留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

终末期肝泡型包虫病的肝移植治疗

庞北川, 张娜, 左邦佑, 等. 终末期肝泡型包虫病的肝移植治疗[J]. 器官移植, 2024, 15(2): 163-170. doi: 10.3969/j.issn.1674-7445.2023254
引用本文: 庞北川, 张娜, 左邦佑, 等. 终末期肝泡型包虫病的肝移植治疗[J]. 器官移植, 2024, 15(2): 163-170. doi: 10.3969/j.issn.1674-7445.2023254
Pang Beichuan, Zhang Na, Zuo Bangyou, et al. Liver transplantation for end-stage hepatic alveolar echinococcosis[J]. ORGAN TRANSPLANTATION, 2024, 15(2): 163-170. doi: 10.3969/j.issn.1674-7445.2023254
Citation: Pang Beichuan, Zhang Na, Zuo Bangyou, et al. Liver transplantation for end-stage hepatic alveolar echinococcosis[J]. ORGAN TRANSPLANTATION, 2024, 15(2): 163-170. doi: 10.3969/j.issn.1674-7445.2023254

终末期肝泡型包虫病的肝移植治疗

doi: 10.3969/j.issn.1674-7445.2023254
基金项目: 国家自然科学基金(82373189);四川省科技厅重大消化系统疾病诊治(2021YFS0375);四川省科技厅重点研发项目(2022YFS0596);吴阶平医学基金(2022HX017)
详细信息
    作者简介:
    通讯作者:

    张宇(ORCID 0000-0002-9191-7708),Email:zhangyuqg@med.uestc.edu.cn;邓绍平(ORCID 0000-0002-8084-4283),Email:Sdeng10@163.com

  • 中图分类号: R617, R53

Liver transplantation for end-stage hepatic alveolar echinococcosis

More Information
  • 摘要: 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。

     

  • FIG. 2984.  FIG. 2984.

    FIG. 2984..  FIG. 2984.

    图  1  es-HAE的升阶梯治疗策略

    注:PVE为选择性门静脉栓塞;ALPPS为联合肝脏离断和门静脉结扎的二步肝切除术;LVD为肝静脉剥夺术。

    Figure  1.  The "ascending staircase" treatment strategy for es-HAE

  • [1] ALVI MA, ALI RMA, KHAN S, et al. Past and present of diagnosis of echinococcosis: a review (1999-2021)[J]. Acta Trop, 2023, 243: 106925. DOI: 10.1016/j.actatropica.2023.106925.
    [2] WANG L, GONGSANG Q, PANG H, et al. Assessment of echinococcosis control in Tibet Autonomous Region, China[J]. Infect Dis Poverty, 2022, 11(1): 59. DOI: 10.1186/s40249-022-00987-9.
    [3] LAASRI K, ZHIM M, NAGGAR A, et al. Hydatid cyst of the liver invading the inferior vena cava[J]. Radiol Case Rep, 2023, 18(12): 4341-4344. DOI: 10.1016/j.radcr.2023.09.007.
    [4] 白天根, 宋铭杰, 温浩. 肝泡型棘球蚴病侵犯下腔静脉研究进展[J/CD]. 中华普外科手术学杂志(电子版), 2023, 17(3): 343-346. DOI: 10.3877/cma.j.issn.1674-3946.2023.03.028.

    BAI TG, SONG MJ, WEN H. Research progress of hepatic alveolar echinococcosis invading inferior vena cava[J/CD]. Chin J Oper Proced Gen Surg (Electr Edit), 2023, 17(3): 343-346. DOI: 10.3877/cma.j.issn.1674-3946.2023.03.028.
    [5] XU X, QIAN X, GAO C, et al. Advances in the pharmacological treatment of hepatic alveolar echinococcosis: from laboratory to clinic[J]. Front Microbiol, 2022, 13: 953846. DOI: 10.3389/fmicb.2022.953846.
    [6] 唐群科, 张瑛, 张巍娜. 泡型包虫病手术治疗的现状与进展[J]. 中华地方病学杂志, 2023, 42(10): 857-860. DOI: 10.3760/cma.j.cn231583-20211130-00389.

