肝移植治疗晚期泡型肝包虫病五例

目的探讨肝移植治疗晚期泡型肝包虫病的效果。方法为5例无法行肝叶切除术的晚期泡型肝包虫病患者施行原位肝移植术,1例不行体外静脉转流,4例肝移植在体外静脉转流下进行,其中3例采取先体外静脉转流、后游离肝周的技术,供、受者的肝动脉及胆管均行端端吻合,2例胆管内放置T管。手术耗时平均为8.3h。结果1例术后第10dT管脱出,再次手术置入T管,另1例发生胆漏,再次手术行腹腔冲洗、胆道引流,此2例术后恢复顺利。术后4例完全康复,1例因肺部感染、急性排斥反应和肝动脉栓塞导致的败血症、多器官功能衰竭而死亡。存活的4例术后随访21~37个月,随访期间生活正常。结论肝移植术可用于晚期泡型肝包虫病的治疗,其临床效果良好。

Liver transplantation for hepatic alveolar echinococcosis (5 cases report)

Objective To explore the therapeutic effect of liver transplantation on hepatic alveolar echinococcosis (HAE) in late stage.Methods Five HAE cases in late stage failed to be treated by hepatic lobectomy underwent liver transplantation, in which 4 cases were performed under veno-venous bypass and 1 without bypass. Three cases were subjected to veno-venous bypass prior to mobilization of the liver. The end-to-end anastomosis was made between the hepatic artery and hepatic artery, and between the bile duct and bile duct. Two cases received placement of T tube in the bile duct. The mean duration of surgery was 8.3 h. Results One patient was reoperated because of the T tube falling off on the postoperative day 10, and one because of the bile leakage. Four patients recovered completely in the postoperative period, one died of multiple organ failure (MOF) and septi-caemia caused by pneumonia, acute rejection and embolism of the liver artery. Four patients were followed up for 21 months to 37 months, showing a good quality of their life. Conclusion Liver transplantation can be applied in treatment of hepatic alveolar echinococcosis in end stage, and can ensure a better clinical result.