两期广泛切除干预在肝播散性包虫病手术治疗中的效果

A. O. Krasnov, K. A. Krasnov, V. A. Peltz, O. A. Krasnov, V. Pavlenko
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引用次数: 0

摘要

介绍。外科手术是治疗肝包虫病的主要和有效的选择。在假定器官功能储备不足和术后肝功能不全的情况下,晚期肝包虫病手术干预类型的选择问题仍然是热门话题。该研究的目的是介绍和分析两期广泛切除干预治疗晚期肝包虫病的有效性。材料和方法。本文介绍了在克麦罗沃以M.A. Podgorbunskiy命名的库兹巴斯临床急救医院第二外科收治的22例患者的手术治疗结果,其中男性8例(36.4%),女性14例(63.6%)。纳入研究的标准是采用两阶段广泛切除方案。我们研究中用于预防术后肝衰竭的手术分期方法在以下参数上显示出有效性:CT体积(p < 0.05), 15分钟吲哚菁绿残留浓度(p < 0.05),统计预测模型值(p < 0.05),并允许患者在足够的安全性水平下为切除广泛干预做好准备。广泛切除后特异性并发症9例(40.1%),非特异性并发症3例(13.6%)。特异性并发症以PPN表现为主,6例(66.7%),其中按ISGLS分级为A类5例(83.3%),B类1例(16.7%)。在任何研究组中都没有死亡或复发。在分析文献时,人们倾向于寻找有效和安全的方法来阻止肝门静脉系统的血流,以实现残余的代行性肥大。一种常见的获得未来肝残余代发性肥厚的技术是对门静脉血流进行不透射线的手术栓塞。然而,该程序的可用性存在技术限制。腹腔镜右门静脉分支夹持术是另一种手术选择。实现残余肝脏代行性肥厚的技术已被证明是有效的,并为广泛切除肝脏的患者做好了准备。对于晚期肝包虫病,在专门的肝病中心进行两阶段广泛切除干预是有效和足够安全的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Efficiency of two-stage extensive resection interventions in the surgical treatment of patients with disseminated echinococcosis of the liver
Introduction. Surgical operations are the main and effective option for treatment of hepatic echinococcosis. The problem of the choice of the type of surgical intervention in the advanced form of hepatic echinococcosis in the conditions of supposed deficiency of the organ functional reserves and development of post-resection hepatic insufficiency remains topical.The aim of the study was to present and analyze the effectiveness of two-stage extensive resection interventions in patients with advanced liver echinococcosis.Materials and methods. The paper presents the results of surgical treatment of 22 patients, 8 male (36.4%) and 14 female (63.6%) operated in the surgical department № 2 of Kuzbass Clinical Emergency Hospital named after M.A. Podgorbunskiy in Kemerovo. The criterion for inclusion in the study was to use of a two-stage extensive resection protocol.Results. The surgical staging methods used in our study to prevent post-resection liver failure showed efficacy in the following parameters: CT volumetry (p < 0.05), residual concentration of indocyanine green at 15 minutes (p < 0.05), statistical predictive model value (p < 0.05) and allowed to prepare patients for resection extensive intervention with a sufficient level of safety. Specific postoperative complications after extensive resection were identified in nine patients (40.1 %) and non-specific complication in three patients (13.6 %). Specific complications are mainly represented by manifestations of PPN manifistations − six cases (66.7 %), including 5 cases (83.3%) with “A” category according to ISGLS, with “B” category − one case (16.7 %). There were no fatalities or relapses in any of the study groups. Discussion When analysing the literature, there is a tendency to search for effective and safe methods of stopping the blood flow of the liver portal system in order to achieve vicarious hypertrophy of the remnant. A common technique for obtaining vicarious hypertrophy of the future liver remnant is radiopaque endosurgical embolization of the portal blood flow. However, there are technical limitations to the availability of the procedure. Laparoscopic clipping of the right portal vein branch is an alternative surgical option.Conclusion. Techniques to achieve vicarious hypertrophy of the liver remnant have proven effective and have prepared patients for extensive liver resections. Two-stage extensive resection interventions for advanced liver echinococcosis are effective and sufficiently safe when performed in specialised hepatology centres.
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