    TANG KQ, ZHANG Y, ZHANG WN. Current status and progress of surgical treatment for alveolar echinococcosis[J]. Chin J Endemiol, 2023, 42(10): 857-860. DOI: 10.3760/cma.j.cn231583-20211130-00389.
    [7] PICHLMAYR R, GROSSE H, HAUSS J, et al. Technique and preliminary results of extracorporeal liver surgery (bench procedure) and of surgery on the in situ perfused liver[J]. Br J Surg, 1990, 77(1): 21-26. DOI: 10.1002/bjs.1800770107.
    [8] LI F, YANG M, LI B, et al. Initial clinical results of orthotopic liver transplantation for hepatic alveolar echinococcosis[J]. Liver Transpl, 2007, 13(6): 924-926. DOI: 10.1002/lt.21187.
    [9] MAIMAITINIJIATI Y, AJI T, JIANG TM, et al. Approaches to reconstruction of inferior vena cava by ex vivo liver resection and autotransplantation in 114 patients with hepatic alveolar echinococcosis[J]. World J Gastroenterol, 2022, 28(31): 4351-4362. DOI: 10.3748/wjg.v28.i31.4351.
    [10] QIU Y, HUANG B, YANG X, et al. Evaluating the benefits and risks of ex vivo liver resection and autotransplantation in treating hepatic end-stage alveolar echinococcosis[J]. Clin Infect Dis, 2022, 75(8): 1289-1296. DOI: 10.1093/cid/ciac195.
    [11] KERN P, WEN H, SATO N, et al. WHO classification of alveolar echinococcosis: principles and application[J]. Parasitol Int, 2006, 55(Suppl): S283-S287. DOI: 10.1016/j.parint.2005.11.041.
    [12] 黄国强, 叶谢智华, 郭亚民, 等. 减体积式病灶切除联合药物治疗在终末期肝泡型包虫病中的治疗体会[J]. 中国普外基础与临床杂志, 2021, 28(7): 904-909. DOI: 10.7507/1007-9424.202009020.

    HUANG GQ, YE XZH, GUO YM, et al. Experience of reduced volume lesion resection combined with drug therapy in treatment of end-stage alveolar hepatic echinococcosis[J]. Chin J Base Clin Gen Surg, 2021, 28(7): 904-909. DOI: 10.7507/1007-9424.202009020.
    [13] QIU Y, YANG X, SHEN S, et al. Vascular infiltration-based surgical planning in treating end-stage hepatic alveolar echinococcosis with ex vivo liver resection and autotransplantation[J]. Surgery, 2019, 165(5): 889-896. DOI: 10.1016/j.surg.2018.11.007.
    [14] BRUNETTI E, KERN P, VUITTON DA, et al. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans[J]. Acta Trop, 2010, 114(1): 1-16. DOI: 10.1016/j.actatropica.2009.11.001.
    [15] 四川省包虫病临床医学研究中心, 四川省医师协会包虫病专业委员会. 泡型肝包虫病诊疗专家共识(2020版)[J]. 中国普外基础与临床杂志, 2020, 27(1): 13-17. DOI: 10.7507/1007-9424.201911105.

    Sichuan Clinical Medical Research Center for Echinococcus, Echinococcus Professional Committee of Sichuan Medical Association. Expert consensus on diagnosis and treatment of hepatic alveolar echinococcosis (2020 edition)[J]. Chin J Base Clin Gen Surg, 2020, 27(1): 13-17. DOI: 10.7507/1007-9424.201911105.
    [16] CHAPUIS Y, HOUSSIN D, BROUZES S, et al. Hepatic transplantation in alveolar echinococcosis. 3 attempts[J]. Chirurgie, 1987, 113(6): 634-640.
    [17] AJI T, DONG JH, SHAO YM, et al. Ex vivo liver resection and autotransplantation as alternative to allotransplantation for end-stage hepatic alveolar echinococcosis[J]. J Hepatol, 2018, 69(5): 1037-1046. DOI: 10.1016/j.jhep.2018.07.006.
    [18] FERRER INAEBNIT E, MOLINA ROMERO FX, SEGURA SAMPEDRO JJ, et al. A review of the diagnosis and management of liver hydatid cyst[J]. Rev Esp Enferm Dig, 2022, 114(1): 35-41. DOI: 10.17235/reed.2021.7896/2021.
    [19] ALIAKBARIAN M, TOHIDINEZHAD F, ESLAMI S, et al. Liver transplantation for hepatic alveolar echinococcosis: literature review and three new cases[J]. Infect Dis (Lond), 2018, 50(6): 452-459. DOI: 10.1080/23744235.2018.1428823.
    [20] BRESSON-HADNI S, KOCH S, MIGUET JP, et al. Indications and results of liver transplantation for echinococcus alveolar infection: an overview[J]. Langenbecks Arch Surg, 2003, 388(4): 231-238. DOI: 10.1007/s00423-003-0394-2.
    [21] BRESSON-HADNI S, VUITTON DA, BARTHOLOMOT B, et al. A twenty-year history of alveolar echinococcosis: analysis of a series of 117 patients from Eastern France[J]. Eur J Gastroenterol Hepatol, 2000, 12(3): 327-336. DOI: 10.1097/00042737-200012030-00011.
    [22] KOCH S, BRESSON-HADNI S, MIGUET JP, et al. Experience of liver transplantation for incurable alveolar echinococcosis: a 45-case European collaborative report[J]. Transplantation, 2003, 75(6): 856-863. DOI: 10.1097/01.TP.0000054230.63568.79.
    [23] ZORZETTI N, LAURO A, KHOUZAM S, et al. Immunosuppression, compliance, and tolerance after orthotopic liver transplantation: state of the art[J]. Exp Clin Transplant, 2022, 20(Suppl 1): 3-9. DOI: 10.6002/ect.MESOT2021.L13.
    [24] 温浩, 董家鸿, 张金辉, 等. 体外肝切除联合自体肝移植治疗肝泡型包虫病[J]. 中华消化外科杂志, 2011, 10(2): 148-149. DOI: 10.3760/cma.j.issn.1673-9752.2011.02.024.

