Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 23
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Khirurgiia (Mosk) ; (11): 27-33, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34786913

RESUMO

OBJECTIVE: To study the risk factors of severe blood loss in extensive liver resections, consequences of hemorrhagic problems and their correction. MATERIAL AND METHODS: The study included 374 patients. Group 1 comprised 282 patients (118 men and 164 women aged 54.1±0.7 years) who underwent surgery between 2000 and 2012. Group 2 included 92 patients (34 women and 58 men aged 53.6±1.3 years) operated on for the period 2013-2019. RESULTS: Technical equipment for mobilization and dissection of hepatic parenchyma has fundamentally changed for the period 2013-2019. This processes reduced blood loss by more 50% and consumption of donor blood components (red blood cells by 2.8 times, FFP by 1.8 times). Compression of hepatoduodenal ligament (Pringle maneuver) and tumor type did not affect intraoperative blood loss. Neoplasms over 10 cm increased blood loss. An increase in the number of resected segments by 2 times contributed to increase of blood loss by 2.7 times. Body mass index >25 kg/m2 was also associated with higher blood loss.


Assuntos
Hepatectomia , Neoplasias Hepáticas , Perda Sanguínea Cirúrgica/prevenção & controle , Feminino , Hepatectomia/efeitos adversos , Humanos , Fígado , Neoplasias Hepáticas/cirurgia , Masculino , Fatores de Risco
2.
Khirurgiia (Mosk) ; (7): 111-118, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32736475

RESUMO

The researches devoted to blood-saving technologies in extensive liver resections are analyzed in the manuscript. Resection of three and more liver segments is effective method of surgical treatment of various focal liver lesions. Surgical (anatomical resection with hilar glissonean access, Pringle maneuver, modern technical equipment, etc.), anesthesiological (reduction of central venous pressure, hemostatic agents) and transfusion (autologous blood donation, transfusion, cell saver, etc.) methods contribute to prevention and reduction of blood loss. Intraoperative measures for blood loss prevention should include adequate surgical incision and liver mobilization, precise techniques of parenchymal dissection (for example, cavitation surgical aspirator-destructor), use of clip applicators and local or systemic hemostatic agents.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Hemostasia Cirúrgica/métodos , Hepatectomia/métodos , Hepatopatias/cirurgia , Fígado/cirurgia , Humanos , Fígado/irrigação sanguínea , Recuperação de Sangue Operatório/métodos
3.
Khirurgiia (Mosk) ; (1): 25-32, 2020.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-31994496

RESUMO

OBJECTIVE: To analyze the immediate results of PDE in patients younger and older 70 years. MATERIAL AND METHODS: The study included patients who underwent PDE for various indications from March 2010 to February 2019. All patients are divided into 2 groups: <70 years old and ≥70 years old. Primary endpoints were postoperative mortality and complication rate. RESULTS: There were 110 procedures within 9 years. There were 93 patients aged <70 years (group 1) and 17 patients aged ≥70 years (group 2). ASA (American Society of Anesthesiologists) and PMP scores (Preoperative Mortality Predictor) were higher in group 2: 3 (2-3) vs 2 (1-3) (p=0,002) and 12 (6-15) vs 6.5 (5-15) (p<0.001), respectively. Mortality rate was higher in group 2 (11.7% vs. 3.2%) without statistical significance (p=0.16). Overall morbidity (72% vs 76%; p=1.0), incidence of major complications grade ≥IIIa (29% vs 29%), delayed gastric emptying B/C (17.2% vs 17.6%), pancreatic fistula grade B/C (23.6% vs 35.3%, p=0.3), biliary fistula grade B/C (7.5% vs 11.8%; p=0.62), postoperative hospital-stay [22 (8-165) days vs 23 (9-71) days; p=0.92] were comparable in both groups. CONCLUSION: Short-term results of PDE in patients aged <70 and ≥70 years are comparable despite higher ASA and PMP scores in the group 2. General status and concomitant diseases should be considered during selection of patients with resectable tumors for PDE. Age per se is not a contraindication for surgery.


