransplantation simultaneously)followed by XELOX adjuvant chemotherapy.Without serious postoperative complications,the patient was successfully discharged on the 20th day after the operation.Pathological examination of the excised specimen indicated that gastrectomy with D2 lymph node dissection for primary gastric tumors and R0 resection for liver metastases were achieved.The resected mass was confirmed to be poorly differentiated gastric carcinoma(hepatoid adenocarcinoma with neuroendocrine differentiation)with liver metastases in segments VIII.No recurrence or metastasis within the liver was found during a 7.5-year follow-up review that began 1 mo after surgery.CONCLUSION Application of ex vivo liver resection followed by autotransplantation in radical resection for GCLM can help selected patients with intrahepatic metastases located in complex sites obtain a favorable clinical outcome.

A new veno-venous bypass type for ex-vivo liver resection in dogs

Ex-vivo liver resection is a procedure in which the liver is completely removed, perfused and after bench surgery, the liver is autotransplanted to the original site. Ex vivo liver resection is an important treatment for unresectable liver tumors. This surgical procedure requires long operation time, during which blood flow must be carefully maintained to avoid venous congestion. An effective veno-venous bypass (VVB) may meet this requirement. The present study was to test our new designed VVB device which comprised one heparinized polyvinylchloride tube and three magnetic rings The efficacy of this device was tested in five dogs. A VVB was established in 6-10 minutes. There was no leakage during the procedure. Hemodynamics was stable at anhepatic phase, which indicated that the bypass was successful. This newly-developed VVB device maintained circulation stability during ex-vivo liver resection in our dog model and thus, this VVB device significantly shortened the operation time.

Pediatric living donor liver transplantation using liver allograft after ex vivo backtable resection of hemangioma: A case report

BACKGROUND Use of liver allograft with hepatic hemangioma after in vivo resection of hemangioma in living donor liver transplantation(LDLT)has been previously reported.However,there are few reports describing ex vivo backtable resection of hemangioma from liver allografts in LDLT.CASE SUMMARY A 55-year-old male was evaluated as a donor for an 8-month-year old patient with acute hepatic failure due to biliary atresia.Pre-operative contrast enhanced computed tomography revealed a 9 cm hemangioma in segment 4 with vascular variations in the donor.During LDLT,an intra-operative intrahepatic cholangiography was performed to ensure no variation in the anatomy of the intrahepatic bile duct.After intra-operative pathological diagnosis,ex vivo backtable resection of the hemangioma was performed and the liver allograft was transplanted into the recipient.The donor’s and recipient’s post-operative course were uneventful.At the 2-year follow-up,the liver allograft showed good regeneration without any recurrence of hemangioma.CONCLUSION Liver allografts with hemangiomas are an acceptable alternative strategy for LDLT.Ex vivo backtable resection of hemangioma from the donor liver during pediatric LDLT is safe and feasible,and can effectively reduce the operative time and intra-operative bleeding for the donor.

Ex vivo liver resection followed by autotransplantation for end-stage hepatic alveolar echinococcosis

