Novosti
Khirurgii

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Year 2012 Vol. 20 No 6

GENERAL AND SPECIAL SURGERY

A.E. SHCHERBA, L.V. KIRKOVSKY, A.M. DZYADZKO, E.L. AVDEY, A.F. MINOU, L.S. BOLONKIN, O.O. RUMO

LIVER RESECTION UNDER HYPOTHERMIC PERFUSION

ME “The 9th Minsk City Clinical Hosptal”,
Republican Scientific Research Center of Transplantation of Organs and Tissues,
The Republic of Belarus

Objectives. To demonstrate the experience of the liver resection applying methods of hypothermic perfusion in conditions of the total vascular exclusion at tumors and parasitic lesions localization in the hepatocaval confluence and/or inferior vena cava regions.
Methods. The treatment results of 155 patients who had undergone the liver resections (LR) were analyzed. Vascular occlusion techniques (Pringle maneuver, selective vascular isolation, total vascular exclusion (TVE)) were applied in 80 patients (51,6%). Pringle maneuver was used in 68 patients (43,8%), selective vascular isolation in 42 (27%), total vascular isolation (TVI) – in 4 (6%) and TVE with hypothermic perfusion in 5 (3,3%).
Results. The average time of LR was longer at TVI with hypothermic perfusion, 712±155 min, then at standard major LR, 280±154 min (Mann-Whitney, p=0,00001). The average blood loss at LR with TVI and hypothermic perfusion (n=9) was 2880±1948 ml and 588±478 ml at standard major LR (n=47; Mann-Whitney, p=0,00003). Hepatic failure developed in 1 of 5 LR at hypothermic perfusion (20%) and in 7 of 47 standard major LR (14,9%). Biliary complications developed in 3 of 9 (33,3%) LR with TVI and hypothermic perfusions and in 9 of 47 (19,1%) at standard major LR, but the difference was not statistically significant. There were no mortality cases after LR with TVI and LR with hypothermic perfusions. Mortality after standard major LR made up 6,3% (3 of 47; Fisher test, p=0,9).
Conclusions. Liver resection at the hypothermic conservation promotes the overcoming limitations of the thermal ischemia and brings an additional time for resection and reconstruction as well as expands the possibilities of the resection surgery and permits to avoid the liver transplantation at benign hardly accessible liver tumors.

Keywords: liver resection, hypothermic liver perfusion
p. 45 – 52 of the original issue
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Address for correspondence:
220116, Respublika Belarus, g. Minsk, ul. Semashko, d. 8, UZ «9-ya Gorodskaya klinicheskaya bolnitsa g. Minska», RNPTs Transplantatsii organov i tkaney, otdel transplantologii,
e-mail: aleina@tut.by,
Scherba Aleksey Evgenevich
Information about the authors:
Shcherba A.E. Candidate of medical sciences, head of the transplantation department of ME “The 9th Minsk City Clinical Hospital”
Kirkovsky L.V. Candidate of medical sciences, surgeon of the portal hypertension chair of ME “The 9th Minsk City Clinical Hospital”, RSRC of Transplantation of organs and tissues
Dzyadzko A.M. Candidate of medical sciences, head of the anesthesiology and resuscitation department of ME “The 9th Minsk City Clinical Hospital”
Avdey E.L., Candidate of medical sciences, head of the portal hypertension chair of ME “The 9th Minsk City Clinical Hospital”, RSRC of Transplantation of organs and tissues
Minou A.F., head of the anesthesiology department of ME “The 9th Minsk City Clinical Hospital”, RSRC of Transplantation of organs and tissues
Bolonkin L.S., anesthesiologist of the anesthesiology department of ME “The 9th Minsk City Clinical Hospital”, RSRC of Transplantation of organs and tissue.
Rumo O.O. Doctor of medical sciences, deputy head physician on surgery of ME “The 9th Minsk City Clinical Hospital”, head of RSRC of Transplantation of organs and tissues.
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