    WEN H, DONG JH, ZHANG JH, et al. Ex-vivo liver resection combined liver autotransplantation for the treatment of hepatic alveolar echinococcosis[J]. Chin J Dig Surg, 2011, 10(2): 148-149. DOI: 10.3760/cma.j.issn.1673-9752.2011.02.024.
    [25] YANG C, YANG HJ, DENG SP, et al. Current status of ex-vivo liver resection and autologous liver transplantation for end-stage hepatic alveolar echinococcosis[J]. Ann Palliat Med, 2020, 9(4): 2271-2278. DOI: 10.21037/apm-20-184.
    [26] 中华人民共和国国家卫生健康委员会. 自体器官移植技术临床应用管理规范(2022年版)[EB/OL]. [2023-11-11]. http://zs.kaipuyun.cn/s.
    [27] 四川省包虫病临床医学研究中心, 四川省医师协会包虫病专业委员会. 复杂肝泡型包虫病诊疗专家共识(2020版)[J]. 中国普外基础与临床杂志, 2020, 27(1): 18-23. DOI: 10.7507/1007-9424.201911096.

    Sichuan Clinical Medical Research Center for Echinococcus, Echinococcus Professional Committee of Sichuan Medical Association. Expert consensus on diagnosis and treatment of complex hepatic alveolar echinococcosis (2020 edition)[J]. Chin J Base Clin Gen Surg, 2020, 27(1): 18-23. DOI: 10.7507/1007-9424.201911096.
    [28] BELDI G, VUITTON D, LACHENMAYER A, et al. Is ex vivo liver resection and autotransplantation a valid alternative treatment for end-stage hepatic alveolar echinococcosis in Europe?[J]. J Hepatol, 2019, 70(5): 1030-1031. DOI: 10.1016/j.jhep.2018.12.011.
    [29] SHEN S, KONG J, QIU Y, et al. Ex vivo liver resection and autotransplantation versus allotransplantation for end-stage hepatic alveolar echinococcosis[J]. Int J Infect Dis, 2019, 79: 87-93. DOI: 10.1016/j.ijid.2018.11.016.
    [30] 段小辉, 毛先海, 周力学, 等. 离体肝切除联合自体肝移植治疗肝巨大血管瘤1例[J]. 中国现代医学杂志, 2018, 28(14): 125-128. DOI: 10.3969/j.issn.1005-8982.2018.014.027.

    DUAN XH, MAO XH, ZHOU LX, et al. One case of giant hepatic hemangioma treated with ex vivo liver resection combined with autologous liver transplantation[J]. China J Mod Med, 2018, 28(14): 125-128. DOI: 10.3969/j.issn.1005-8982.2018.014.027.
    [31] 张国锋, 丁一, 杨合英, 等. 离体肝切除治疗儿童炎性肌纤维母细胞瘤1例报告[J]. 中国实用外科杂志, 2022, 42(4): 477-478,480. DOI: 10.19538/j.cjps.issn1005-2208.2022.04.25.

