PDF(Pubmed)
Abstract：
BACKGROUND: Alveolar echinococcosis (AE) primarily affects the liver and potentially spreads to other organs. Managing recurrent AE poses significant challenges, especially when it involves critical structures and multiple major organs.
METHODS: We present a case of a 59-year-old female with recurrent AE affecting the liver, heart, and lungs following two previous hepatectomies, the hepatic lesions persisted, adhering to major veins, and imaging revealed additional diaphragmatic, cardiac, and pulmonary involvement. The ex vivo liver resection and autotransplantation (ELRA), first in human combined with right atrium (RA) reconstruction were performed utilizing cardiopulmonary bypass, and repairs of the pericardium and diaphragm. This approach aimed to offer a potentially curative solution for lesions previously considered inoperable without requiring a donor organ or immunosuppressants. The patient encountered multiple serious complications, including atrial fibrillation, deteriorated liver function, severe pulmonary infection, respiratory failure, and acute kidney injury (AKI). These complications necessitated intensive intraoperative and postoperative care, emphasizing the need for a comprehensive management strategy in such complicated high-risk surgeries.
CONCLUSIONS: The multidisciplinary collaboration in this case proved effective and yielded significant therapeutic outcomes for a rare case of advanced hepatic, cardiac, and pulmonary AE. The combined approach of ELRA and RA reconstruction under extracorporeal circulation demonstrated distinct advantages of ELRA in treating complex HAE. Meanwhile, assessing diaphragm function during the perioperative period, especially in patients at high risk of developing pulmonary complications and undergoing diaphragmectomy is vital to promote optimal postoperative recovery. For multi-resistant infection, it is imperative to take all possible measures to mitigate the risk of AKI if vancomycin administration is deemed necessary.
METHODS: We present a case of a 59-year-old female with recurrent AE affecting the liver, heart, and lungs following two previous hepatectomies, the hepatic lesions persisted, adhering to major veins, and imaging revealed additional diaphragmatic, cardiac, and pulmonary involvement. The ex vivo liver resection and autotransplantation (ELRA), first in human combined with right atrium (RA) reconstruction were performed utilizing cardiopulmonary bypass, and repairs of the pericardium and diaphragm. This approach aimed to offer a potentially curative solution for lesions previously considered inoperable without requiring a donor organ or immunosuppressants. The patient encountered multiple serious complications, including atrial fibrillation, deteriorated liver function, severe pulmonary infection, respiratory failure, and acute kidney injury (AKI). These complications necessitated intensive intraoperative and postoperative care, emphasizing the need for a comprehensive management strategy in such complicated high-risk surgeries.
CONCLUSIONS: The multidisciplinary collaboration in this case proved effective and yielded significant therapeutic outcomes for a rare case of advanced hepatic, cardiac, and pulmonary AE. The combined approach of ELRA and RA reconstruction under extracorporeal circulation demonstrated distinct advantages of ELRA in treating complex HAE. Meanwhile, assessing diaphragm function during the perioperative period, especially in patients at high risk of developing pulmonary complications and undergoing diaphragmectomy is vital to promote optimal postoperative recovery. For multi-resistant infection, it is imperative to take all possible measures to mitigate the risk of AKI if vancomycin administration is deemed necessary.
摘要：
背景：肺泡包虫病（AE）主要影响肝脏，并可能扩散到其他器官。管理复发性AE带来了重大挑战，特别是当它涉及关键结构和多个主要器官时。
方法：我们介绍了一例59岁女性，反复发作，影响肝脏，心,和之前两次肝切除术后的肺，肝脏病变持续存在，坚持主要静脉，成像显示额外的膈肌，心脏,和肺部受累。离体肝切除和自体移植（ELRA），首先在人类联合右心房（RA）重建采用体外循环，和修复心包和隔膜。这种方法旨在为先前认为无法手术的病变提供潜在的治愈解决方案，而无需供体器官或免疫抑制剂。患者出现多种严重并发症,包括心房颤动,肝功能恶化，严重的肺部感染,呼吸衰竭,急性肾损伤（AKI）。这些并发症需要密集的术中和术后护理，强调在这种复杂的高风险手术中需要全面的管理策略。
结论：在这种情况下，多学科合作被证明是有效的，并且对一种罕见的晚期肝，心脏,和肺AE。体外循环下ELRA和RA重建的联合方法显示了ELRA治疗复杂HAE的明显优势。同时,评估围手术期的膈肌功能，尤其是在发生肺部并发症的高危患者中，进行膈肌切除术对于促进最佳的术后恢复至关重要。对于多重耐药感染，如果万古霉素治疗有必要,必须采取一切可能的措施来降低AKI的风险.
方法：我们介绍了一例59岁女性，反复发作，影响肝脏，心,和之前两次肝切除术后的肺，肝脏病变持续存在，坚持主要静脉，成像显示额外的膈肌，心脏,和肺部受累。离体肝切除和自体移植（ELRA），首先在人类联合右心房（RA）重建采用体外循环，和修复心包和隔膜。这种方法旨在为先前认为无法手术的病变提供潜在的治愈解决方案，而无需供体器官或免疫抑制剂。患者出现多种严重并发症,包括心房颤动,肝功能恶化，严重的肺部感染,呼吸衰竭,急性肾损伤（AKI）。这些并发症需要密集的术中和术后护理，强调在这种复杂的高风险手术中需要全面的管理策略。
结论：在这种情况下，多学科合作被证明是有效的，并且对一种罕见的晚期肝，心脏,和肺AE。体外循环下ELRA和RA重建的联合方法显示了ELRA治疗复杂HAE的明显优势。同时,评估围手术期的膈肌功能，尤其是在发生肺部并发症的高危患者中，进行膈肌切除术对于促进最佳的术后恢复至关重要。对于多重耐药感染，如果万古霉素治疗有必要,必须采取一切可能的措施来降低AKI的风险.