Assuntos
Pancreatopatias/cirurgia , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/mortalidade , Fatores Etários , Idoso , Humanos
4.
Khirurgiia (Mosk) ; (12): 45-49, 2018.
Artigo em Russo | MEDLINE | ID: mdl-30560844

RESUMO

Liver resection remains the method of choice for treatment of colorectal liver metastases with good long-term results. Regional lymph nodes involvement is significant negative prognostic factor. Moreover, it has been considered as a contraindication for liver resection for a long time. The role of lymphadenectomy remains controversial. Current state of this problem is reviewed in the article. Liver regional lymph nodes involvement takes place in 10-20% of cases. PET/CT is the most sensitive method of preoperative diagnosis. Involvement of liver regional lymph nodes is currently not absolute contraindication for liver resection. Routine lymphadenectomy does not make sense, and, perhaps, is justified only within scientific trials for more accurate disease staging. Indications for lymphadenectomy are suspicious changes of lymph nodes revealed by preoperative visualization methods or by intraoperative exploration. Modern chemotherapy regimens allow to reconsider the prognostic importance of liver regional lymph node metastases and to extend indications for liver resections.


Assuntos
Neoplasias Colorretais/secundário , Neoplasias Hepáticas/terapia , Excisão de Linfonodo , Linfonodos/patologia , Antineoplásicos/uso terapêutico , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/patologia , Neoplasias Colorretais/terapia , Hepatectomia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Linfonodos/diagnóstico por imagem , Metástase Linfática , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Prognóstico
6.
Khirurgiia (Mosk) ; (1): 4-9, 2018.
Artigo em Russo | MEDLINE | ID: mdl-29376950

RESUMO

AIM: To analyze immediate and long-term results of surgical treatment of patients with non-functioning pancreatic neuroendocrine tumors (pNETs). MATERIAL AND METHODS: Outcomes in 21 patients with non-functioning pNETs were retrospectively analyzed. RESULTS: Long-term results were followed-up in 18 (85%) cases, median follow-up was 39 months. Postoperative mortality was 4.7%. The incidence of postoperative complications Clavien-Dindo degree IIIA and over was 20.8%, overall 5-year survival - 89%, desease-free 5-year survival - 78%. CONCLUSION: At present time surgical intervention remains the only radical method of non-functioning pNETs management. Threshold tumor dimension should be 15 mm that determines surgical intervention or active surveillance. From an oncological point of view tumor enucleation is permissible only in case of small dimensions (up to 2 cm) and full confidence in low degree of malignancy. Lymphadenectomy should be performed in all cases in standard fashion because lymph node involvement is reliably poor prognostic sign.


Assuntos
Excisão de Linfonodo/métodos , Pancreatectomia , Neoplasias Pancreáticas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Avaliação de Processos e Resultados em Cuidados de Saúde , Pancreatectomia/efeitos adversos , Pancreatectomia/métodos , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/fisiopatologia , Neoplasias Pancreáticas/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Prognóstico , Carga Tumoral
7.
Khirurgiia (Mosk) ; (12): 36-40, 2017.
Artigo em Russo | MEDLINE | ID: mdl-29286028

RESUMO

AIM: To present own experience of surgical treatment of isolated pancreatic metastases of renal cell carcinoma. MATERIAL AND METHODS: There are 3 cases of pancreatic metastases of renal cell carcinoma. They were diagnosed in women aged 55, 66 and 67 years in 9, 11 and 23 years after nephrectomy respectively. RESULTS: The tumors were placed in head (60 mm), body (10 and 5 mm) and tail (30 mm) of the pancreas. There were 2 distal pancreatectomy with splenectomy and 1 pancreatoduodenectomy. All patients are alive within 39, 49 and 8 months after surgery respectively. One woman has been diagnosed pulmonary metastases after 19 months. 20-month sunitinib administration contributes to regression of the disease. There was no recurrent disease in other two patients. CONCLUSION: Isolated pancreatic metastases of renal cell carcinoma can occur in decades after nephrectomy. Therefore, lifelong follow-up is necessary. Pancreatectomy for focal lesion is associated with good long-term outcome.


