Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery最新文献

{"title":"Long-term outcomes of combined treatment of primary resectable pancreatic head cancer in patients over 70 years","authors":"L. G. Zhukova, R. Izrailov, N. N. Semenov, M. Mikhnevich, I. E. Khatkov","doi":"10.16931/10.16931/1995-5464.2024-1-81-89","DOIUrl":"https://doi.org/10.16931/10.16931/1995-5464.2024-1-81-89","url":null,"abstract":"   Aim. To evaluate long-term oncological outcomes of pancreatoduodenectomy in resectable pancreatic head cancer in patients over 70 years of age.   Materials and methods. A retrospective analysis of the Moscow Clinical Scientific Center registry revealed 63 patients aged > 70 years with resectable  pancreatic head cancer. In 2016–2023, these patients underwent pancreatoduodenectomy. Males accounted for 35 %, and the median age comprised 75 years. Stage II was diagnosed in 44.4 % of patients, stage I – in 31.7 %, and stage III – in 23.8 %. Median follow-up accounted for 34.5 months. The authors analyzed the effect of patient characteristics, tumor, perioperative data and method of surgery on overall survival.   Results. Adjuvant chemotherapy (p = 0.005; HR 0.28, CI 0.115–0.62) and low preoperative albumin levels (p = 0.004; HR 0.203, CI 0.28–0.61) had a significant impact on overall survival. After open surgery, 56 % of patients did not receive adjuvant chemotherapy, after minimally invasive surgery – 15.4 % (p = 0.0001).   Conclusion. Minimally invasive pancreatoduodenectomy reveals no negative effect on the oncological outcomes of treatment for resectable pancreatic head cancer in patients ≥ 70 years old. Adjuvant chemotherapy and hypoalbuminemia prior to surgery are considered to be statistically significant factors influencing overall survival. Minimally invasive techniques enable adjuvant chemotherapy to be administered to a larger number of patients compared to open intervention.","PeriodicalId":505469,"journal":{"name":"Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery","volume":" 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140391459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infectious complications after elective surgeries on the liver and pancreas","authors":"V.  . Zagainov, O. V. Ruina, N. V. Zarechnova, D. Kuchin, N. M. Kiselev, N. Naraliev, Sh. Kh. Mukhanzaev","doi":"10.16931/1995-5464.2023-4-71-80","DOIUrl":"https://doi.org/10.16931/1995-5464.2023-4-71-80","url":null,"abstract":"Aim. To analyze the complications of liver and pancreas surgeries, including infectious complications, and to describe the evolution of microbial flora in the hepatopancreatobiliary surgery unit.Materials and methods. The study involved 650 patients who underwent pancreatoduodenectomy and 1253 patients after liver resection. Types of preoperative biliary drainage were evaluated in terms of their influence on the treatment results. The incidence and nature of postoperative bile leakage were studied. The study included an analysis of microbial flora in the hepatopancreatobiliary surgery unit for 10 years.Results. The rate of significant complications, including infectious complications, appeared to be unaffected by a type of bile ducts drainage with potential infection at a standard course after pancreatoduodenectomy. A pancreatic fistula is considered to be a major factor in the development of abdominal infectious complications and the main cause of unfavorable outcomes. A bile leakage was most often revealed after liver resection in 95 observations (7.5%), and significantly more often after extensive liver resections. Gram-negative flora prevailed in bile from external drains of bile ducts and wound exudates in two thirds of cases. Gram-positive microorganisms were detected in one third of patients, fungi – in less than 5% of cases. The drainage fluids mostly obtained polyresistant gram-negative microorganisms. The majority of strains revealed resistance to cephalosporins, fluoroquinolones, penicillins, and an increasing resistance to carbapenems in dynamics.Conclusion. Bacterobilia after bile duct drainage significantly determines a microbial landscape of a hepatopancreatobiliary surgery unit. Pancreatodigestive anastomotic leakage is recognized as an important predictor of infectious complications in the area of intervention after pancreatoduodenectomy. Cases of this kind require the antimicrobial therapy with respect to the initial flora of the biliary tract. A bile leakage is considered to be a main contributor to infectious complications after liver resection. Extensive liver resection can lead to a sepsis-like state in the early postoperative period, predisposing to infectious complications.","PeriodicalId":505469,"journal":{"name":"Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery","volume":"456 