Clinical Study On Reconstruction Of Inferior Vena Cava In Ex-vivo Liver Resection And Auto-Transplantation For Hepatic Alveolar Echinococcosis

Objective: To explore and analyze the safety and effectiveness of three reconstruction methods of retrohepatic inferior vena cava(RHIVC)in the ex-vivo liver resection and autotransplantation(ELRA)for the treatment of hepatic alveolar echinococcosis(AE).Methods: A total of 88 patients with end-stage hepatic AE treated by ELRA in Frist Affiliated Hospital of Xinjiang Medical University from August 2010 to December 2018.All the cases were divided into the three groups as follows: Group A,RHIVC repair and reconstruction group(n=50);Group B,RHIVC replacement group(n=31);Group C,RHIVC resection without reconstruction group(n=7).The clinical data,including the operative time,anhepatic phase,intraoperative blood loss,complications and postoperative hospital stay,were analyzed and the patients were routinely followed up.Results: All subjects were clinically followed up with a median duration of 30.50 months(12-107).The survival rate in the three groups was 90.00%,90.32% and 71.43% respectively(P > 0.05).The 30-day mortality and overall mortality was 6.82%(6/88)and 11.49%(10/87)respectively.There were 9 patients IVC stenosis was found and the thrombus was formed in 4 patients,and the complications appeared inferior vena cava(IVC)related was 20.41%(10/49)in group A;the 9.68%(3/31)in group B.The average operative time was 16.32±3.20 h for group A,15.99±3.32 h for group B and 16.86±4.18 h for group C(P>0.05),and the average anhepatic phase was 398.48±104.12 min,389.41±135.25 min,337.43±108.65 min following group A,B and C(P>0.05).The average hospital stay after surgery in the three groups was 30.64±18.54 d,25.94±16.37 d,51.29±29.43 d respectively(P<0.05),which was significantly less in group B than other two groups.Conclusion: 1.ELRA can be considered as a the safely and effective option for the end-stage hepatic AE patients with RHIVC infiltration.2.when the defect of RHIVC after resection is less than 2/3 of the lumen circumference,the repairment with autologous vascular patch may be the optimal choice.As the defect has exceeded 2/3 of the circumference and difficult to repair by autologous patch,the replacement of RHIVC can be used.3.The RHIVC resection without reconstruction method should be considered with caution for the patients who RHIVC completely blocked and a collateral circulation network had been formed.