肝多房棘球蚴病的手术治疗进展

doi:10.12140/j.issn.1000-7423.2024.06.014

摘要/Abstract

摘要：

肝多房棘球蚴病（HAE）是一种人兽共患病，在我国主要流行于新疆、青海、西藏、四川等地区。HAE可造成严重且不可逆的损伤，严重影响人体健康和地区经济，其防治工作仍然是国家疾病预防控制工作的重点之一。根治性肝切除术是目前治疗HAE的首选方法，难以根治性切除的晚期HAE可行姑息性手术、介入治疗、肝移植术等治疗手段。本文就HAE的治疗现状和最新进展作一综述。

关键词: 肝多房棘球蚴病, 手术治疗, 治疗进展

Abstract:

Hepatic alveolar echinococcosis (HAE) is a zoonotic disease. It is predominantly found in regions such as Xinjiang, Qinghai, Xizang and Sichuan in China. HAE can cause severe and irreversible damage, and significantly impacting human health and regional economies. The prevention and control of HAE remains a key focus of national disease prevention and control efforts. Radical surgical resection is the preferred treatment for HAE; while palliative surgery and liver transplantation are alternative options for late-stage HAE cases radical resection is not suitable. This article provides an overview of the current treatment status and latest advancements in the management of HAE.

Key words: Hepatic alveolar echinococcosis, Surgical treatment, Advances in treatment

中图分类号:

R532.32

祖力皮喀尔·图孙尼亚孜, 蒋铁民, 温浩. 肝多房棘球蚴病的手术治疗进展[J]. 中国寄生虫学与寄生虫病杂志, 2024, 42(6): 783-789.

ZULIPIKAER Tusunniyazi, JIANG Tiemin, WEN Hao. Advances in surgical treatment of hepatic alveolar echinococcosis[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2024, 42(6): 783-789.

