[STATE OF HEPATIC HEMODYNAMICS IN TRANSPLANTATION OF ITS RIGHT PART WITH MEDIAN HEPATIC VEIN].

Peculiarities of regional hemodynamics in transplantation of right hepatic part with median hepatic vein were studied. The blood flow parameters ­ the volume portal blood flow (VPBF), linear speed of blood flow (LSBF), the resistance index (RI) in hepatic artery; phasic structure of the blood flow along hepatic veins were determined in 31 patients in accordance to ultrasonographic flowmetry data. Maximal value of VPBF was observed on a second postoperative day, minimal one ­on the fourth day. Аrterial blood flow have had enhanced immediately after transplantation up to maximal one on the second day, and from second to the fourth day ­ have had reduced to minimal one. Phasic structure of blood flow along hepatic vein have had changed postoperatively in 12 (38%) patients. Changes in the hepatosplanchnic blood flow after transplantation constitutes a consequence of the vascular resistance reduction, the venous outflow and regenerative activity of the transplanted hepatic part improvement.

[ROENTGEN-ENDOVASCULAR EMBOLIZATION OF THE PORTAL VEIN BRANCHES AS A PATIENTS CONDITIONING FOR EXTENSIVE HEPATIC RESECTION].

The results of surgical treatment of 316 patients, suffering focal hepatic diseases, in whom for preoperative preparation a portal vein embolization (PVE) was performed, were analyzed. PVE was applied in a small planned hepatic residual volume. The patients have aged from 21 to 77 yrs, (57 ± 10.6) yrs at average. During (22 ± 7) days after the procedure a hypertrophy of a planned postresectional hepatic volume by 58.6% was observed, while a hypertrophy degree have depended on the embolization volume performed: 57.3%--after embolization of branches of C(V)-C(VIII) hepatic segments, 66%--the segments C(V)-C(VIII) + C(IV). In 281 (89%) patients the extensive hepatic resection was performed, a fatal postresection hepatic insufficiency was not observed. A three-year and five-year disease-free survival have constituted 43.8 and 16.4% accordingly. Thus, a PVE constitutes a miniinvasive intervention, permitting to achieve a planned residual hepatic volume, to expand a diapazon of application of radical extensive hepatic resection in patients, suffering focal hepatic diseases while a small planned residual hepatic volume.

[IMMUNOLOGICAL FACTORS OF THE INNATE IMMUNITY IN PATIENTS WITH HEPATOCELLULAR CARCINOMA OF A LARGE SIZE].

Factors of the inborn immunity in patients, suffering hepatocellular carcinoma of large size, were studied. Preoperatively the raising of metabolic activity of neutrophils in spontaneous NST-test, the neutrophils reserve reduction in NST-test, weak activation of the neutrophils absorption function in a phagocytosis reaction were noted. On the 7-8th postoperative day a reduction of quantity of formazan--positive neutrophils in spontaneous NST--test, raising of reserve of the neutrophils metabolic activity, comparing with initial values, were observed.

[DYNAMICS OF HEPATIC BLOOD FLOW IN IMMEDIATE PERIOD AFTER PREOPERATIVE EMBOLIZATION OF A PORTAL VEIN].

The changes in intrahepatic blood flow, occuring after embolization of right branch (ERB) of portal vein (PV) in 42 patients, to whom a major hepatic resection was planned for focal hepatic diseases, were analyzed. Together with cessation of blood flow along the PV embolized branch, there was noted the enhancement of the volume blood flow along the PV left branch by 226% on the third day after embolization with its subsequent enhancement by 337% comparing with initial one. Enhancement of a volume blood flow along right hepatic artery (HA) by 282% was noted on the third day after ERB PV with subsequent nonsignificant reduction, and a blood flow along the left hepatic artery branch did not change essentially. The blood flow enhancement in left hepatic lobe have promoted her regeneration and increase of volume of the organ residual planned.

[Preoperative portal vein embolization: dynamics of portal pressure].

The pressure dynamics was studied in a portal vein (PV) in patients, suffering focal hepatic pathology, to whom portal vein embolization (PVE) was performed as a stage of preparation to radical hepatic resection. In 236 patients the immediate measurement of pressure in a PV was performed intraoperatively before and after PVE, in 26 - catheter for control portography and monitoring of pressure in a PV was left in its trunk for 24 h postoperatively. There was noted a pressure rising in a PV immediately after its embolization by 86.7%, positive correlation was established between PVE volume and pressure gradient in a PV before and after it. While doing monitoring during 24 h there was observed the pressure rising in a PV during 3 h after its embolization with subsequent lowering down to initial. Application of PVE as a preparation procedure for performance of extended hepatic resection, together with enhancement of residual liver minimizes sharp postresectional pressure rising in PV, what constitutes essential factor of the hepatocytes damage of residual hepatic part in immediate postoperative period.

[Results of preoperative embolization of portal vein in patients with biliary hepatic tumors].