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139179148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Puncture biliodigestive bypass in obstructive jaundice of tumor genesis","authors":"V. G. Ivshin, A. A. Tsybin, P. V. Kuznetsov","doi":"10.16931//1995-5464.2023-4-81-87","DOIUrl":"https://doi.org/10.16931//1995-5464.2023-4-81-87","url":null,"abstract":"The experience of successful surgical treatment of two patients with malignant non-resectable tumor of hepatopancreaticoduodenal organs complicated with obstructive jaundice using minimally invasive surgery is described in clinical observations for the first time. The patients underwent fluoroscopy-guided biliodigestive bypass. The study presents a detailed description of the technique and stages of surgery using Ivshin® surgical kit. The proposed method prevents from such negative consequences of palliative surgeries as formation of biliodigestive anastomosis by conventional access or external cholecystostomy, the main disadvantages of which include surgery injury, hypocholia, acholia, as well as water and electrolyte disorders.","PeriodicalId":505469,"journal":{"name":"Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139182312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic diagnosis and treatment for proximal biliary obstruction of tumor origin (literature review)","authors":"L. A. Marinova, M. D. Baidarova, A. Leonova, V. S. Shirokov","doi":"10.16931//1995-5464.2023-4-42-48","DOIUrl":"https://doi.org/10.16931//1995-5464.2023-4-42-48","url":null,"abstract":"Proximal biliary obstruction occurs in Klatskin tumor, intrahepatic cholangiocarcinoma, gallbladder cancer or metastatic lesion of the portal fissure and implies poor prognosis. Endoscopic techniques have been advanced towards more accurate diagnosis and safer drainage. Transpapillary brush and forceps biopsy are widely used for morphologic diagnosis. Development of diagnostic techniques includes peroral cholangioscopy and confocal laser endomicroscopy. Due to the development of various tools and advances in ERCP and EUS technologies, a number of technically and clinically successful procedures for high biliary obstruction is increasing. Nevertheless, stent parameters, potential of locoregional palliative care and some other aspects remain disputable. The literature review presents best practices of endoscopic diagnosis and treatment for proximal malignant biliary obstruction, obtained from the analysis of recent scientific publications.","PeriodicalId":505469,"journal":{"name":"Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery","volume":"1 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139182710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differentiated approach in providing care to patients with fresh bile duct injuries","authors":"R. Avanesyan, M. Korolev, L. Fedotov, M. E. Gorovoy","doi":"10.16931//1995-5464.2023-4-32-41","DOIUrl":"https://doi.org/10.16931//1995-5464.2023-4-32-41","url":null,"abstract":"Aim. To demonstrate the efficacy of minimally invasive surgery for bile duct injuries.Materials and methods. The results of combined minimally invasive treatment of 52 patients with fresh bile duct injuries from 2006 to 2023 were analyzed. Bile duct injuries diagnosed within 1–10 days after the operation were referred to as “fresh”. Intraoperative detection of bile duct injury was the criterion of exclusion from the analysis. In 80.8% of observations, combined minimally invasive interventions were performed in the form of percutaneous operations under ultrasound and radiography control. In 19.2% of observations, antegrade percutaneous and retrograde endoscopic access was used.Results. The algorithm for conducting minimally invasive procedures for bile duct injuries and strictures should be selected depending on the terms of injury and the character of injury and complications. In the majority of fresh bile duct injuries, a two-stage algorithm of duct patency restoration was applied. This prevented additional complications and allowed the patient to be prepared for stent biliary drainage after analyzing the primary data of fistula cholangiography. In all observations, minimally invasive procedures of bile duct patency restoration were completed with stent biliary drainage. Complications were noted in eight patients (15.4%).Conclusion. In fresh bile duct injuries, combined minimally invasive methods are an effective alternative to conventional reconstructive surgeries.","PeriodicalId":505469,"journal":{"name":"Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery","volume":"41 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139182649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Energy deficit in surgery on the examples of cholestasis and massive liver