参考文献 58

[1]	Chen JZ, Yu DG, Lan XR, et al. Multiple disciplinary team discussion on complex hepatic alveolar echinococcosis[J]. J Hepatopancreatobiliary Surg, 2020, 32(3): 152-156. (in Chinese)
	(陈见中, 喻定刚, 兰晓蓉, 等. 复杂泡型肝包虫病MDT讨论[J]. 肝胆胰外科杂志, 2020, 32(3): 152-156.)
[2]	Wang ZD, Jiang TM, Aji T, et al. Massive sympathetic nerve infiltration in advanced hepatic alveolar echinococcosis: a case report and review of the literature[J]. BMC Infect Dis, 2022, 22(1): 489.
[3]	Fu SQ, Wang ZX, Wang HJ, et al. Clinical characteristics of 175 cases with advanced hepatic alveolar echinococcosis[J]. Chin J Schisto Control, 2019, 31(2): 204-206, 209. (in Chinese)
	(付世强, 王志鑫, 王海久, 等. 175例晚期肝多房棘球蚴病患者临床特征分析[J]. 中国血吸虫病防治杂志, 2019, 31(2): 204-206, 209.)
[4]	Ma YY, Li JJ, Liu YM, et al. Identification and exploration of a new M2 macrophage marker MTLN in alveolar echinococcosis[J]. Int Immunopharmacol, 2024, 131: 111808.
[5]	Chen J, Wen H. Progress in diagnosis and treatment of hepatic echinococcosis[J]. J Southeast Univ Med Sci Ed, 2018, 37(5): 929-934. (in Chinese)
	(陈骏, 温浩. 肝棘球蚴病的诊断与治疗进展[J]. 东南大学学报(医学版), 2018, 37(5): 929-934.)
[6]	Yakubov FR, Sapaev DS. Surgical treatment of liver echinococcosis[J]. J Med Life, 2022, 15(11): 1409-1414. doi: 10.25122/jml-2022-0268 pmid: 36567844
[7]	Zhang Y, Zhang G. Progress in treatment of alveolar echinococcosis[J]. Sichuan Med J, 2018, 39(11): 1294-1297. (in Chinese)
	(张宇, 张刚. 泡型肝包虫病治疗进展[J]. 四川医学, 2018, 39(11): 1294-1297.)
[8]	Fang D, Chen ZY. Diagnosis and treatment of hepatic alveolar echinococcosis[J]. J Clin Hepatol, 2017, 33(5): 990-993. (in Chinese)
	(方丹, 陈哲宇. 肝泡状棘球蚴病的诊断和治疗[J]. 临床肝胆病杂志, 2017, 33(5): 990-993.)
[9]	Partensky C, Landraud R, Valette PJ, et al. Radical and nonradical hepatic resection for alveolar echinococcosis: report of 18 cases[J]. World J Surg, 1990, 14(5): 654-659. pmid: 1700555
[10]	Kasai Y, Koshino I, Kawanishi N, et al. Alveolar echinococcosis of the liver[J]. Ann Surg, 191 (2) :145-152.
[11]	Ayifyhan AH, Tuerganaili, Shao YM, et al. Current status of surgical treatment of hepatic echinococcosis[J]. J Hepatobiliary Surg, 2009, 17(1): 13-14. (in Chinese)
	(阿依甫汗•阿汗, 吐尔干艾力, 邵英梅, 等. 肝包虫病的外科治疗现状[J]. 肝胆外科杂志, 2009, 17(1): 13-14.)
[12]	Lu YQ, Deng Y, Zhang LQ, et al. Progress of clinical treatment of hepatic alveolar echinococcosis[J]. Chin J Bases Clin Gen Surg, 2016, 23(5): 547-551. (in Chinese)
	(路越晴, 邓勇, 张灵强, 等. 泡型肝包虫病的临床治疗进展[J]. 中国普外基础与临床杂志, 2016, 23(5): 547-551.)
[13]	Chen ZY. Surgical treatment of complex hepatic echinococcosis[J]. Chin J Bases Clin Gen Surg, 2017, 24(7): 785-787. (in Chinese)
	(陈哲宇. 复杂肝包虫病的外科治疗[J]. 中国普外基础与临床杂志, 2017, 24(7): 785-787.)
[14]	Deng X, Yang D, Zhang LQ, et al. Current status of the surgical treatment of hepatic alveolar echinococcosis[J]. J Clin Hepatol, 2021, 37(8): 1963-1965. (in Chinese)
	(邓旭, 阳丹才让, 张灵强, 等. 泡型肝包虫病的外科治疗现状[J]. 临床肝胆病杂志, 2021, 37(8): 1963-1965.)
[15]	Kamiyama T. Recent advances in surgical strategies for alveolar echinococcosis of the liver[J]. Surg Today, 2020, 50(11): 1360-1367.
[16]	Kristianova H, Kolarova L, Krska Z, et al. Surgical treatment of alveolar echinococcosis: a single centre experience and systematic review of the literature[J]. Rozhl Chir, 2019, 98(4): 167-173. pmid: 31159550
