右半肝切除术联合肝动脉、胆管重建及门静脉、下腔静脉修补治疗终末期肝泡型包虫病一例OA

Hepatic alveolar echinococcosis(HAE)in its end stage readily invades critical hilar structures such as blood vessels and bile ducts,making radical resection extremely difficult and posing a significant clinical challenge.This paper reports one patient with end-stage HAE who underwent radical resection at Senior Department of Hepatology,Chinese PLA General Hospital,and summarizes the selection of individualized treatment options and key surgical techniques.A 44-year-old male patient was admitted for obstructive jaundice on 18 Feb 2025.He had a history of percutaneous transhepatic cholangial drainage(PTCD)and biliary stent placement 4 years prior due to compression from the echinococcal lesion,and presented with jaundice for 2 months.Abdominal computed tomography angiography(CTA),magnetic resonance cholangiopancreatography(MRCP)and three-dimensional reconstruction revealed that the lesion encircled the main right hepatic artery and common bile duct,with involvement of the main portal vein and inferior vena cava.After precise preoperative three-dimensional imaging evaluation,the patient underwent right hemihepatectomy combined with biliary-enteric anastomosis,portal vein repair,inferior vena cava(IVC)repair,and hepatic artery resection with anastomosis.Key surgical steps included mobilizing the liver,repairing the IVC and exploring the hilar anatomy,preparing for hepatic artery reconstruction,repairing the portal vein,resecting the right lobe and caudate lobe,reconstructing the hepatic artery via anastomosis of the gastroduodenal artery to the left hepatic artery,and performing biliary reconstruction.The operation lasted 12 hours with an intraoperative blood loss of 2 500 mL.Low-molecular-weight heparin anticoagulation was initiated on postoperative day 4.The abdominal drainage tube was removed on day 20,and the patient was discharged on day 24.During an 8-month postoperative follow-up,no lesion recurrence was observed,blood flow at the vascular anastomoses was patent,and liver function was normal.For patients with end-stage HAE involving multiple critical ducts,precise preoperative three-dimensional imaging evaluation and surgical planning,an individualized strategy combining hepatectomy with duct reconstruction and repair,meticulous intraoperative vascular and biliary anastomotic techniques,and standardized postoperative management are crucial.