Мета. Порівняння функціональної активності печінки після трансплантації правої частки від живого родинного донора з серединною веною та без неї. Матеріали і методи. Проаналізовано результати 75 трансплантацій правої частки печінки від живого родинного донора у двох групах реципієнтів: 1–ша група – реципієнти (37), яким трансплантовано праву частку печінки з серединною веною, 2–га група – реципієнти (38), яким трансплантовано праву частку печінки без серединної вени. Для аналізу використовували дані біохімічних показників крові в обох групах протягом першого тижня та на 10, 14, 21, 30–ту добу після трансплантації. Результати. Встановлено, що пікові рівні аланінамінотрансферази (АЛТ), аспартатамінотранферази (АСТ) і загального білірубіну були вищими у 2–й групі (відповідно 384,43; 399,77 і 206,70), ніж у 1–й групі (відповідно 212,64; 285,57; 203,18). Суттєвої різниці між рівнями гамаглутамілтранспептидази (ГГТП), лужної фосфотази (ЛФ), показниками протромбінового часу (ПЧ) і міжнародного нормалізованого співвідношення (МНС) не було. Висновки. Формування адекватного венозного відтоку від п’ятого та восьмого сегментів трансплантата правої частки печінки забезпечує ефективність його функціонування. Функція трансплантата правої частки печінки з серединною веною відновлюється більш повноцінно порівняно з трансплантатом без серединної вени за рахунок відсутності венозного застою в правій частці печінки.
Objective. To estimate the immediate and late results in recipients while transplantation of the hepatic right part with median hepatic vein and without her. Маterials and methods. Postoperative data about 86 patients, to whom the hepatic right half was transplanted in 2003 - 2018 yrs., with the objective to estimate the impact of presence of median hepatic vein in the transplant on the morbidity rate development, were analyzed. The patients were divided into two groups: Group I - the patients, to whom the hepatic right half was transplanted without median hepatic vein, while Group II - the patients, to whom the hepatic right half was transplanted with median hepatic vein. Results. The investigation have revealed a higher rate of vascular complications in patients, to whom the hepatic right half was transplanted without median hepatic vein, comparing with the patients, to whom the hepatic right half was transplanted with median hepatic vein. The infection-septic complications have developed more frequently in patients, to whom the hepatic right part was transplanted without median hepatic vein. Nonspecific surgical morbidity developed in 10 (23.3%) patients of the Group I and in 8 (18.6%) patients of the Group II. The rate of development of the small hepatic transplant syndrome was higher in the Group I. Оne-year, two-year and five-year survival in the Group I have constituted 79, 72 and 69% accordingly, in the Group II - 83, 74 and 70% accordingly. Conclusion. Our experience of performance of the hepatic right half transplantation witnesses, that presence of median hepatic vein in the transplant correlates with lowering of the postoperative morbidity rate, as well as with frequency of development the small hepatic transplant syndrome, postoperative mortality and the stationary stay duration.
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Objective. To analyze late results of preoperative embolization of the portal hepatic vein branches (EPHVB) in patients, suffering extended hepatic tumors and extremely border-like small calculated residual hepatic volume(CRHV). Маterials and methods. From 2004 to 2014 yr the extended hepatic resection (HER) was performed in 285 patients, to whom EPHVB was applied (the main group), аnd in 353 patients as well, but without endovascular preparation (control group). In both groups dynamics of laboratory indices, structure of complications and lethality, late survival were studied. Results. In the main group a trustworthily lower rate of an acute hepatic insufficiency and connected with a lower postoperative lethality - accordingly 2.3 and 4.6%, comparing with a control group - 9.3 and 8.8%, were suggested. The laboratory data dynamics have witnessed a lesser intensiveness of postoperative hepatocytolysis and lesser degree of the hepatic synthetic function lowering in the main group, what have confirmed a better functional adaptation of hepatic residual in patients, to whom preoperative EPHVB was applied. Conclusion. Preoperative EPHVB permits to lower the postoperative complications and lethality rate in patients, suffering hepatic tumors, due to better functional adaptation of hepatic residual.
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