Assuntos
Carcinoma de Células Renais , Indóis/administração & dosagem , Neoplasias Renais , Neoplasias Pulmonares , Nefrectomia/efeitos adversos , Pancreatectomia , Neoplasias Pancreáticas , Complicações Pós-Operatórias , Pirróis/administração & dosagem , Idoso , Antineoplásicos/administração & dosagem , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/cirurgia , Feminino , Humanos , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Pâncreas/cirurgia , Pancreatectomia/efeitos adversos , Pancreatectomia/métodos , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/secundário , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Sunitinibe , Resultado do Tratamento
9.
Khirurgiia (Mosk) ; (12): 4-18, 2016.
Artigo em Russo | MEDLINE | ID: mdl-28091451

RESUMO

AIM: To study surgical and oncological outcomes in patients with metastatic colorectal liver cancer who underwent radiofrequency ablation in the structure of combined approach. MATERIAL AND METHODS: It is a prospective analysis of treatment of 76 patients with metastatic colorectal liver cancer who underwent RFA for the period 2004-2013. Overall survival was analyzed using univariate and multivariate analysis. RESULTS: According to univariate analysis overall 5-year survival is negatively determined by following factors: primary localization of the tumor in rectum (36.2% and 7.2%; p=0.021); bilobed metastatic liver disease (35.9% and 15.4%; p=0.068); metastases dimensions over 5 cm (27.4% and 0%, p=0.091); augmentation of CAE levels over 4 norms (26.7% and 11.4%, p=0.09); RFA as a component of two-stage liver surgery (23.3% and 26.0%, p=0.09). CONCLUSION: RFA is an effective method of local antineoplastic effect for metastatic colorectal cancer. Dimensions of coagulated metastases, volume of metastatic lesion, carcinoembryonic antigen level, ablation as a component of two-stage surgery affect long-term survival after RFA.


Assuntos
Neoplasias Colorretais/cirurgia , Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Ablação por Radiofrequência , Neoplasias Colorretais/patologia , Humanos , Neoplasias Hepáticas/secundário , Estudos Prospectivos , Análise de Sobrevida
11.
Khirurgiia (Mosk) ; (9): 23-9, 2014.
Artigo em Russo | MEDLINE | ID: mdl-25327741

RESUMO

Major hepatic resection is often necessary for cure in patients with multiple colorectal cancer metastases but low future liver remnant (FLR) volume makes surgery risky because of the posthepatectomy liver failure (PHLF). Right portal vein ligation/embolization and two-stage hepatectomy were proposed previously to overcome this problem. Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel approach aimed for FLR volume hypertrophy. During the first stage right portal vein is ligated followed by liver parenchyma in situ splitting. Right liver lobe removal is performed during the second stage when FLR hypertrophy becomes sufficient. Three patients with colorectal cancer liver metastases were scheduled for major hepatic resection. ALPPS was applied because of insufficient FLR volume. We observed FLR hypertrophy of 77, 90 and 70% after 7, 7 and 14 days waiting period. FLR/Total Liver Volume ratio increased from 22, 23 and 15% to 33, 35 and 32% respectively. The second stage was performed successfully in all patients. All patients are alive and they have not disease relapse after 17, 15 and 15 months after surgery. ALPPS is promising technique that allows rapid FLR hypertrophy and enables curative liver resections in initially unresectable patients. But it is necessary more data concerning ALPPS safety and long-term results.


