Бюллетень сибирской медицины (Jun 2014)
PALLIATIVE RESECTIONS OF A LIVER USING CRYODESTRUCTION FOR THE PATIENTS WHO HAVE BEEN REPEATEDLY OPERATED FOR ALVEOCOCCOSIS
Abstract
The purpose of work was the assessment of influence of a palliative resection of a liver with application of cryodestruction and without cryodestruction application on the remote results of treatment of the patients who have been repeatedly operated for alveococcosis.The analysis of surgical treatment of 14 patients operated repeatedly for alveococcosis of a liver is carried out. Patients were operated in the complicated stage of a disease in the presence of germination of a parasite in caval and/or portal gate of organ. Primary interventions were various – a diagnostic laparotomy, a cytoreduction and a marsupialization of a parasite, a liver resection. All patient at repetition intervention executed palliative resections of a liver. Resections were carried out by a clinic technique with imposing the ginglymoid of ligatures on remaining tissue of a liver at distance of 2–3 cm from the deleted parasitic knot taking into account a segmentary structure of organ. At all patients on "dangerous zones" (a zones of gate of a liver, a hepatoduodenal ligament) plates of parasitic fabric of various sizes from 1 2 cm to 2 4 cm were left. At 10 patients they were exposed to cryodestruction. The exposition in one point made from 1 to 2 minutes at a temperature –196 С. Postoperatively, patients received a dose of 10 mg/kg albendazole.Development of hepatic insufficiency after palliative resections of a liver is noted in one case. Lethal outcomes weren't.All patients for convenience of the analysis were divided into two groups: group of patients without application of cryotechnologies (n = 4) and group of the patients operated with application of cryodestruction (n = 10). Efficiency of palliative resections estimated on a median of survival of patients. Calculation of survival carried out Kaplan–Meier's method. The survival median in groups made 12 and 17 years respectively.When comparing survival of patients by Gehan's test with Yates's correction distinction of survival in two selections are statistically significant (z = 2,94; p < 0,005).Among patients repeatedly operated for alveococcosis when involving in parasitic process of gate of a liver, lack of possibility of prosthetics of vascular structures and developments of a compensatory hypertrophy of not struck departments of body the palliative resection allows to achieve survival of 50% of patients more than 16,8 years.Cryodestruction is the effective and safe method, allowing to increase survival of patients after a p alliative resection of a liver, through the destruction left in the area of the liver gate parasitic tissue sections.
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