[17]	Hillenbrand A, Gruener B, Kratzer W, et al. Impact of safe distance on long-term outcome after surgical therapy of alveolar echinococcosis[J]. World J Surg, 2017, 41(4): 1012-1018. doi: 10.1007/s00268-016-3813-6 pmid: 27822723
[18]	Sozuer E, Akyuz M, Akbulut S. Open surgery for hepatic hydatid disease[J]. Int Surg, 2014, 99(6): 764-769. doi: 10.9738/INTSURG-D-14-00069.1 pmid: 25437585
[19]	Reich H, McGlynn F, DeCaprio J, et al. Laparoscopic excision of benign liver lesions[J]. Obstet Gynecol, 1991, 78(5 Pt 2): 956-958.
[20]	Li JW, Wang XJ, Cao L, et al. Clinical efficacy and experiences of laparoscopic hepatectomy: a report of 2 048 cases[J]. Chin J Dig Surg, 2017, 16(8): 818-821. (in Chinese)
	(李建伟, 王小军, 曹利, 等. 2048例腹腔镜肝切除术的临床疗效及经验总结[J]. 中华消化外科杂志, 2017, 16(8): 818-821.)
[21]	Duan S, Zhong K, Ma JX, et al. Value of 3D laparoscopic hepatectomy for hepatic alveolar echinococcosis[J]. Chin J Laparosc Surg Electron Ed, 2019, 12(6): 366-369. (in Chinese)
	(段帅, 钟锴, 马建雄, 等. 3D腹腔镜肝切除术在肝泡型包虫病中的应用[J]. 中华腔镜外科杂志(电子版), 2019, 12(6): 366-369.)
[22]	Feng SP, Guo YM, Han XM. The status and progress of minimally invasive surgical treatment on hepatic alveolar echinococcosis[J]. Parasitoses Infect Dis, 2021, 19(1): 51-56. (in Chinese)
	(冯少培, 郭亚民, 韩秀敏. 肝泡型棘球蚴病的微创外科治疗现状及进展[J]. 寄生虫病与感染性疾病, 2021, 19(1): 51-56.)
[23]	Wan L, Ran B, Aji T, et al. Laparoscopic or open treatment for hepatic alveolar echinococcosis: a single-institution experience[J]. Int J Infect Dis, 2021, 107: 182-187. doi: 10.1016/j.ijid.2021.04.017 pmid: 33862206
[24]	Salm LA, Lachenmayer A, Perrodin SF, et al. Surgical treatment strategies for hepatic alveolar echinococcosis[J]. Food Waterborne Parasitol, 2019, 15: e00050.
[25]	Gloor S, Candinas D, Beldi G, et al. Laparoscopic resection of hepatic alveolar echinococcosis: a single-center experience[J]. PLoS Negl Trop Dis, 2022, 16(9): e0010708.
[26]	Zhang YH, Fan HN. Surgical treatment of hepatic alveolar echinococcosis[J]. J Clin Med Lit, 2016, 3(5): 987, 990. (in Chinese)
	(张昀昊, 樊海宁. 肝泡型包虫病的外科治疗[J]. 临床医药文献电子杂志, 2016, 3(5): 987, 990.)
[27]	Jide A, Chai JP, Guo WL, et al. Study on the effect of quasi-radical lesion resection on the quality of life of patients with advanced hepatic alveolar echinococcosis[J]. Front Surg, 2021, 8: 821373.
[28]	He Y, Wang WT. Research advances in multimodal surgical treatment of hepatic alveolar echinococcosis[J]. Chin J Bases Clin Gen Surg, 2021, 28(9): 1243-1248. (in Chinese)
	(何洋, 王文涛. 肝泡型棘球蚴病的手术多模式治疗研究进展[J]. 中国普外基础与临床杂志, 2021, 28(9): 1243-1248.)
[29]	Maimaiti WSL, Tuerganaili AJ. Research advances in surgical treatment of hepatic alveolar echinococcosis[J]. J Clin Hepatol, 2018, 34(3): 645-648. (in Chinese)
	(买买提•瓦司力, 吐尔干艾力•阿吉. 肝泡型包虫病的手术治疗进展[J]. 临床肝胆病杂志, 2018, 34(3): 645-648.)
[30]	Buttenschoen K, Gruener B, Carli Buttenschoen D, et al. Palliative operation for the treatment of alveolar echinococcosis[J]. Langenbecks Arch Surg, 2009, 394(1): 199-204.
[31]	Wang J, Li H, Ma J, et al. Value of CT combined with MRCP in the diagnosis of hepatic hydatid biliary complications[J]. Radiol Pract, 2020, 35(9): 1132-1137. (in Chinese)
	(王佳, 李辉, 马进, 等. CT联合MRCP诊断肝包虫病胆道并发症的价值[J]. 放射学实践, 2020, 35(9): 1132-1137.)
[32]	Tuerhongjiang KHE. Application of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of biliary complications of hepatic echinococcosis[D]. Urumqi: Xinjiang Medical University, 2018: 4. (in Chinese)
