Результаты резекционных вмешательств на печени на фоне хронической диффузной гепатопатии

Abstract

Relevance Improvement of the technical aspects of performing liver resections allowed to neutralize the risk of many specific postresection complications. However, among the last until now, post-resection hepatic failure (PHF) remains a difficult problem, which on the background of diffuse changes in the liver, significantly complicates the postoperative period. The purpose of the study To evaluate an influence of concomitant chronic diffuse liver disease on the results of resections performed for benign and malignant focal lesions of the liver. Materials and methods To assess the impact of chronic diffuse liver process in the frequency of complications of liver resections analyzed a control group of patients (81 patients), operated in the department of surgery of the liver and biliary tract and in the department of surgery of portal hypertension and pancreatoduodenal zone during the period from 1998 to 2009. Patients were divided into a group with concomitant diffuse liver disease (chronic viral hepatitis and steatosis) - 53 patients (65.4%) and a group of 28 patients without concomitant liver pathology. Results and their discussion Study the frequency of PHF showed that the development of severe complications in the early postoperative period is clearly correlated with the presence of diffuse liver disease. Thus, in patients without chronic liver diseasePHF occurred in 2 cases against the background of extensive liver resections, which amounted to 7.1% (2/28). In patients with hepatic pathology, the incidence of PHF of varying severity amounted to 18.9% (10/53). The overall incidence of PHF in the study group was 14.8% (12/81). On the background of extensive liver resections PHF complicated the postoperative period, more than twice as often in the presence of chronic liver disease, 28.6% versus 13.3% (8/28 vs. 2/13). At segmental resections PHF occurred only in patients with chronic pathologies in the liver and was 8.0%. The presence of concomitant chronic diffuse liver disease causes a significant decrease in functional status of hepatocytes, which represents a decline of hepatic extraction fraction at 17,1% (67,5 ± 2,3% against 81,4 ± 1,9%) and an increase in half-life of the radiopharmaceutical drop to 26 5% (37,2 ± 1,7 min vs. 29,4 ± 1,2 m) (P <0,001) relative to the group without parenchymatous processes. Conclusion Performing of resection interventions in focal liver disease with chronic diffuse pathology of a liver increases the risk of PHF, which is associated with reduced functional reserve of hepatocytes and slowing compensatory regeneration process.