| Background: Hepatic alveolar echinococcosis(HAE)a parasitic disease of human and animal(beast).It is widely occurs in some animal husbandry areas.In 2016 alone,more than 50 million people in China were trapped in this disease,the national prevalence rate is 0.34%.However,the prevalence rate in Xinjiang,Qinghai and Ganzi Prefecture is as high as 94%,and the economic losses caused by it are as high as 3 billion yuan per year.Although it is a benign disease,its special growth characteristics,like malignant tumors,often invade important vessels and anatomical structures,and are easy to metastasize and recur in the distant place.Therefore,it is called "worm cancer" and "second cancer".At present,the main treatment for HAE is radical hepatectomy.Because it is safe and effective,the residual rate of lesions is low,and the low recurrence rate after surgery,it is the ideal way to treat hepatic echinococcosis.Because patients are mostly from Tibetan areas,economic difficulties,special religious beliefs,clinical diagnosis difficulties and other comprehensive factors lead many patients to miss the opportunity of radical hepatectomy,at this time most can only take medication or palliative treatment.With the development of liver surgical techniques and the spread of liver transplantation techniques,allogeneic liver transplantation(ALT)is an effective way to treat the patients of advanced HAE.However,due to the shortage of liver source,postoperative rejection,postoperative life-suppression of immunosuppressive agents,low immunity,prone to hydagosis,high cost,etc.,this technique has been limitedly treated in advanced HAE.Since 2010,the Wenhao’s team has successfully treated patients with advanced HAE for the first time using in vitro hepatectomy combined with ALT.Many centers at home and abroad have begun to use this method to treat advanced HAE.Therefore,it may be an effective treatment for advanced HAE.Purpose:This study retrospectively analyzed the clinical data of patients with advanced HAE treated with ALT in Sichuan Provincial People’s Hospital Organ Transplantation Center.And initially explored the safety and efficacy of ALT in patients with advanced HAE.Method: To retrospectively analyze the clinical data and follow-up data of patients with advanced HAE admitted to Sichuan Provincial People’s Hospital Organ Transplantation Center from July 2017 to February 2019,and analyze the safety and efficacy of ALT in the treatment of advanced liver HAE.Results: All patients underwent successful ALT,with 8 patients undergoing semi-ex vivo hepatectomy and 12 patients undergoing ex vivo liver resection combine with ALT.The average operation time of 20 patients:(12.08±2.61)h;mean blood loss after operation:(2253±842)ml;average red blood cell suspension volume:(9.5±7.5)U;input fresh frozen plasma:(1053±983)ml.There were 2 deaths during the perioperative period,7 complications after operation,2 cases of bile leakage,3 cases of pleural effusion,and 3 cases of jaundice.Eighteen patients recovered and were discharged after surgery.One of them was followed up for 5 months after surgery.The remaining patients recovered without recurrence.Conclusions: 1.ALT is a safe and effective method for the treatment of patients with advanced HAE.2.The principle of physical priority is very important for ALT.3.Intraoperative liver and liver cleft palate,individualized tubing is a key step in surgery.4.Preoperative accurate assessment,perioperative management,and choice of surgical methods are very important.5.For patients with long-term history of jaundice and Child-pugh grade B,patients should be fully evaluated to improve liver function,and ALT should be performed cautiously. |
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