resection","authors":"E. I. Galperin","doi":"10.16931//1995-5464.2023-4-49-60","DOIUrl":"https://doi.org/10.16931//1995-5464.2023-4-49-60","url":null,"abstract":"The paper is dedicated to the energy processes associated with diseases in living organisms. Experiments involved 151 rats. Liver tissue was taken to determine its energy state in cholestasis (common bile duct ligation) and after resection of 60% and 80% of the parenchyma (without cholestasis). Adenine nucleotides (ATP, ADP, and AMP) and activity of gluconeogenesis enzymes were studied in cholestasis every 3 days for 15 days and after liver resection – every 6 hours for 3 days. Particular attention was paid to the energy deficit in liver tissue. A certain level of energy deficit n agent of metabolic stress. The experiments revealed that the energy deficit in the liver tissue increased by 15% by day 6 of cholestasis and by 48–50% of the initial energy level by days 12–15. The increase in energy deficit in liver tissue inversely correlated with the decrease in the activity of gluconeogenesis enzymes – by day 15 glucose-6- phosphate dehydrogenase reduced by 44% and isocitrate dehydrogenase – by 48% of the initial energy level. Decompression after 15 days from the onset of cholestasis was followed by an increase in energy deficit by 15%, as compared to the initial energy level, within 3–5 days. No development of metabolic stress was evidenced by a decrease in the activity of gluconeogenesis enzymes. After 12 hours after resection of 60% and 80% of the liver parenchyma, the liver energy deficit in both groups accounted for 50% of the initial energy level. After resection of 60% of the liver parenchyma, the energy deficit decreased rapidly: after 24 hours to 30%, after 72 hours to 11%; 2 rats out of 30 died during this period. After 12 hours after resection of 80% of the liver parenchyma, the energy deficit rose sharply: after 24 hours to 70% of the initial energy level. This led to the death of 26 animals out of 31. Both groups of animals demonstrated an inverse relationship between the decreased amount of energy used for hepatocyte function and the increased activity of key enzymes of gluconeogenesis. The obtained results suggest that in both groups of animals, metabolic stress developed after liver resection, however, after resection of 80% of the organ parenchyma, it “choked” due to the deficit of remnant hepatocytes. Most of the energy was spent for the development of regeneration. Metabolic stress and regeneration develop simultaneously. A deficit of 50% of energy in liver tissue with a further increase may indicate a critical condition, both in cholestasis and after a massive resection. The research into energy changes in cholestasis and after massive liver resections reveals new patterns of internal processes of the body.","PeriodicalId":505469,"journal":{"name":"Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery","volume":"11 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139182080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted liver resections in locally advanced intrahepatic cholangiocarcinoma","authors":"M. G. Efanov, N. Britskaia, P. V. Tarakanov, A. Koroleva, A. Vankovich, D. Kovalenko, V. Tsvirkun","doi":"10.16931//1995-5464.2023-4-61-70","DOIUrl":"https://doi.org/10.16931//1995-5464.2023-4-61-70","url":null,"abstract":"Aim. To evaluate the immediate results of robot-assisted liver resections in locally advanced intrahepatic cholangiocarcinoma.Materials and methods. The research methodology involved the analysis of intraoperative and direct results of robotassisted liver resections from 2015 to June 2023.Results. Total of 89 patients with intrahepatic cholangiocarcinoma underwent surgery. Open liver resection was performed in 59 cases (66.3%), laparoscopic resection – in 22 cases (24.7%), robot-assisted resection – in 8 cases (8.9%). The share of massive liver resections accounted for 83%. The average duration of robot-assisted liver resection amounted to 545 (327–640) minutes, blood loss volume – 300 (100–750) ml, number of resected lymph nodes – 7 (5–11), resection margin width – 6 (5–14) mm. All patients underwent extensive resection with elements of vascular or biliary resection. Severe complications developed only in half of the patients. No deaths or liver failures were reported. The average duration of hospital stay after surgery amounted to 11 (6–15) days.Conclusion. Robot-assisted liver resections expand the indications for minimally invasive surgeries in intrahepatic cholangiocarcinoma due to patients with locally advanced forms. Satisfactory immediate results justify further accumulation and evaluation of the experience of such interventions.","PeriodicalId":505469,"journal":{"name":"Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery","volume":"143 