|
|
|
| Portal vein embolization combined with ex vivo liver resection and autotransplantation: A novel treatment strategy for end-stage and metastatic hepatic alveolar echinococcosis |
| Qiang Guo a , b , # , Mao-Lin Wang a , b , # , Kai Zhong a , b , # , Jia-Long Li a , b , Tie-Min Jiang a , b , Hao Wen a , b , c , Tuerganaili Aji a , b , Ying-Mei Shao a , b , ∗ |
a Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
b Clinical Medical Research Center of Echinococcosis and Hepatobiliary Disease of Xinjiang Uygur Autonomous Region, Urumqi 830054, China
c State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi 830054, China
∗ Corresponding author at: Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China.
E-mail address: syingmei1@163.com (Y.-M. Shao) .
# Contributed equally |
|
|
|
|
Abstract Alveolar echinococcosis (AE) is a lethal parasitic disease caused by Echinococcus multilocularis larvae, and more than 90% of primary AE lesions occur in the liver. Most of the affected individuals remain asymptomatic and the disease is often diagnosed at an advanced stage. The infection may spread to organs adjacent to the liver or distant locations, eventually causing end-stage multiple organ AE. Brain metastasis of AE is the most fatal with an incidence rate of 0.2% [1] . End-stage AE has a mortality rate of 90% if left untreated [2] . When important blood vessels such as the confluence of three hepatic veins and retrohepatic inferior vena cava are invaded, in vivo R0 resection and reconstruction of these vessels are extremely burdensome [3] . In recent years, ex vivo liver resection and autotransplantation (ELRA) has been used as one of the radical treatment modalities for patients with end-stage hepatic AE [4] . However, in most patients, large or multiple lesions invade important blood vessels, resulting in insufficient future liver remnant volume (FLRV). Several techniques that promote the proliferation of hepatic lobes including portal vein embolization (PVE) and two-stage hepatectomy (TSH) may induce compensatory hypertrophy and hyperplasia of the healthy-side hepatic lobes [5–7] . When FLRV is greater than 30% of total liver volume (TLV), ELRA then may be performed to guarantee operation safety and avoid the occurrence of postoperative liver failure. Here, we reported a rare case of hepatic AE with insufficient FLRV combined with brain metastasis, which was successfully treated through PVE and ELRA.
|
|
|
|
|
|
|
|
|
2024, Vol. 23 