	(吐尔洪江•卡哈尔. 经内镜逆行性胰胆管造影术(ERCP)在治疗肝包虫病胆道并发症中的应用[D]. 乌鲁木齐: 新疆医科大学, 2018: 4.)
[33]	Lin YZ, Ran B. Progress in ERCP treatment of biliary complications in patients with hepatic echinococcosis[J]. Adv Clin Med, 2023, 13(3): 4013-4020. (in Chinese)
	(林燕泽, 冉博. ERCP治疗两型肝棘球蚴病胆道并发症相关进展[J]. 临床医学进展, 2023, 13(3): 4013-4020.)
[34]	Tamarozzi F, Vuitton L, Brunetti E, et al. Non-surgical and non-chemical attempts to treat echinococcosis: do they work?[J]. Parasite, 2014, 21: 75. doi: 10.1051/parasite/2014071 pmid: 25531730
[35]	Ren L, Hu T, Deng Y, et al. Efficacy of endoscopic retrograde cholangiopancreatography in the treatment of alveolar echinococcosis complicated with obstructive jaundice[J]. Chin J Dig Endosc, 2016, 33(11): 795-797. (in Chinese)
	(任利, 胡涛, 邓勇, 等. 经内镜逆行胰胆管造影治疗泡型肝包虫病合并梗阻性黄疸的有效性分析[J]. 中华消化内镜杂志, 2016, 33(11): 795-797.)
[36]	Ambregna S, Koch S, Sulz MC, et al. A European survey of perendoscopic treatment of biliary complications in patients with alveolar echinococcosis[J]. Expert Rev Anti Infect Ther, 2017, 15(1): 79-88. pmid: 27788612
[37]	Zhao SY AJD, Wu SL, et al. Present situation and progress of treatment of advanced hepatic alveolar echinococcosis[J]. Chin J Hepatobiliary Surg, 2020, 26(3): 233-236. (in Chinese)
	(赵顺云, 阿吉德, 吴世乐, 等. 晚期肝泡型包虫病的治疗现状及进展[J]. 中华肝胆外科杂志, 2020, 26(3): 233-236.)
[38]	Liu ZS. Comparison of PTBD and ERCP in the treatment of alveolar echinococcosis complicated with obstructive jaundice[D]. Xining: Qinghai University, 2017. (in Chinese)
	(刘志胜. PTBD和ERCP治疗泡型肝包虫病合并梗阻性黄疸的疗效对比[D]. 西宁: 青海大学, 2017.)
[39]	Baimas-George M, Thompson KJ, Watson MD, et al. The technical aspects of ex vivo hepatectomy with autotransplantation: a systematic review and meta-analysis[J]. Langenbecks Arch Surg, 2021, 406(7): 2177-2200.
[40]	Pichlmayr R, Grosse H, Hauss J, et al. Technique and preliminary results of extracorporeal liver surgery (bench procedure) and of surgery on the in situ perfused liver[J]. Br J Surg, 1990, 77(1): 21-26.
[41]	Hannoun L, Balladur P, Delva E, et al. “Ex situ-in vivo” surgery of the liver: a new technique in liver surgery. Principles and preliminary results[J]. Gastroenterol Clin Biol, 1991, 15(10): 758-761.
[42]	Wen H, Dong JH, Zhang JH, et al. Ex-vivo liver resection combined liver autotransplantation for the treatment of hepatic alveolar echinococcosis[J]. Chin J Dig Surg, 2011, 10(2): 148-149. (in Chinese)
	(温浩, 董家鸿, 张金辉, 等. 体外肝切除联合自体肝移植治疗肝泡型包虫病[J]. 中华消化外科杂志, 2011, 10(2): 148-149.)
[43]	Lu Q, Aini A, Tang R, et al. From liver surgery to liver transplant surgery: new developments in autotransplantation[J]. Curr Opin Organ Transplant, 2022, 27(4): 337-345.
[44]	Wen H, Dong JH, Zhang JH, et al. Ex vivo liver resection and autotransplantation for end-stage alveolar echinococcosis: A case series[J]. Am J Transplant, 2016, 16(2): 615-624. doi: 10.1111/ajt.13465 pmid: 26460900
[45]	Tuerhongjiang TX, Abdusalamu AN, Li YP, et al. Systematic review of feasibility, safety and efficacy of ex situ liver resection and autotransplantation[J]. Natl Med J China, 2016, 96(28): 2251-2257. (in Chinese)
	(吐尔洪江•吐逊, 阿卜杜萨拉木•艾尼, 李玉鹏, 等. 非原位肝切除技术安全性、可行性和有效性的系统评价[J]. 中华医学杂志, 2016, 96(28): 2251-2257.)