Background For patients with end-stage hepatic alveolar echinococcosis （AE）, in vivo resection of the involved parts of the liver is usually very difficult, therefore, allogenic liver transplantation is indicated. However, we hypothesize that for selected patents, ex vivo liver resection for thorough elimination of the involved tissues and liver autotransplantation may offer a chance for clinical cure. Methods We presented a 24-year-old women with a giant hepatic AE lesion who was treated with hepatectomy, ex vivo resection of the involved tissue and hepatic autotransplantation. The patient had moderate jaundice and advanced hepatic AE lesion which involved segments I, IV, V, VI, VII, VIII and retrohepatic inferior vena cava. The lateral segments （II and III） of the left liver remained normal with over 1000 ml in its volume. No extrahepatic metastases （such as to the lung or brain） could be found. As the first step of treatment, X-ray guided percutaneous transhepatic cholangiodrainage （PTCD） was performed twice for bile drainage in segment III and II separately until her serum total bilirubin decreased gradually from 236 to 88 umol/L. Total liver resection was then performed, followed by extended right hepatic trisegmentectomy and the entire retrohepatic vena cava was surgically removed en bloc while her hemodynamics parameters were stable. Neither veino-veinous bypass nor temporary intracorporeal cavo-caval or porto-caval shunt was used during the 5.7-hour anhepatic phase. The remained AE-free lateral segments of the-left liver were re-implanted in situ. The left hepatic vein was directly anastomosed end-to-end to the suprahepatic inferior vena cava due to the lack of the retrohepatic inferior vena cava with AE total infiltration. Because compensatory retroperitoneal porto-caval collateral circulation developed, we enclosed remained infrahepatic inferior vena cava at renal vein level without any haemodynamics problems. Results During a 60-day following-up after operation, the patient had a good recovery except for a mildly elevated serum total bilirubin. Conclusions As a radical approach, ex vivo liver resection and liver autotransptantation in a case has shown a optimal potential for treatment of the end-stage hepatic AE. Strict compliance with its indications, evaluation of vessels of patients pre-operatively, and precise surgical techniques are the keys to improve the prognosis of patients.

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。

高原地区体外肝切除联合自体肝移植术治疗晚期肝泡型包虫病的术后并发症及其防治策略

目的探讨高原地区体外肝切除联合自体肝移植术治疗终末期肝泡型包虫病的术后并发症并探讨防治策略。方法收集青海省人民医院2013年1月—2019年3月接受自体肝移植术的11例终末期肝泡型包虫病患者的手术资料及随访资料,对术中及术后情况进行分析。结果11例患者均成功行自体肝移植术,无术中死亡,其中2例(18.18%)行半离体肝切除,9例(81.82%)行全离体肝切除。肝后下腔静脉重建方式中,采用自体大隐静脉进行重建者2例(18.18%),采用人造血管重建者4例(36.36%),5例(45.45%)保留自体肝后下腔静脉。胆道重建方式中,8例(72.73%)行胆肠吻合术,3例(27.27%)行胆管端端吻合术。11例患者的术后并发症主要有出血2例(18.18%);胆汁漏、腹腔感染4例(36.36%),胆肠吻合口狭窄1例(9.09%),血栓2例(18.18%),肺部感染、胸腔积液2例(18.18%);包虫复发1例(9.09%)。11例患者发生围术期死亡2例(18.18%),其余9例(81.82%)患者均好转出院。结论出血、胆道并发症和感染是造成高原地区自体肝移植患者死亡的主要原因,精准把握手术适应证、术前仔细多学科评估、术中精湛的操作、外科技术流程的标准化及精细的围术期管理是降低自体肝移植术围术期病死率、避免和减少术后并发症以及使患者获得长期良好生存的关键。

离体肝切除联合剩余肝脏自体移植治疗巨块型肝癌临床探讨

目的总结离体肝切除联合剩余肝脏自体移植术治疗巨块型肝癌的临床经验并探讨其优点.方法回顾性分析昆明医科大学第二附属医院肝胆外科2011年10月收治的1例巨块型肝癌患者的临床资料.结果该例患者手术过程顺利,术后未发生肝衰、肾衰、肝性脑病等情况,术后20 d肝功能完全恢复正常,术后22 d出院.术后半年随访未复发肿瘤,肝功能正常.结论离体肝切除联合剩余肝脏自体移植术可以有效治疗一些常规方法无法切除的肝脏占位性病变.