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139182684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver transplantation in Budd–Chiari patients with history of portacaval shunt surgery","authors":"D. A. Altman, A. E. Poltorak, E. A. Kitsenko, B. K. Sarsenbaev, I. Y. Bondarevsky, A. S. Ryzhikh, A. G. Istomin, T. E. Dorofeeva, M. A. Poltorak, E. M. Khalilov","doi":"10.16931//1995-5464.2023-4-93-99","DOIUrl":"https://doi.org/10.16931//1995-5464.2023-4-93-99","url":null,"abstract":"The paper presents the experience of successful treating a patient with diuretic-resistant ascites associated with Budd– Chiari syndrome. The authors provide a clinical observation of deceased donor liver transplantation to a patient with Budd–Chiari syndrome type 1, total hepatic vein occlusion, and diuretic-resistant ascites after portacaval shunt surgery. The post-transplantation period is observed as stable, with no signs of liver failure; ascites is reduced. The first experience of surgical treatment of a patient with Budd–Chiari syndrome, as well as the first experience of liver transplantation after portacaval shunting is appeared to be successful.","PeriodicalId":505469,"journal":{"name":"Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139182453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nodular hepatocellular carcinoma","authors":"L. Antipina, G. Dambaev, D. V. Vasilchenko, M. M. Solovev, A. P. Pisarev","doi":"10.16931//1995-5464.2023-4-88-92","DOIUrl":"https://doi.org/10.16931//1995-5464.2023-4-88-92","url":null,"abstract":"The paper describes a clinical observation of asymptomatic course and late diagnosis of hepatocellular carcinoma with solitary giant tumor atypically located “on a pedicle” in a liver segment. The patient independently detected a neoplasm in the abdominal cavity. The paper presents stages of outpatient laboratory and instrumental diagnostics. Pattern of 13 cm tumor growth in one segment of the liver was considered uncommon but appropriate for the surgery – atypical liver resection. Such location of the tumor raised doubts about the organ reference prior to surgery. The patient underwent successful surgical treatment, specific treatment and follow-up in a certain medical institution.","PeriodicalId":505469,"journal":{"name":"Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery","volume":"20 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139182414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstructive jaundice: epidemiology, diagnosis and choice of optimal method of biliary decompression","authors":"V. Darvin, P. S. Vetshev, S. V. Onishchenko, M. Lysak, T. Vardanyan, A. L. Kostrubin","doi":"10.16931//1995-5464.2023-4-16-23","DOIUrl":"https://doi.org/10.16931//1995-5464.2023-4-16-23","url":null,"abstract":"Aim. To analyze epidemiological features and morbidity structure in obstructive jaundice, to estimate the results of diagnosis and treatment of this category of patients and to evaluate factors affecting the effectiveness of the treatment and diagnostic program.Materials and methods. The study was based on four-year experience of treatment of 484 patients with mechanical jaundice. Ultrasound, CT, MRI, endoscopic ultrasound, and cholangioscopy were used to diagnose the level of the obstruction and the causes of obstructive jaundice. The main method of decompression involved transpapillary interventions in 365 patients. Two patients underwent choledochoduodenostomy under endoscopic ultrasound guidance. Percutaneous transhepatic interventions and “rendezvous” method were applied in 82 cases.Results. The efficacy of transpapillary endoscopic retrograde procedures in obstructive jaundice accounted for 93.4%. Complications developed in 33 patients (8.4%) including postmanipulation pancreatitis – in 19 patients (4.9%), pancreatonecrosis – in 2 patients (0.5%), bleeding – in 9 patients (2.3%), retroduodenal perforation – in 2 patients (0.5%), Mallory–Weiss syndrome – in 1 patient (0.3%). The efficacy of antegrade percutaneous transhepatic interventions comprised 95.1%, while liver parenchyma bleeding developed in 3.7% of patients. In-hospital mortality amounted to 0.8% (malignant tumor progression).Conclusion. The increasing share of patients with mechanical jaundice in the structure of general surgical emergencies, as well as the need to use high-tech equipment for diagnosis and treatment, necessitate creating centers for treatment of patients with mechanical jaundice. Retrograde and antegrade minimally invasive surgeries for specific indications are considered to be the main methods of biliary decompression.","PeriodicalId":505469,"journal":{"name":"Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery","volume":"13 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139182681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}