经正中裂联合左右侧入路完整切除肝尾状叶治疗小儿肝泡型包虫病1例报告

李汗; 侯立朝; 王海久; 王聪; 樊海宁

doi:10.3969/j.issn.1001-5256.2022.02.033

经正中裂联合左右侧入路完整切除肝尾状叶治疗小儿肝泡型包虫病1例报告

DOI: 10.3969/j.issn.1001-5256.2022.02.033

李汗^{1, 2},
侯立朝^2, ,,
王海久²,
王聪²,
樊海宁²

1.
青海大学研究生院，西宁 810001
2.
青海大学附属医院肝胆胰外科，西宁 810001

基金项目:

青海省科技厅重点实验室专项 (2020-ZJ-Y01)

利益冲突声明：所有作者均声明不存在利益冲突。

作者贡献声明：李汗负责课题设计，资料采集与分析，撰写论文；樊海宁、王海久、王聪参与对文章的知识性内容作批评性审阅；侯立朝参与文章批评性审阅并指导撰写文章并最后定稿。

详细信息

通信作者:
侯立朝，zhuoyue_1973@163.com

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- 被引次数: 0
出版历程
- 收稿日期: 2021-06-04
- 录用日期: 2021-07-06
- 出版日期: 2022-02-20

Complete resection of hepatic vesicular hydatid of caudate lobe in a child by midline fissure approach combined with left and right approaches: A case report

Han LI^{1, 2},
Lizhao HOU^{2
, ,},
Haijiu WANG²,
Cong WANG²,
Haining FAN²

1.
Graduate School of Qinghai University, Xining 810001, China
2.
Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Qinghai University, Xining 810001, China

Research funding:

Key Laboratory Project of Science and Technology Department of Qinghai Province (2020-ZJ-Y01)

More Information

Corresponding author: HOU Lizhao, zhuoyue_1973@163.com

摘要

- 棘球蚴病, 肝 /
- 肝切除术 /
- 儿童
- Echinococcosis, Hepatic /
- Hepatectomy /
- Child

HTML全文

图 1 2020年9月22日肝脏超声、肝包虫动态CT、MR增强

注: a，肝脏超声可见肝S1、S7段分别探及高回声结节，内部回声欠均匀(箭头)；b，肝包虫动态CT增强静脉期可见肝S1~S7段团块状混杂密度影，其内见多发钙化影(箭头)；c，肝包虫动态MRI增强静脉期可见肝S1~S7段团块样混杂信号影，边缘呈高信号(箭头)。

下载: 全尺寸图片幻灯片

图 2 2020年9月23日肝脏三维重建

注: a，正面观(标记黄色部分为病灶)；b，上面观(标记黄色部分为病灶)；c，病灶与其余肝段的关系(标记黄色部分为病灶)。

下载: 全尺寸图片幻灯片

图 3 2020年10月13日术中可见

注: a，术中可见包虫淋巴结转移灶位于IVC左侧、LRV下缘；b，为术中切除的包虫淋巴结转移灶标本；c，于肝脏脏面、胆囊床左侧缘作预切开标记；d，劈开肝脏过程中保留了肝中静脉分支V5、V4b及其汇合处(B点)；e，将病灶从肝脏上游离下来；f，将病灶从IVC前壁上切下来；g，从IVC上切下来的病灶标本；h，肝S7段、尾状叶完全从下腔静脉上分离下来后，可见修补后的IVC、RHV、第一肝门及其血流阻断带。

下载: 全尺寸图片幻灯片

图 4 2020年10月20日复查腹部CT

注: 肝尾状叶、肝S7组织切除术后，术区多发渗出，正中及右侧腹壁皮下多发渗出；腹腔内置管(3根)(箭头)。

下载: 全尺寸图片幻灯片

表 1 术后血生化指标

检测时间	TBil (μmol/L)	DBil (μmol/L)	Alb (g/L)	ALT (U/L)	AST (U/L)	Hb (g/L)	WBC (×10⁹/L)	N (%)	INR	PT (s)	APTT (s)
手术当天	11.3	4.3	30.3	491	608	130	23.04	92.3	1.25	14.6	37.6
术后第1天	12.2	5.2	31.4	538	446	129	15.23	77.5	1.31	15.5	30.2
术后第3天	16.8	7.3	31.4	369	143	109	11.99	82.0	-	-	-
术后第7天	5.0	2.5	32.1	91	25	112	7.75	68.6	1.01	12.1	27.5
术后第10天	4.8	2.0	31.7	41	-	110	9.21	70.2	-	-	-
术后第13天	3.4	1.6	32.2	27	-	110	9.18	71.7	-	-	-
注：N，中性粒细胞百分比。

下载: 导出CSV

参考文献(15)