Assuntos
Neoplasias Colorretais/patologia , Hepatectomia , Ligadura/métodos , Falência Hepática , Neoplasias Hepáticas , Veia Porta , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Vasculares , Adulto , Pesquisa Comparativa da Efetividade , Hepatectomia/efeitos adversos , Hepatectomia/métodos , Humanos , Cuidados Intraoperatórios/métodos , Falência Hepática/etiologia , Falência Hepática/prevenção & controle , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia , Radiografia , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/métodos
12.
Khirurgiia (Mosk) ; (3): 37-41, 2013.
Artigo em Russo | MEDLINE | ID: mdl-23612336

RESUMO

Two-stage liver surgery with preliminary right portal vein occlusion procedure (ligation or embolisation) became standard in clinical practice and allows liver resections in 60-82% of initially inoperable patients. Right portal vein ligation with concomitant liver partition in situ (in situ splitting, ISS) is innovatory and promising approach. Right portal vein ligation and in situ splitting was performed in 40 years old male with two metachronous rectal metastases in right liver lobe and insufficient volume of future liver remnant (22%). MRI on 7th postoperative day showed left liver lobe hypertrophy rate of 77% and left liver lobe volume increase from 22 to 33.5%. Right hemihepatectomy was performed on day 8 after the first stage. There were no signs of postoperative liver failure. Conclusion. New two-stage surgery approach (ISS) can decrease number of patients who were inoperable because of insufficient volume of future liver remnant and high risk of postoperative liver failure.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias Colorretais/patologia , Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Veia Porta/cirurgia , Adenocarcinoma/diagnóstico , Adenocarcinoma/secundário , Adulto , Seguimentos , Humanos , Ligadura/métodos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/secundário , Imageamento por Ressonância Magnética , Masculino
13.
Khirurgiia (Mosk) ; (2): 8-16, 2013.
Artigo em Russo | MEDLINE | ID: mdl-23503377

RESUMO

The article highlights survey stakes of surgical hepatology in world and Russia, and the 20 years experience of the Russian Scientific Center of Surgery named after B.V. Petrovskiy. 472 liver resections were performed during the period. Main indications for surgery were malignant liver tumors, predominantly metastatic (75.8%). Technical and tactical questions, as well as treatment results were discussed. The issue compares own data with world's experience.


Assuntos
Gastroenterologia/história , Cirurgia Geral/história , Hepatopatias/história , Centros Cirúrgicos/história , História do Século XX , História do Século XXI , Humanos , Hepatopatias/cirurgia , Federação Russa
14.
Khirurgiia (Mosk) ; (12): 4-13, 2012.
Artigo em Russo | MEDLINE | ID: mdl-23257694

RESUMO

51 patients with liver alveococcosis were operated on: radical operations with the whole hydatid tumor removal, cytoreductive operations with 50-80% of the tumor removal and alveococcal nodes' preserving on vital organs; and palliative manipulations, aimed the relief of complications were performed. According to the treatment results, the radical liver resection proved to be the most effective. When the complete tumor removal is impossible, cytoreductive operations are possible. Combination with antiparasitic therapy is required.


Assuntos
Doenças Biliares , Equinococose Hepática , Equinococose , Hepatectomia , Icterícia Obstrutiva , Complicações Pós-Operatórias , Adulto , Antiparasitários/uso terapêutico , Doenças Biliares/etiologia , Doenças Biliares/terapia , Progressão da Doença , Equinococose/diagnóstico , Equinococose/cirurgia , Equinococose Hepática/complicações , Equinococose Hepática/diagnóstico , Equinococose Hepática/fisiopatologia , Equinococose Hepática/terapia , Feminino , Hepatectomia/efeitos adversos , Hepatectomia/métodos , Humanos , Icterícia Obstrutiva/etiologia , Icterícia Obstrutiva/cirurgia , Fígado/patologia , Fígado/cirurgia , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Análise de Sobrevida , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ultrassonografia/métodos
15.
Khirurgiia (Mosk) ; (9): 13-20, 2012.
Artigo em Russo | MEDLINE | ID: mdl-23222975

