Abstract: Objective:To investigate the efficacy and feasibility of segmentorientated anatomical liver resection for the treatment of hepatic alveolar echinococcosis (HAE) in the middle lobe of the liver.
Methods:The clinical data of a female patient with HAE in the middle lobe of the liver who was admitted to the First Affiliated Hospital of Xi′an Jiaotong University in September 2013 were retrospectively analyzed. Before operation, various surgical plannings were facilitated by a threedimensional reconstruction system, and then the surgical planning was determined with the assistance of the multivariate analysis (volume measurement of liver, resectability of remnant functional liver, evaluation of vascular resection and reconstruction, ChildPugh score and indocyanine green retention at 15 minutes ). Segmentorientated anatomical liver resection(segment Ⅴ, Ⅷ and Ⅳb) was performed on the patient. There was a close relationship between the HAE and the first and the second hepatic portal during operation, and the anatomical liver resection of segment Ⅴ, Ⅷ and Ⅳb was precisely carried out. The patient was followed up by outpatient examination and telephone interview every month up to April 2014. The condition of the liver was observed by B ultrasound and computed tomography examinations.
Results:The threedimensional reconstruction of the CT data of the patient clearly displayed the anatomical structure and adjacent relationship between the tumor, abdominal organs and major abdominal vessels. The preoperative evaluation of the anatomy of tumor based on threedimensional images was confirmed with operative findings. The operation time and volume of blood loss were 410 minutes and 1 000 mL, respectively. The patient did not receive blood transfusion. The intraoperative vital signs of the patient were stable. There were no complications such as hepatic insufficiency. The duration of postoperative hospital stay was 15 days. Surgical incision was healed at discharge. The results of 〖HJ*4〗blood routine and blood biochemistry test, daily diet and basic selfcare ability were in normal condition. HAE was diagnosed based on the result of pathological examination. Albendazole was administered with 1 200 mg/d after operation. The patient was followed up for 6 months and returned to work. The weight of the patient increased by 5 kilograms than that at discharge, without complaint of discomfort. There was no recurrence of HAE and hepatic echinococcosis of organs.
Conclusions:Segmentorientated anatomical liver resection is not only a method for complete resection, but also maximizes the functional remnant of liver on the basis of intraoperative threedimensional reconstruction system together with selective hepatic inflow occlusion and vessel reconstruction technique. The patient gets a full recovery with satisfactory outcome.