演題

SY-8-1

Extracorporal liver resection for complicated hepatic echinococcosis

[演者] Jiahong Dong:1
[著者] Hao Wen:2, Jia-Hong Dong:3, Jin-Hui Zhang:2, Wei-Dong Duan:3, Jin-Ming Zhao:2, Yu-Rong Liang:3, Ying-Mei Shao:2, Xue-Wen Ji:2, Qin-Wen Tai:2, Tao Li:2, Hao Gu:3, Tuerhongjiang Tuxun:2, Yi-Biao He:2, Jie-Fu Huang:4
1:Beijing Qinghua Changgung Hospital, Medical Center, Tsinghua Univ Hospital & Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, China, 2:Department of Liver & Laparoscopic Surgery, Digestive & Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, 3:Hospital & Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, 4:Department of Hepatobiliary Surgery, Peking Union Medical College Hospital

BACKGROUND & AIMS: The role of ex situ liver resection and autotransplantation in end-staged hepatic alveolar echinococcosis is unclear. We aimed to present our experience and propose a possible selection criterion for ex situ liver resection and autotransplantation in patients with end-staged alveolar echinococcosis. METHODS: 15 patients with end-staged hepatic alveolar echinococcosis was considered unresectable by conventional resection due to hepatocaval region with three hepatic veins and retrohepatic vena cava were invaded, as well as the tertiary portal and arterial supply., thus complex reconstruction was mandatory. Detailed information about patient lesion characteristics and survival was tabulated, and the possible criteria was proposed. RESULTS: 15 patients successfully underwent ex vivo extended right hepatectomy and autotransplantation without intra-operative mortality, Synchronous lung lobectomy was performed in two cases. The median autograft volume and weight respectively were 788 cm3 and 706.g. Median operative time was 15.5 hours with the median anhepatic time 283.8 minutes. Intraoperative blood transfusion employed in 13 patients with median requirement of 7.9 units. During the surgery the priority for safe resection margin was guaranteed through repeated frozen section. Post-operative complication Clavien-Dindo grade IIIa or higher occurred in three patients. The median ICU stay was three days with postoperative hospital stay was 32.3 days. CONCLUSIONS: This is the largest reported series of patients autotransplanted for end-stage hepatic alveolar echinococcosis. This technique requires no organ donor, post-operative immune suppressant with relative low cost in comparison with allo-transplantation. The early postoperative mortality was low with acceptable morbidity. Preoperative precise assessment is necessary and strict patient selection is of utmost importance.
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