Application Of Selective Portal Vein Embolization In The Treatment Of Advanced Hepatic Alveolar Echinococcosis

Objective: To explore the efficacy and application value of selective portal vein embolization(PVE)in the treatment of advanced hepatic alveolar echinococcosis.Methods: Retrospective analysis of clinical data of 6 patients with complicated advanced hepatic alveolar echinococcosis who underwent selective portal vein embolization between September 2014 and April 2018 in the First Affiliated Hospital of Xinjiang Medical University,in which,3 males and 3 females,aged 21-68 years old,with an average of 40.67±19.31 years old;Hepatic alveolar echinococcosis was diagnosed with preoperative abdominal CTA.One patient had pulmonary metastases and one patient had chronic hepatitis.The patients all had preoperative Child-Pugh grade A;Three-dimensional visualization technology was used to measure the liver volume,lesion volume,future liver remnant volume of all patients,Selective portal vein embolization was performed to patients with hepatic alveolar echinococcosis who have insufficient remnant liver volume after surgery and are not eligible for radical surgery under the guidance of DSA.After the future liver remnant volume is compensated for hyperplasia,the second stage operations were performed.Patient demographics,general clinical case data were analyzed.Changes in future liver remnant volume before and after PVE,changes in liver function before and after PVE;PVE and second-stage surgical procedures,complications were recorded;All patients were followed up closely,and change in remnant liver volume after secondary resection were recorded to estimate the long-term effects of PVE.The measurement data were compared using t test,and the comparison of group measurement data was performed by t test of two independent sample data.Results:All six patients were successfully treated with PVE.One patient developed abdominal pain,one patient developed nausea and vomiting,and the other patients had no complications.Two patients developed transient hepatic dysfunction after PVE,andrecovered shortly after liver protection treatment;The mean FLRV before PVE was(577.43±250.98)cm3,and the mean FLRV before the second operation was(1027.02±330.55)cm3.The difference was statistically significant(P<0.05).The mean FLRV/TLV before PVE was(26.00±5.57)%,the average FLRV/TLV before surgery was(43.99±4.71)%,and the average liver volume during PVE and second surgery increased by 17%.The difference was statistically significant.(P<0.05).All the patients underwent secondary surgery,two of whom underwent expanded hepatectomy,four underwent autologous liver transplantation,three of whom developed pleural effusion,one had peritoneal effusion,and others did not develop severe complications.The postoperative follow-up period was 1 to 27 months.All patients had good survival.The residual functional liver volume continued to increase during the follow-up period,with no long-term complications,recurrence and death.Conclusions: PVE is a very useful assisted procedure that can increase the candidacy and safety of major hepatectomy for liver tumors.It can also be applied to the treatment of complex hepatomegaly alveolar echinococcosis.The effect is remarkable,and the perioperative complications are small and the long-term survival is good.It is an auxiliary method for inducing residual liver volume hyperplasia before radical resection of advanced hepatic alveolar echinococcosis.