Objective:To explore the application of different reconstruction methods of retrohepatic inferior vena cava (RHIVC) in the ex-vivo liver resection and auto-transplantation(ELRA)for hepatic alveolar echinococcosis (AE).Methods:The 88 patients with end-stage hepatic AE treated by ELRA from August 2010 to December 2018 were divided into 3 groups according to the different methods of RHIVC reconstruction, respectively , group A, autologous vascular repair and reconstruction group (n=50); group B, RHIVC replacement group (n=31); group C, RHIVC resection without reconstruction group (n=7), and the clinical data were analyzed and followed up.Results:The average operation time of group A, B and C was 16.32±3.20 h, 15.99±3.32 h, 16.86±4.18 h ( P>0.05), The average anhepatic phase was398.48±104.12 min, 389.41±135.25 min, 337.43±108.65 min( P>0.05), The differences were not statistically significant. The average hospital stays after surgery in the three groups were 30.64±18.54 d, 25.94±16.37 d, 51.29±29.43 d ( P<0.05), There were significant statistical differences, and the results showed that the group B was significantly less than other two groups. The incidence of IVC related complications in group A and B was 20.0% and 9.7%. Among all the subjects, RHIVC stenosis was found in 9 patients and thrombus was formed in 4 patients in postoperative. Conclusions:RHIVC reconstruction methods can be selected appropriately according to the defect degree of lumen after resection.

ObjectiveTo investigate the role of transforming growth factor (TGF-β1) in hepatic fibrosis induced by echinococcus multilocular infection and its possible mechanisms in this process.Methods Forty-five C57BL/6 mice were randomly divided into the model group（30）and the control group (15). Protoscolece suspension of echinococcus multilocular was infused through portal vein in the model group (4000/each). Mice in the control group was injected the same volume of normal saline solution. Six mice in the model group and 3 mice in the control group were sacrificed at 1, 2, 4, 8 and 12 weeks after infection. The liver tissues were observed the histopathological changes by using hematoxylin-eosin (H&E) staining. The fibrosis degree and glycogen synthesis function of liver tissue were observed by Sirius-red staining and Periodic acid schiff (PAS), respectively. The expression levels of TGF-β1 and a-smooth muscle actin (α-SMA) were measured by immunohistochemical staining.ResultsThe obvious abnormal changes were not observed in 1 week after model setup. The diffuse distribution of multiple white spots began to appear at 2 weeks, but the amount of white plaques decreased after 8 weeks. Meanwhile, forming small lesions were not obviously observed the boundary with the surrounding normal liver tissue. Clear echinococcal vesicles were seen at week 12. H&E staining showed that hepatic tissue structure of control group was normal. In the model group, the number of lesions with worms decreased gradually and amount of granulomas were increased. The inflammatory lesions did not change significantly. Sirius-red staining demonstrated that collagen deposition in the control group was mainly around the bile duct and blood vessels. However, the deposition in the model group was mainly around the lesion and the degree of fibrosis became more serious with time. PAS staining displayed that the content of glycogen in the liver tissues of the control group was rich, evenly distributed and stained uniformly. However, the glycogen staining positive area decreased with the time of infection and the staining became lighter in the model group. Immunohistochemical staining indicated that the positive expression of α-SMA and TGF- β1 in the control group were mainly found in the bile ducts and perivascular areas. The positive areas in the model group were mostly granulomatous areas around the metacercariae and fibroblasts. Expression of α-SMA and TGF- β1 increased over time after infection with the expression peak at 12 weeks(16.80±2.09、4.10±2.14).ConclusionThe degree of fibrosis in liver tissues at different time points was consistent with the expression trend of TGF- β1 and α-SMA. TGF-β1 may promote collagen deposition and lead to fibrosis by activating hepatic stellate cells.