[1]	Sichuan Clinical Medical Research Center for Hydatid Diseases, Professional Committee for Hydatid Diseases of Sichuan Academy of Physicians. Expert consensus on diagnosis and treatment of alveolar hydatid disease (2020 Edition)[J]. Chin J Bases Clin Gen Surg, 2020, 27(1): 13-17. DOI: 10.7507/1007-9424.201911105. 四川省包虫病临床医学研究中心, 四川省医师协会包虫病专业委员会. 泡型肝包虫病诊疗专家共识(2020版)[J]. 中国普外基础与临床杂志, 2020, 27(1): 13-17. DOI: 10.7507/1007-9424.201911105.
[2]	GERAMIZADEH B, ATTARAN Y, MALEK-HOSSEINI SA, et al. Photoclinic. Alveolar hydatid cyst of the liver[J]. Arch Iran Med, 2011, 14(3): 211-212. https://pubmed.ncbi.nlm.nih.gov/21529115/
[3]	LIU JJ, GU H. Advances in radiofrequency ablation of hepatocellular carcinoma originating from the caudate lobe[J]. J Clin Hepatol, 2020, 36(11): 2574-2578. DOI: 10.3969/j.issn.1001-5256.2020.11.040. 刘俊杰, 谷昊. 尾状叶肝癌射频消融治疗新进展[J]. 临床肝胆病杂志, 2020, 36(11): 2574-2578. DOI: 10.3969/j.issn.1001-5256.2020.11.040.
[4]	HUANG ZQ, ZHOU NX. Caudate lobe surgery-the final field in hepatobiliary surgery[J]. J Dig Surg, 2004, 3(1): 1-17. DOI: 10.3760/cma.j.issn.1673-9752.2004.01.001. 黄志强, 周宁新. 尾状叶外科——肝外科的最后领域[J]. 消化外科, 2004, 3(1): 1-17. DOI: 10.3760/cma.j.issn.1673-9752.2004.01.001.
[5]	YANG GS, ZHAO WC. Operative techniques and difficulties for safe resection of hepatic caudate lobe[J]. Chin J Pract Surg, 2010, 30(8): 651-654. 杨广顺, 赵文超. 安全实施肝尾状叶切除术的技术原则与难点[J]. 中国实用外科杂志, 2010, 30(8): 651-654.
[6]	WANG ZG, FU SY, ZHOU WP, et al. Total caudate lobectomy via anterior hepatic transection[J]. Chin J Dig Surg, 2012, 11(1): 55-57. DOI: 10.3760/cma.j.issn.1673-9752.2012.01.016. 汪珍光, 傅思源, 周伟平, 等. 经中央入路肝全尾状叶肿瘤切除术[J]. 中华消化外科杂志, 2012, 11(1): 55-57. DOI: 10.3760/cma.j.issn.1673-9752.2012.01.016.
[7]	HE XL, ZENG Y. Applied anatomy and operative approach of caudate lobe of liver[J]. Sichuan Med, 2008, 29(3): 363-365. DOI: 10.16252/j.cnki.issn1004-0501-2008.03.039. 何贤禄, 曾勇. 肝脏尾状叶的应用解剖与手术入路[J]. 四川医学, 2008, 29(3): 363-365. DOI: 10.16252/j.cnki.issn1004-0501-2008.03.039.
[8]	COLONNA JO 2nd, SHAKED A, GELABERT HA, et al. Resection of the caudate lobe through "bloody gultch"[J]. Surg Gynecol Obstet, 1993, 176(4): 401-402.
[9]	DENG ZC, QIN L, QIAN HX. One case of surgical resection of hepatic caudate lobe tumor and discussion of surgical methods[J]. Chin J Hepatobiliary Surg, 2011, 17(11): 942-943. DOI: 10.3760/cma.j.issn.1007-8118.2011.11.023. 邓志成, 秦磊, 钱海鑫. 肝脏尾状叶肿瘤手术切除一例及手术方式探讨[J]. 中华肝胆外科杂志, 2011, 17(11): 942-943. DOI: 10.3760/cma.j.issn.1007-8118.2011.11.023.
[10]	LI JT, YU YQ. Surgical approach and technique of total caudate lobe hepatectomy[J]. Chin J Pract Surg, 2014, 34(8): 793-795. DOI: 10.7504/CJPS.ISSN1005-2208.2014.08.35. 李江涛, 于源泉. 全尾状叶肝切除手术入路及技巧[J]. 中国实用外科杂志, 2014, 34(8): 793-795. DOI: 10.7504/CJPS.ISSN1005-2208.2014.08.35.
[11]	Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO Informal Working Group on Echinococcosis[J]. Bull World Health Organ, 1996, 74(3): 231-242. https://www.who.int/groups/informal-working-groups-on-echinococcosis
[12]	KERN P, WEN H, SATO N, et al. WHO classification of alveolar echinococcosis: Principles and application[J]. Parasitol Int, 2006, 55 (Suppl): S283-S287. DOI: 10.1016/j.parint.2005.11.041.
[13]	WEN H, LUAN MX, YANG WG, et al. Study on standard classification and clinical significance for hepatic echinococcosis[J]. J Xinjiang Med Univ, 2002, 25(2): 129-130. DOI: 10.3969/j.issn.1009-5551.2002.02.005. 温浩, 栾梅香, 杨文光, 等. 肝包虫病的标准化分型及临床意义探讨[J]. 新疆医科大学学报, 2002, 25(2): 129-130. DOI: 10.3969/j.issn.1009-5551.2002.02.005.
[14]	Liver Surgery Group, Chinese Society of Surgery, Chinese Medical Association. Expert consensus on perioperative management of hepatectomy[J]. Chin J Pract Surg, 2017, 37(5): 525-530. DOI: 10.19538/j.cjps.issn1005-2208.2017.05.17. 中华医学会外科学分会肝脏外科学组. 肝切除术围手术期管理专家共识[J]. 中国实用外科杂志, 2017, 37(5): 525-530. DOI: 10.19538/j.cjps.issn1005-2208.2017.05.17.
[15]	ZHOU LT. Ame interview with Li Hui: Strict before operation, proficient in operation, diligent after operation[J]. J Clin Pathol Res, 2015, 35(7): 1222-1223. DOI: 10.3978/j.issn.2095-6959.2015.07.003. 周丽桃. AME专访\|李辉: 严于术前, 精于术中, 勤于术后[J]. 临床与病理杂志, 2015, 35(7): 1222-1223. DOI: 10.3978/j.issn.2095-6959.2015.07.003.