To investigate the feasibility and safety of autologous round ligament graft for vascular reconstruction in the treatment of advanced hepatic alveolar echinococcosis involving the posterior inferior vena cava.

Clinical data of 8 patients with advanced hepatic alveolar echinococcosis admitted to Qinghai Provincial People's Hospital from January 2018 to July 2019 were retrospectively analyzed. Among them, 5 patients were male and 3 female, aged from 18 to 56 years with a median age of 37 years. The informed consents of all patients were obtained and the local ethical committee approval was received. Preoperative imaging examination prompted the diagnosis of hepatic alveolar echinococcosis involving the first porta hepatis and posterior inferior vena cava. 8 patients were classified as stage P4N0M0, and the lesions were mainly located in the right liver lobe. Surgical condition and postoperative recovery were observed.

All 8 patients completed staged hepatectomy successfully, including 2 cases of extended right hemihepatectomy and 6 cases of right hemihepatectomy. Intraoperatively, 3 cases received reconstruction of posterior inferior vena cava and the first porta hepatis, and 5 cases received reconstruction of posterior inferior vena cava. No perioperative death was reported. The average operation time was (518±140) min. Intraoperative blood loss was (746±212) ml. The length of hospital stay was (16.1±2.5) d. A large amount of right pleural effusion occurred in 2 cases after operation, who were cured with ultrasound-guided thoracic puncture and drainage. Abdominal encapsulated ascites was observed in 1 case, who was healed by ultrasound-guided catheter drainage. Grade A bile leakage occurred in 1 case, who was cured after drainage and anti-infection treatment. All patients were followed up for 12-23 months, with a median of 15 months. No anastomotic stenosis, embolism or recurrence occurred during postoperative follow-up.

For patients with advanced hepatic alveolar echinococcosis involving the posterior inferior vena cava, autologous round ligament graft is a safe, convenient and economical surgical approach for the inferior vena cava reconstruction after radical hepatectomy.