    ZHANG GF, DING Y, YANG HY, et al. One case report of ex vivo liver resection for the treatment of inflammatory myofibroblastoma in children[J]. Chin J Pract Surg, 2022, 42(4): 477-478,480. DOI: 10.19538/j.cjps.issn1005-2208.2022.04.25.
    [32] 盛嘉麟, 董青福, 史武江, 等. 离体肝切除和自体肝移植术的手术研究进展[J]. 腹部外科, 2024,37(1):7-12. DOI: 10.3969/j.issn.1003-5591.2024.01.002.

    SHENG JL, DONG QF, SHI WJ, et al. Surgical advances in ex-vivo liver resection and autotransplantation[J]. J Abdom Surg, 2024,37(1):7-12. DOI: 10.3969/j.issn.1003-5591.2024.01.002.
    [33] 温浩, 董家鸿. 离体肝切除和自体肝移植术[M]. 北京: 人民卫生出版社, 2021.
    [34] 彭永海, 陈熙, 胡朝辉, 等. 流出道储囊在离体肝切除联合自体肝移植治疗晚期肝包虫病中的应用体会[J]. 肝胆胰外科杂志, 2022, 34(8): 501-504,512. DOI: 10.11952/j.issn.1007-1954.2022.08.012.

    PENG YH, CHEN X, HU ZH, et al. Application experience of outflow tract reservoir in the treatment of advanced hepatic echinococcosis with ex vivo liver resection combined with autologous liver transplantation[J]. J Hepatopancreatobiliary Surg, 2022, 34(8): 501-504,512. DOI: 10.11952/j.issn.1007-1954.2022.08.012.
    [35] 黄良, 张娜, 杨冲, 等. 多种血管材料重建肝静脉在离体肝脏切除联合自体肝脏移植治疗晚期肝包虫病中的应用[J]. 中国普外基础与临床杂志, 2022, 29(9): 1169-1173.

    HUANG L, ZHANG N, YANG C, et al. Application of hepatic vein reconstruction with various vascular materials in treatment of end-stage hepatic alveolar echinococcosis by ex-vivo liver resection and autologous liver transplantation[J]. Chin J Bases Clin Gen Surg, 2022, 29(9): 1169-1173.
    [36] 李睿, 郝希伟, 张桓瑜, 等. Hisense计算机辅助手术系统三维重建在小儿肝脏肿瘤精准治疗中的应用价值[J]. 中华消化外科杂志, 2022, 21(6): 816-821. DOI: 10.3760/cma.j.cn115610-20220425-00234.

    LI R, HAO XW, ZHANG HY, et al. Application value of Hisense computer-assisted surgery system three-dimensional reconstrution in precision treatment of pediatric liver tumors[J]. Chin J Dig Surg, 2022, 21(6): 816-821. DOI: 10.3760/cma.j.cn115610-20220425-00234.
    [37] 费发珠, 张帅, 刘发蓉, 等. 三维可视化联合术中ICG荧光引导腹腔镜肝包虫病切除术一例[J/CD]. 中华肝脏外科手术学电子杂志, 2023, 12(5): 577-580. DOI: 10.3877/cma.j.issn.2095-3232.2023.05.020.

    FEI FZ, ZHANG S, LIU FR, et al. Laparoscopic hepatic echinococcosis resection guided by 3-dimensional visualization and intraoperative indocyanine green fluorescence imaging: report of one case[J/CD]. Chin J Hepatic Surgy (Electr Edit), 2023, 12(5): 577-580. DOI: 10.3877/cma.j.issn.2095-3232.2023.05.020.
    [38] KIM SH, KIM KH, CHO HD. Donor safety of remnant liver volumes of less than 30% in living donor liver transplantation: a systematic review and meta-analysis[J]. Clin Transplant, 2023, 37(9): e15080. DOI: 10.1111/ctr.15080.
    [39] CHEN J, WEI L, CHEN TW, et al. Triphase contrast-enhanced CT to evaluate indications for autologous liver transplantation in patients with end-stage hepatic alveolar echinococcosis[J]. Sci Rep, 2021, 11(1): 22096. DOI: 10.1038/s41598-021-01586-8.
    [40] CASSESE G, HAN HS, AL FARAI A, et al. Future remnant liver optimization: preoperative assessment, volume augmentation procedures and management of PVE failure[J]. Minerva Surg, 2022, 77(4): 368-379. DOI: 10.23736/S2724-5691.22.09541-7.
    [41] PICCUS R, JOSHI K, HODSON J, et al. Significance of predicted future liver remnant volume on liver failure risk after major hepatectomy: a case matched comparative study[J]. Front Surg, 2023, 10: 1174024. DOI: 10.3389/fsurg.2023.1174024.
    [42] 杨文昊, 廖玉波, 黄良, 等. "在体优先"的离体肝切除联合自体肝移植术治疗晚期肝泡型包虫病的应用效果[J]. 中国普外基础与临床杂志, 2022, 29(10): 1308-1312. DOI: 10.7507/1007-9424.202206057.