自体肝移植技术治疗晚期肝泡型包虫病16例临床疗效分析

目的探讨自体肝移植技术在治疗晚期肝泡型包虫病的疗效及安全性。方法回顾性分析本中心2017年8月至2018年11月收治的16例晚期肝泡型包虫病患者的临床资料,其中8例行半离体肝切除和8例行离体肝切除联合自体肝移植技术,分析患者的术中及术后随访情况。结果 16例患者手术时间(11. 5±3. 1) h,术中输血(8. 2±8) UU,术中失血(2253±842. 5) ml,术后住院时间(15±13) d。围手术期并发症6例,死亡1例;术后15例均随访,随访期间14例患者未见包虫复发及远处转移,1例术后5月死亡。结论自体肝移植是治疗晚期泡型包虫病的有效治疗方法,术中肝脏劈裂及个体化管道重建是手术的关键步骤,术前的精确评估、围手术期管理、手术方式非常重要。

全离体肝切除、自体肝移植治疗终末期肝泡型包虫病临床护理体会

目的总结全离体肝切除、余肝自体移植治疗终末期肝泡型包虫病（AE）临床护理经验和技巧。方法回顾性分析新疆医科大学第一附属医院2010年8月-2013年6月实施全离体肝切除、余肝自体移植术的10例终末期肝泡型包虫病患者的临床资料，分析临床护理中的方法与技巧，总结护理经验和规范。结果10例终末期肝AE患者均成功接受了全离体肝切除、余肝左外叶自体移植术。10例均顺利出院，未发生护理相关并发症。术后随访2～26个月，除病例Ⅰ于移植术后6个月因高热意外死亡外，余9例肝功能各项指标正常，肝内外均未见新生病灶，均健康存活。结论自体肝移植术后早期护理工作极为重要。严密监测各项生命体征，维持内环境稳态，密切观察各引流管分泌物，及早发现和处置潜在的手术相关并发症是自体肝移植临床护理的关键。

离体肝切除自体肝移植治疗终末期肝泡型棘球蚴病的研究进展

离体肝切除自体肝移植技术的临床应用解决了终末期肝泡型棘球蚴病不能根治的难题,打破了中央型肝病灶侵犯肝静脉和下腔静脉常规手术无法根治的禁忌,但其手术操作复杂、难度系数及手术创伤大,患者的预后与术前精准的影像学评估与准备、术中技术要点的应用与监测处理、术后并发症的预防及处理等密切相关。因此,加强围绕手术实施的研究是十分必要的,不仅可改善患者预后、提高生存率,还可为指导后期离体肝切除自体肝移植技术的临床推广与应用提供参考。

离体肝切除和自体肝移植术的手术研究进展

离体肝切除和自体肝移植术(ex-vivo liver resection and autotransplantation,ELRA)是肝脏外科中的一种复杂术式。ELRA适合于侵犯下腔静脉、门静脉与肝静脉及它们分支的复杂病灶的切除。近几年,经过众多学者对ELRA进行大量的手术实践与研究分析后,ELRA迅速发展。在疾病的适应证中,ELRA着重于晚期肝恶性肿瘤与终末期肝泡型棘球蚴病的治疗。最新的研究中,肝脏Child-Pugh评分B级和残余肝脏体积与标准肝脏体积之比为0.35~0.40的病人也能满足ELRA的肝脏要求。另外,体内临时的门腔静脉分流技术也因其术后死亡率低于过去的体外静脉-静脉转流技术而成为术中首选。术中的血管重建,重点围绕肝后下腔静脉重建方式的选择。对于需重建肝后下腔静脉的病人,则根据病灶切除后肝后下腔静脉壁缺损的程度,采用直接缝合、使用补片、使用人工血管的方式进行重建。现结合文献,对上述领域进行综述。

离体肝切除联合自体肝移植术在肝胆疾病中的应用

目的对离体肝切除联合自体肝移植术(ex vivo liver resection and autotransplantation,ELRA)在肝胆疾病中的应用进行总结和分析。方法对近年来国内外ELRA用于治疗各类肝胆占位性疾病的相关文献进行全面检索及归纳总结。结果ELRA在治疗肝胆占位性疾病时,突破了传统手术操作空间小的局限,减少了对供肝的依赖,同时也避免了移植后的排斥反应。目前ELRA已在肝泡型棘球蚴病、肝癌、胆管癌及罕见肝脏占位性疾病的治疗中得到应用。结论随着ELRA技术的不断成熟和离体肝脏灌注技术的不断提高,以及严格的术前评估和精细的术后管理,ELRA术后并发症较应用初期已明显减少。严格把握手术适应证,该术式将被用于越来越多的肝胆占位性疾病的治疗。

