Abstract
Aim . To improve the efficiency of treatment of advanced liver alveococcosis using modern surgical techniques including transplantation. Material and Methods. It was analyzed surgical treatment of 25 patients with advanced liver alveococcosis for the period 2008–2014. Operations were performed in 21 cases. Lung metastasis were diagnosed in two of them. Long-term obstructive jaundice was observed in 5, portal hypertension – in 2. 1 patient with associated HBV had liver cirrhosis. Results . Surgical interventions had extended volume and included liver resection “in situ” in 16 cases, orthotopic liver transplantation (OLT) in 3 patients. Invasion into IVC was detected in 9 cases. In 6 patients IVA was made a prosthetic appliance using PTFE-prosthesis including 1 case with left hepatic vein orifice repair and 3 cases with partial resection. Resection and reconstruction of portal vein were required in 6 cases. 9 patients underwent resection of the extrahepatic bile ducts. Resection of the right dome of the diaphragm was made in 4 cases. In one case explorative laparotomy was performed. All patients after surgery receive antiparasitic therapy. There was 1 death in the early postoperative period due to multiple organ failure. There were no recurrences within 7-year follow-up. Antiparasitic therapy after liver transplantation did not require adjustment of immunosuppressive therapy. Conclusion . Surgical interventions for liver alveococcosis have advanced volume and are combined with reconstruction of great vessels and bile ducts. Maximum tendency to resection is caused by potential risk of immunosuppressive therapy after transplantation for the progression of the disease, that justifies difficult resections “ex situ”.
Highlights
Resection and reconstruction of portal vein were required in 6 cases. 9 patients underwent resection of the extrahepatic bile ducts
Resection of the right dome of the diaphragm was made in 4 cases
Maximum tendency to resection is caused by potential risk of immunosuppressive therapy after transplantation for the progression of the disease, that justifies difficult resections “ex situ”
Summary
Zagaynov V.E.1, 2, Kiselev N.M.1, 2, Gorokhov G.G.1, Vasenin S.A.1, Belskiy V.A.1, Shalapuda V.I.1, Rykhtik P.I.1. Aim. To improve the efficiency of treatment of advanced liver alveococcosis using modern surgical techniques including transplantation. It was analyzed surgical treatment of 25 patients with advanced liver alveococcosis for the period 2008–2014. Surgical interventions had extended volume and included liver resection “in situ” in 16 cases, orthotopic liver transplantation (OLT) in 3 patients. In 6 patients IVA was made a prosthetic appliance using PTFE-prosthesis including 1 case with left hepatic vein orifice repair and 3 cases with partial resection. Resection and reconstruction of portal vein were required in 6 cases. Resection of the right dome of the diaphragm was made in 4 cases. In one case explorative laparotomy was performed. Antiparasitic therapy after liver transplantation did not require adjustment of immunosuppressive therapy
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