Application of associating liver partition and portal vein ligation for two-stage hepatectomy in hepatic alveolar echinococcosis

Abstract

Objective To explore the safety and efficacy of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in treating hepatic alveolar echinococcosis. Methods Clinical data of 2 patients with hepatic alveolar echinococcosis undergoing ALPPS in the First Affiliated Hospital of Xi'an Jiaotong University between June 2015 and January 2016 were analyzed retrospectively. The informed consents of both patients were obtained and the local ethical committee approval was received. Case 1 was male, 47 years old. Case 2 was female, 24 years old. Both were diagnosed as hepatic echinococcosis. For case 1, ligation of the right portal vein and division of the left medial lobe and left lateral lobe were performed in the first stage, and resection of 3 right lobes was performed in the second stage. For case 2, right hemihepatectomy and division of the left medial lobe and left lateral lobe were performed in the first stage, and hepatic left lateral lobectomy was performed in the second stage. Results For case 1 in the first stage, the operation duration was 540 min, blood loss was 2 000 ml, intraoperative RBC infusion was 8 U, and plasma infusion was 800 ml; in the second stage, the operation duration was 660 min, blood loss was 4 500 ml, RBC infusion was 32 U, and plasma infusion was 2 000 ml. Case 1 recovered well after the first stage operation, but suffered from bile leakage after the second stage operation, then received percutaneous transhepatic biliary drainage and recovered afterward. For case 2 in the first stage, the operation duration was 405 min, blood loss was 2 000 ml, intraoperative RBC infusion was 10 U, and plasma infusion was 2 000 ml; in the second stage, the operation duration was 190 min, blood loss was 1 000 ml, RBC infusion was 4 U, and plasma infusion was 800 ml. The patient recovered well after operation. Both 2 patients were followed up for 24 months after operation and lived in a good condition, no complication or recurrence of hydatid disease was observed. Conclusion ALPPS has provided a new option for the operative treatment of complex hepatic alveolar echinococcosis with insufficient remnant liver volume. Key words: Echinococcosis, hepatic; ALPPS; Remnant liver volume; Hepatectomy