体外肝切除联合自体移植治疗终末期肝泡型棘球蚴病132例:术后严重并发症危险因素及预测模型

目的探讨终末期肝泡型棘球蚴病(又称“肝泡型包虫病”)患者接受体外肝切除联合自体移植(ex vivo liver resection and autotransplantation,ELRA)术后发生严重并发症(Clavien-Dindo分级Ⅲa级及以上者)的危险因素,并建立列线图预测模型。方法回顾性分析2014年1月至2024年6月期间在四川大学华西医院接受ELRA手术的终末期肝泡型棘球蚴病患者的临床资料。采用logistic回归分析ELRA术后严重并发症的危险因素;使用LASSO回归筛选风险因素后建立列线图预测模型,并通过受试者操作特征曲线、校准曲线和决策曲线分析评估列线图模型预测术后严重并发症发生的效能;同时采用广义线性回归模型探索影响总手术时间的术前风险因素。检验水准α=0.05。结果本研究共纳入132例接受了ELRA手术的终末期肝泡型棘球蚴病患者,术后有47例(35.6%)发生了严重并发症。多因素logistic回归分析发现,门静脉主干或对侧第一门静脉分支受侵(P2型,华西-PHI分型,下同)患者较病灶同侧第一门静脉分支受侵(P1型)患者术后发生严重并发症风险更高[比值比(odds ratio,OR)和95%可信区间(95%confidence interval,95%CI)=8.24(1.53,44.34),P=0.014],白蛋白胆红素指数分级1级者较2级及以上者术后发生严重并发症的风险更低[OR(95%CI)=0.26(0.08,0.83),P=0.023],随着总手术时间延长及自体血回输量增加术后发生严重并发症风险增高[OR(95%CI)=1.01(1.00,1.01),P=0.009;OR(95%CI)=1.00(1.00,1.00),P=0.043]。LASSO回归筛选出的2个风险因素白蛋白-胆红素指数分级和总手术时间构建的列线图预测模型对ELRA术后是否发生严重并发症的区分度良好[受试者操作特征曲线下面积(95%CI)为0.717(0.625,0.808)]。广义线性回归模型分析发现门静脉侵犯程度P2型和更远的对侧第二门静脉分支受侵(P3型)及有远处转移是影响总手术时间的风险因素[P2型/P1型:β(95%CI)=110.26(52.94,167.58),P<0.001;P3型/P1型:β(95%CI)=109.25(50.99,167.52),P<0.001;远处转移有/无:β(95%CI)=61.22(4.86,117.58),P=0.035]。结论从本研究分析结果看,对门静脉侵犯程度为P2型、白蛋白-胆红素指数分级2级及以上、总手术时间长和自体血回输量多的晚期肝泡型棘球蚴病患者需要密切关注,术前严格评估第一肝门侵犯和远处转移情况,以降低ELRA术后发生严重并发症的风险。本研究基于白蛋白-胆红素指数分级和总手术时间构建的列线图预测模型展现出对术后发生严重并发症的良好预测效能,可为临床制定干预决策提供参考。

体外肝切除联合自体肝移植治疗肝泡型包虫病

目前,对于常规手术无法根治的终末期肝泡型包虫病,国内外学者实施的异体肝移植已超过65例,疗效肯定.我国肝包虫病患者多为农牧民,难以承受异体肝移植的高昂费用.因此,体外肝切除＋自体肝移植不失为治疗该病的一种理想选择.2010年8月22日,我们为1例巨大肝泡型包虫病患者施行体外肝切除＋自体肝移植,取得较好疗效.