Abstract
Aim. Analysis of the techniques of advanced liver resections involving transplantation technologies which affect the results of surgery for advanced liver alveococcosis.Material and methods. There were 65 patients with massive complicated liver alveococcosis for the period from 2008 to 2018. Radical procedures were applied in 82% of cases (n = 53). Mechanical jaundice was observed in 45% ofpatients, portal hypertension — in 25%. Previous palliative surgery was applied in 58% of patients. Thirty-three patients (50.8%) had advanced parasitic lesion with involvement of afferent and (or) efferent vascular structures. Distant metastases were detected in 6 patients: metastatic lung lesions occurred in 5 of them, simultaneous injury of brain and lungs — in 1 case.Results. There were 47 RO-resections with application of transplantation technologies including 4 extracorporeal resections and 6 orthotropic liver transplantations. Reconstruction of great afferent and efferent vascular structures was performed in 47% of cases: IVC repair — 25 cases, PV repair — 25 cases. Resection of extrahepatic bile ducts was made in 33 cases. Postoperative complications occurred in 26 cases: Clavien-Dindo type II — 5, IIIb — 13, IVb — 2, V — 6. Bile leakage ISGLS class B occurred in 6 cases, class C — in 11 cases.Conclusion. Transplantation technologies for advanced liver resections and liver or its segment transplantation allow to achieve radical surgery in 82% of patients. Advanced operations are indicated for advanced liver alveococcosis due to good outcomes. There are various technical aspects of such operations which are useful to avoid most of complications.
Highlights
Выполнено 47 резекционных вмешательств R0 с применением трансплантационных технологий, из них 4 экстракорпоральных резекции и 6 трансплантаций печени
Mechanical jaundice was observed in 45% of patients, portal hypertension – in 25%
Reconstruction of great afferent and efferent vascular structures was performed in 47% of cases: IVC repair – 25 cases, PV repair – 25 cases
Summary
Более века прошло после первого описания альвеококкоза печени немецким ученым Franz Buhl в 1852 г. С внедрением в клиническую практику трансплантации печени (Starzl, 1967) как метода лечения неизлечимых заболеваний печени и внедрением трансплантационных приемов в резекционную хирургию печени хирургия альвеококкоза получила новый виток развития [7]. Первая трансплантация печени по поводу альвеококкоза была выполнена Gillet в 1986 г. Влияние иммуносупрессивной терапии после ОТП на рецидивирование и прогрессирование альвеококкоза не изучено [21–23]. Для профилактики рецидива заболевания после резекции и трансплантации печени рекомендована адъювантная терапия альбендазолом [26]. Двадцатилетняя выживаемость после радикального оперативного лечения и адъювантной лекарственной терапии на протяжении 2 лет достигает 98,9%, а рецидив заболевания развивается в 5,6% наблюдений [27–29]. Трансплантация печени, по данным мультицентрового исследования, также демонстрирует приемлемые показатели: выживаемость составляет 90, 85 и 75% через год, 5 и 10 лет после ОТП [30]. Применяемых при обширной резекции печени с использованием трансплантационных технологий при распространенном альвеококкозе печени
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