Postoperative complications of ex vivo liver resection combined with autologous liver transplantation in treatment of advanced hepatic alveolar echinococcosis at high altitude and related prevention and treatment strategies
10.3969/j.issn.1001-5256.2021.09.029
- VernacularTitle: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
- Author:
Qingshan TIAN
1
;
Shaopei FENG
2
;
Yamin GUO
1
;
Xiumin HAN
1
;
Shunyun ZHAO
1
;
Chengjie YE
1
;
Yongde AN
1
;
Shile WU
1
;
Xiangqian WANG
1
;
Haibo ZHENG
1
;
Wenjun ZHU
1
;
Jide A
1
;
Wei GAO
1
;
Hongshuai PAN
1
Author Information
1. Department of General Surgery, Qinghai Provincial People's Hospital, Xining 810000, China
2. Graduate School of Qinghai University, Xining 810000, China
- Publication Type:Original articles_Other liver diseases
- Keywords:
Echinococcosis, Hepatic;
Ex Vivo Liver Resection and Autotransplantation;
Postoperative Complications
- From:
Journal of Clinical Hepatology
2021;37(9):2153-2160
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the postoperative complications of ex vivo liver resection combined with autologous liver transplantation in the treatment of end-stage hepatic alveolar echinococcosis at high altitude and related prevention and treatment strategies. Methods Surgical data and follow-up data were collected from 11 patients with end-stage hepatic alveolar echinococcosis who underwent autologous liver transplantation in Qinghai People's Hospital from January 2013 to March 2019, and intraoperative and postoperative conditions were analyzed. Results All 11 patients underwent autologous liver transplantation successfully, without intraoperative death, among whom 2(18.18%) underwent hemi-extracorporeal hepatectomy and 9 (81.82%) underwent total extracorporeal hepatectomy. For the reconstruction of the retrohepatic inferior vena cava, 2 patients (18.18%) underwent reconstruction with the autologous great saphenous vein, 4 patients (36.36%) underwent reconstruction with artificial vessels, and the autologous retrohepatic inferior vena cava was preserved in 5 patients (45.45%). For biliary reconstruction, 8 patients (72.73%) underwent choledochoenterostomy and 3 (27.27%) underwent choledochocholedochostomy. The main postoperative complications of the 11 patients included bleeding in 2 patients (18.18%), bile leakage and abdominal infection in 4 patients (36.36%), bilioenteric anastomotic stenosis in 1 patient (9.09%), thrombus in 2 patients (18.18%), pulmonary infection and pleural effusion in 2 patients (18.18%), and echinococcosis recurrence in 1 patient (9.09%). Of all 11 patients, 2 (18.18%) died during the perioperative period, and the other 9 patients (81.82%) were improved and discharged. Conclusion Bleeding, biliary complications, and infection are the main causes of death in patients undergoing autologous liver transplantation at high altitude. An accurate understanding of surgical indication, careful multidisciplinary evaluation before surgery, superb operation during surgery, standardized surgical procedures, and fine perioperative management are the key to reducing perioperative mortality, avoiding and reducing postoperative complications, and achieving good long-term survival in patients undergoing autologous liver transplantation.