RESUMO

The treatment results of 178 patients with liver hemangioms were analyzed. 322 liver hemangioms of the average size of 36,5 (4-350) mm were diagnosed in 178 patients. 50 (28%) patients were operated on. The largest operated lesion was 100mm. Basic indications to the surgical treatment were: symptomatic course of the disease (42%), unclear diagnosis (24%) and fast growth of the lesion (16%). The lethality rate was 2% (1 of 50), postoperative complications were registered in 24% (12 of 50). Tumor enucleation was performed in 12 (24%) cases, the liver resection - in 38 (76%). The long-term follow-up (average of 55 months) was achieved in 50%(89 of 178) patients. The were no symptoms of the disease in 88,5% of the operated patients and they disappeared in 84% of the non-operated patients. The majority of the patients with the nonsympomatic course of the disease showed anuy negative dynamics of the process. Thus, in 85,2% there were no hemangiom growth registered, 11,1% demonstrated the enlargement of the lesion on 13-38 mm, and 3,7% showed the smaller diameter of the tumour. The study highlights the seldom necessity of the operative treatment of liver hemangioms: by severe symptoms, unclear diagnosis and the fast tumour growth. The enucleation of the tumor is preferable to the liver resection. The exact diagnosis permits the long observance with the ultrasound control as often as once a year.


Assuntos
Hemangioma Cavernoso/cirurgia , Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Seguimentos , Hemangioma Cavernoso/diagnóstico , Humanos , Neoplasias Hepáticas/diagnóstico , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
19.
Khirurgiia (Mosk) ; (5): 9-14, 2010.
Artigo em Russo | MEDLINE | ID: mdl-20559204

RESUMO

75 patients with biliary liver cysts has been operated on since 1992. 49.3% (n=37) had solitary liver cysts, 50.7% (n=38)--multiple cysts. All patients were divided in 2 groups. Destruction of the functioning intraparenchymatous cyst wall was performed in patients, included in the first group (n=40; 53.3%); no destruction of the epithelial lining was performed in in the second group (n=35; 46.7%). 60 (80%) patients were laparotomized, 12 (16%) were operated on laparoscopically, ultrasound-guided puncter was performed in 3 (4%) patients. Postoperative complications were registered in 6 (8%) patients after laparotomy; 2 (2.7%) patients after laparoscopic treatment and 1 (1.3%) after US-guided manipulations. Recurrence was registered in 2 (3.2%) patients of the first group. There were no cyst recurrences among patients of the second group. Therefore, laparoscopic management of of biliary liver cysts is considered to be the method of choice. When latter is impossible, maximal cystic wall resection with destruction of the epithelial lining should be performed.


Assuntos
Doenças dos Ductos Biliares/cirurgia , Cistos/cirurgia , Hepatopatias/cirurgia , Adolescente , Adulto , Idoso de 80 Anos ou mais , Doenças dos Ductos Biliares/diagnóstico por imagem , Cistos/diagnóstico por imagem , Feminino , Humanos , Laparoscopia , Hepatopatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Radiografia , Adulto Jovem
20.
Khirurgiia (Mosk) ; (6): 26-9, 2007.
Artigo em Russo | MEDLINE | ID: mdl-17690662

RESUMO

UNLABELLED: The main reason of benign biliary strictures is the traumatic bile duct injuries during laparoscopic or open cholecystectomy. Although there are growing possibilities of interventional endoscopic treatment of such pathology the definitive operative drainage is in many cases the therapy of choice. There were analyzed the short- and long-term results of surgical reconstruction in 160 patients with of benign strictures of hepaticocholedochus. Complication rate was 12,5%, mortality 2,5%. Median follow-up period was 53,6+/-51,3 month, good and satisfactory long-term results were observed in 76%. There were revealed two factors, predicting poor outcome: biliary fistula (R=0,31; p=0,0053) and reoperations (R=0,309; small er, Cyrillic=0,0058). CONCLUSION: biliodigestive anastomosis is method of choice for treatment of benign biliary strictures of hepaticocholedochus. Hepaticojejunostomy with Roux-en-jejunal limb is more preferable variant of reconstruction for treatment of benign biliary strictures of HC. Good long-term results can be achieved in most part of the patients. In patient with not wide bile ducts and in technically difficult cases transhepatic biliary drainage is acceptable.


Assuntos
Colestase Extra-Hepática/cirurgia , Ducto Colédoco/cirurgia , Endoscopia Gastrointestinal/métodos , Ducto Hepático Comum/cirurgia , Adolescente , Adulto , Idoso , Anastomose Cirúrgica/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...