[46]	Shen S, Kong JJ, Qiu YW, et al. Ex vivo liver resection and autotransplantation versus allotransplantation for end-stage hepatic alveolar echinococcosis[J]. Int J Infect Dis, 2019, 79: 87-93. doi: S1201-9712(18)34595-8 pmid: 30496849
[47]	Yang XW, Qiu YW, Huang B, et al. Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: a study of 31 cases[J]. Am J Transplant, 2018, 18(7): 1668-1679.
[48]	Zhang HH, Zhou YL, Yang ML, et al. The progress of surgical treatment of hepatic echinococcosis[J]. China Health Stand Manag, 2021, 12(17): 166-168. (in Chinese)
	(张洪胡, 周永利, 杨孟磊, 等. 肝包虫病外科治疗进展[J]. 中国卫生标准管理, 2021, 12(17): 166-168.)
[49]	Ma HL, Fan XT, Shi XJ, et al. Clinical study of treatment for end stage liver alveolar echinococcosis with ex-vivo liver resection and autologous liver transplantation[J]. Chin J Transplant Electron Ed, 2017, 11(1): 1-4. (in Chinese)
	(马海林, 范晓棠, 石绣江, 等. 离体肝切除自体肝移植术治疗终末期肝泡型包虫病临床研究[J]. 中华移植杂志(电子版), 2017, 11(1): 1-4.)
[50]	Yang WH, Liao YB, Huang L, et al. Effect of “in situ first” ex vivo liver resection and autologous liver transplantation for end stage hepatic alveolar echinococcosis[J]. Chin J Bases Clin Gen Surg, 2022, 29(10): 1308-1312. (in Chinese)
	(杨文昊, 廖玉波, 黄良, 等. “在体优先” 的离体肝切除联合自体肝移植术治疗晚期肝泡型包虫病的应用效果[J]. 中国普外基础与临床杂志, 2022, 29(10): 1308-1312.)
[51]	Tian MW. Single-center clinical study of “in situ first” principle combined with vascular reconstruction in the treatment of advanced hepatic alveolarechinococcosis[D]. Luzhou: Southwest Medical University, 2022: 6. (in Chinese)
	(田明武. “在体优先” 原则联合血管重建治疗晚期肝泡型包虫病的单中心临床研究[D]. 泸州: 西南医科大学, 2022: 6.)
[52]	Hu QR, Chen SM, Fan YC, et al. Kidney invasion occurred 2 years following liver transplantation for hepatic alveolar echinococcosis: a case report[J]. BMC Infect Dis, 2023, 23(1): 785.
[53]	Gillet M, Miguet JP, Mantion G, et al. Orthotopic liver transplantation in alveolar echinococcosis of the liver: analysis of a series of six patients[J]. Transplant Proc, 1988, 20(1Suppl 1): 573-576.
[54]	Wen H, Luan MX, Wang XY, et al. Report on the first case of liver transplantation for hepatic alveolar echinococcosis in China[J]. Endem Dis Bull China, 2001, 16(3): 100. (in Chinese)
	(温浩, 栾梅香, 王喜艳, 等. 国内首例肝移植治疗肝泡型包虫病报告[J]. 地方病通报, 2001, 16(3): 100.)
[55]	Shen S. Expert consensus on diagnosis and treatment of alveolar echinococcosis (2020 edition)[J]. Chin J Bases Clin Gen Surg, 2020, 27(1): 13-17. (in Chinese)
	(沈舒. 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.)
[56]	Tian QS, Feng SP, Guo YM, et al. Postoperative complications of ex vivo liver resection combined with autologous liver transplantation in treatment of advanced hepatic alveolar echinococcosis at high altitude and related prevention and treatment strategies[J]. J Clin Hepatol, 2021, 37(9): 2153-2160. (in Chinese)
	(田青山, 冯少培, 郭亚民, 等. 高原地区体外肝切除联合自体肝移植术治疗晚期肝泡型包虫病的术后并发症及其防治策略[J]. 临床肝胆病杂志, 2021, 37(9): 2153-2160.)
[57]	Yang XW. Expert consensus on diagnosis and treatment of complex hepatic alveolar echinococcosis (2020 edition)[J]. Chin J Bases Clin Gen Surg, 2020, 27(1): 18-23. (in Chinese)
	(杨先伟. 复杂肝泡型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): 18-23.)
[58]	Guo YM, Zhu WJ, Zhao SY, et al. Surgical treatment strategy for complex hepatic echinococcosis: a review[J]. Chin J Schisto Control, 2018, 30(6): 705-708. (in Chinese)
	(郭亚民, 朱文君, 赵顺云, 等. 复杂性肝棘球蚴病外科治疗策略研究进展[J]. 中国血吸虫病防治杂志, 2018, 30(6): 705-708.)