    YANG WH, LIAO YB, HUANG L, et al. Effect of "in situ first" ex vivo liver resection and autologous liver transplantation for end stage hepatic alveolar echinococcosis[J]. Chin J Base Clin Gen Surg, 2022, 29(10): 1308-1312. DOI: 10.7507/1007-9424.20220 6057.
    [43] 杨冲, 杨洪吉, 邓绍平, 等. 剩余肝体积不足的晚期肝泡型包虫外科治疗进展[J]. 中国普通外科杂志, 2021, 30(1): 98-104. DOI: 10.7659/j.issn.1005-6947.2021.01.012.

    YANG C, YANG HJ, DENG SP, et al. Progress of surgical management for end-stage hepatic alveolar echinococcosis with insufficient remnant liver volume[J]. Chin J Gen Surg, 2021, 30(1): 98-104. DOI: 10.7659/j.issn.1005-6947.2021.01.012.
    [44] 王燚, 张宇, 邓绍平, 等. 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[J]. 实用医院临床杂志, 2019, 16(3): 59-63. DOI: 10.3969/j.issn.1672-6170.2019.03.018.

    WANG Y, ZHANG Y, DENG SP, et al. The clinical effect of autologous liver transplantation in the treatment of advanced hepatic alveolar echinococcosis: a report of 16 case[J]. Pract J Clin Med, 2019, 16(3): 59-63. DOI: 10.3969/j.issn.1672-6170.2019.03.018.
    [45] 张宇, 杨冲, 王燚, 等. 原位保留部分残余肝脏的离体肝切除联合辅助性自体肝移植治疗复杂肝泡型包虫病[J]. 中国普外基础与临床杂志, 2019, 26(8): 974-979. DOI: 10.7507/1007-9424.201903023.

    ZHANG Y, YANG C, WANG Y, et al. Effect of partial liver preservation in situ for ex-vivo liver resection and auxiliatry autologous liver transplantation in end-stage hepatic alveolar echinococcosis[J]. Chin J Base Clin Gen Surg, 2019, 26(8): 974-979. DOI: 10.7507/1007-9424.201903023.
    [46] 吐尔干艾力·阿吉, 邵英梅, 赵晋明, 等. 肝泡型包虫病自体肝移植中提升功能肝“量与质”的临床实践: 附12例临床病例分析[J]. 中华医学杂志, 2017, 97(4): 270-275. DOI: 10.3760/cma.j.issn.0376-2491.2017.04.007.

    TUERGANAILI AJ, SHAO YM, ZHAO JM, et al. The clinical practice of improvement the "Volume and Quality" of functional liver in autologous liver transplantation for the patients with alveolar echinococcosis[J]. Natl Med J China, 2017, 97(4): 270-275. DOI: 10.3760/cma.j.issn.0376-2491.2017.04.007.
    [47] ZHANG Y, XIE P, YANG C, et al. The value of hepatic vein stent placement as a bridge therapy on treating hepatic alveolar echinococcosis presenting with Budd-Chiari syndrome[J]. Ann Surg, 2021, 273(4): e154-e156. DOI: 10.1097/SLA.0000000000004648.
    [48] 王明宇, 梁英健, 尹兵, 等. 肝静脉剥夺术——残余肝脏不足时手术新思路[J]. 中国实用外科杂志, 2020, 40(1): 102-105. DOI: 10.19538/j.cjps.issn.1005-2208.2020. 01.18.

    WANG MY, LIANG YJ, YIN B, et al. New way of operation for insufficient volume of future liver remnant-liver venous deprivation[J]. Chin J Pract Surg, 2020, 40(1): 102-105. DOI: 10.19538/j.cjps.issn.1005-2208.2020.01.18.
  • 加载中
图(2)
计量
  • 文章访问数:  208
  • HTML全文浏览量:  88
  • PDF下载量:  44
  • 被引次数: 0
出版历程
  • 收稿日期:  2023-11-18
  • 网络出版日期:  2024-01-05
  • 刊出日期:  2024-03-15

目录

    /

    返回文章
    返回