Background. The relevance of the treatment of hepatocellular cancer (HCC) is determined by a significant increase in the incidence rate and its high prevalence among primary malignant hepatic tumors.The aim of the study. To summarize the experience of providing specialized medical care to patients with hepatocellular cancer.Methods. We studied the direct results of treatment of patients with primary hepatic cancer treated at the Kuzbass Regional Hepatological Center for the period from January 2015 to August 2022. The materials for the study were medical records of patients with an established diagnosis of primary hepatic cancer, surgical records, results of pathohistologic examination. The exclusion criterion was diagnosed cholangiocellular carcinoma.Results. During the period from 2015 to 2022, 59 patients with primary hepatic cancer were treated at the Kuzbass Regional Hepatological Center. Among them, hepatocellular cancer was diagnosed in 48 cases, cholangiocellular cancer – in 11 cases; radical surgery was performed in 12 patients with hepatocellular cancer; fatal outcome was noted in 1 (2.1 %) patient, complications in the postoperative period developed in 5 (41.7 %) cases and were ranked as I-3, IIIb-1 and IVb-1 according to Clavien – Dindo classification.Conclusion. The degree of risk of severe post-resection hepatic failure should be considered one of the main criteria in choosing a strategy for radical surgical treatment. New surgical approaches (laparoscopic vascular isolation of the portal blood flow, using temporary hemostasis in laparoscopic hepatic resections and the device for its implementation) in resection surgery of primary hepatic cancer can improve the immediate results of treatment.
Postresection hepatic insufficiency is a formidable complication after liver resections, leading to an unfavorable course of the postoperative period and, often, to a fatal outcome. The article presents a clinical case of successful surgical treatment of tumor of the liver and prophylactics of hard remnant liver insufficiency. The article presents the results of treatment of a patient with a large liver tumor by a staged method, a review of the immediate data is given retrospectively by describing the course of diagnosis and treatment of the disease. We have illustrated a case of successful two-stage surgical treatment of a patient with a large hemangioma of the liver using laparoscopic ligation of the right branch of the portal vein, which makes it possible to prevent the development of severe post-resection liver failure.
A clinical case of successful radical multi-stage surgical treatment of a patient with bilobar parasitic lesion of the liver with echinococcosis complicated by infection of one of the cysts is presented. The patient was admitted to the clinic with volumetric lesions in both lobes of the liver. At the stage of differential diagnosis, on the basis of process verification by puncture biopsy under ultrasound control, the ethiology of mass lesions was reliably established. At the primary stationary stage, infection of one of the echinococcal cysts was diagnosed, for which the cyst was drained under ultrasound control. After that, the patient was discharged to the outpatient care for compensation, correction of the general level of health and nutritional status. At the next stage of the inpatient examination, the patient was determined to have an insufficient level of functional reserves of the liver to perform a radical operation. For this reason, laparoscopic ligation of the right branch of the portal vein was performed in order to develop vicarious hypertrophy of the contralateral lobe. After 30 days, the increased level of functional reserves of the liver made it possible to plan radical surgical treatment with an acceptable risk for the patient. The operation was performed in the amount of right-sided extended hemihepatectomy with marginal resection of the 3rd segment of the liver. The symptoms of liver failure in the postoperative period according to the ISGLS scale were regarded as Grade A. The patient was discharged from the hospital in a satisfactory condition on day 10 after the operation. In the postoperative period, courses of therapy with albendazole were prescribed according to the standard scheme. The patient is under observation for more than a year after treatment. The condition is satisfactory. No recurrence of the disease was noted.
Introduction. Echinococcosis of the liver with subtotal organ damage remains an urgent surgical problem. The development of surgical technologies does not stand still. In the modern scientific community, more and more publications appear that speak of good treatment results with the staged application of various surgical technologies and their combination in various options. The purpose of the study is to present and evaluate the results of treatment of operated patients with liver echinococcosis using a new diagnostic and treatment protocol for surgical treatment. Materials and methods. The results of treatment of 10 patients [4 men (40%), 6 women (60%)] with widespread parasitic lesions of the liver, who underwent 26 surgical interventions for liver echinococcosis in the surgical department No. 2 on the basis of the M.A. Podgorbunsky” in the period from 2017 to 2022. The difference in the number of operations performed and actual patients is explained by the use of a staged method of surgical treatment. Criteria for inclusion in the study group: the absence of an initial sufficient safe level of liver functional reserves to perform a one-stage extensive liver resection based on the results of a comprehensive assessment of clinical, laboratory and instrumental tests in conjunction with the use of a statistical prognostic model. Results. All patients (10/100%) from the study group underwent laparoscopic vascular isolation of the portal blood flow of the right lobe of the liver in order to create vicarious hypertrophy of the contralateral lobe and increase the reserve capacity of the liver. After objective confirmation of the effectiveness of the above surgical stage of treatment, assessment of the perioperative risk using a statistical model, all underwent extensive liver resections as the next stage. In the postoperative period, 8/80% of patients had post-resection hepatic insufficiency of class A (n = 4) and B (n = 4) according to the ISGLS classification. In two patients, the clinical picture and the absence of liver dysfunctions (synthetic, secretory, detoxification) made it possible to judge the absence of liver failure in the postoperative period. Against the background of conservative therapy, the phenomena of liver failure regressed. All patients were discharged in a satisfactory condition. Findings. Staged laparoscopic vascular isolation of portal blood flow is effective and safe. The use of a modern diagnostic algorithm for perioperative examination in combination with staged surgical techniques makes it possible to achieve good treatment results in a specialized surgical center/
Introduction: Surgical operations remain the main and most effective option for the treatment of liver echinococcosis. With the development and mastering of the method, laparoscopic operations are being used more and more widely. New technologies aimed at improving treatment outcomes are being developed and implemented in laparoscopic surgical methods. The purpose of the study is to present and evaluate the results of treatment of operated patients with liver echinococcosis using new technologies. Materials and methods: The results of treatment of 19 patients (9/47.4 % men, 10/52.6 % women) with liver echinococcosis, who were treated with organ-sparing laparoscopic resection techniques using new technologies in the surgical department No. M.A. Podgorbunsky. Results: There was no statistically significant advantage in dissection rate among the methods used (p = 0.74). In the group of patients with the applied hemostatic matrix Floseal, the time of hemostasis was significantly less than in the group without using the method (p = 0.001). In the group of patients with the improved laparoscopic Pringle maneuver, the blood loss was significantly less than in the group without using the technique (p = 0.00008). Findings: A new patented improved method of temporary hemostasis in laparoscopic resection interventions on the liver in the study proved its effectiveness. The use of the Floseal hemostatic matrix made it possible to reduce the time of hemostasis, and, accordingly, reduce the duration of the operation and reduce intraoperative blood loss in general. The laparoscopic method of surgical intervention using the above technologies is effective and safe in the treatment of medium-sized echinococcal liver cysts.
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