The results of preoperative embolization of portal vein (EPV) in 90 patients, operated on for biliary hepatic tumors, were analyzed. In 47 patients Klatskin tumor was revealed, in 29--peripheral cholangiocarcinoma, in 14--tumor of a gallbladder. In all the patients a radical major hepatic resection was planned, a checking hepatic volume (CHHV) did not exceed 40% of a noninvolved parenchyma. The EPV volume have corresponded generally to the planned resection volume. After performance of EPV a pressure in a portal vein have risen by 75%, and later it have had lowered step by step during 24 h. The CHHV index have raised from (354 +/- 72) up to (462 +/- 118) cm3, or from (33 +/- 7) up to (45 +/- 11)%, permitting to perform radical hepatic resection in 79 (87.8%) patients. Thus, application of EPV in patients, suffering biliary hepatic tumors, have permitted to increase the CHHV index after radical resection, and to raise resectability of such tumors.

[The portal vein reconstruction during operations for hepatocellular carcinoma].

There was the objective to improve the results of treatment in patients, suffering hepatocellular carcinoma (HCC) with vena cava invasion by the tumor. In the main group a hepatic resection with the portal vein resection and portoplasty was performed in 21 patients, suffering HCC with vena cava invasion by the tumor of second-third degree (according to J. Shi, 2007); in a control group in 61 patients, suffering the portal vein tumoral invasion of first degree, the hepatic resection only was done. The mortality have constituted 9.5% in the main group and 8.1%--in a control one. The 5-year survival index have constituted 11.5%--in the main group and 25.3%--in a control one. The aggressive surgical tactics application for HCC with portal vein tumoral invasion permits to enhance the indices of the patients far-remote survival.

[Morphological substantiation for the surgical treatment of chronic hepatic abscess].

The results of histological investigation, conducted in 27 patients, operated on for chronic hepatic abscess, are presented. Macroscopic and microscopic characteristic of all zones of hepatic affection is adduced, the mechanisms of formation of pyogenic membrane, zones of infiltration and fibrosis in chronic hepatic abscess formation are delineated.

[A portal vein branch embolization as a method of preparation for liver resection].

The results of preoperative transcutaneous transhepatic embolization of portal vein (PTTEPV) were analyzed in 86 patients, suffering malignant hepatic tumors. Depending on a planned hepatic resection (HR) volume there was conducted embolization of a right lobar portal vein (in 45 patients), right vein with a vein of C(IV) segment (in 32), lobar portal vein with anterior right vein (in 9). In 3-4 weeks after PTTEPV there was noted the enhancement of ratio of a planned residual hepatic volume/total hepatic volume from 16.3 to 27.5%, permitting to perform HR successfully in these patients. In 4 (4.7%) patients HR was not performed because of progressing of the tumor development or a total thrombosis of portal vein. The data obtained witness, that PTTEPV constitute an effective method of the patients preparation for HR while presence of a planned small residual hepatic volume.

[Antibacterial therapy in surgical treatment of chronic hepatic abscess].

The results of surgical treatment of 58 patients for chronic hepatic abscess were presented. In patients of the main group hepatic resection was performed and in a control one--sanation and drainage of the abscess cavity. Antibacterial therapy was conducted in patients of both groups before and after operative treatment. The peculiarities and common efficacy of antibacterial therapy depending on the operative treatment kind were noted.

[Peculiarities of the venous bed vessels reconstruction while performing liver transplantation from live relative donor in children].

The rate of hepatic transplantation from live relative donor in children is increasing in all over the world and in Ukraine as well. Significant incidence of the pathology together with necessity of technically complex intervention performance causes the need for surgical technique improvement, a new methods elaboration and clinical introduction, permitting to lower the postoperative complications rate. Technical complexity constitutes the main peculiarity of transplantation operation of liver, obtained from live relative donor, in children, it is caused by the vessels small diameter, pathological changes of the recipient portal vein and lack of plastic material for reconstruction of vessels. There are proposed various plastic methods for the transplant portal inflow and venous outflow guaranteeing to achieve a success while performing left lateral hepatic section transplantation, permitting to improve the results of hepatic transplantation from live relative donor in children.

[Application of recombinant erythropoietin during preparation for hepatic transplantation operation from the living kindred donor].

First experience of application of the blood autodonorship programme, using recombinant erythropoietin (Eprex) plus preparations containing iron during their preparation for partial hepatic resection, was analyzed. Realization of this programme had permitted to escape the performance of allogenic hemotransfusion in 71.4% of donors, in whom the right or left hepatic lobe was taken out and in 100%--the left lateral section. The erythropoietin dosage regimes in different types of hepatic resections in living kindred donors were proposed.

[Hepatic and the portal vein resection in the surgical treatment of hepatocellular carcinoma].

Modern problems of the portal vein resection while hepatectomy performance are enlighted. Indications for resection of the portal vein bifurcation zone are adduced, various methods of portoplasty are depicted. New methods of the portal vein passability restoration in disparity of its sutured parts diameters are proposed. The results of hepatectomy combined with portal vein resection are studied.

[Hepatic functional state in live relative donors of its right lobe in perioperative period].

Analysis of hepatic functional state in live relative donors of its right lobe in perioperative period was conducted. Temporary hepatic dysfunction was revealed, manifesting by tolerance to glucose lowering, hepatic proteinsynthetic and excretal functions disorder and cytolytic syndrome. In 2 weeks after the operation these disorders are become compensated but not all indices return to initial level.

[New possibilities of surgical treatment of Clatskin tumor and extended focal hepatic affection].

Modern approaches for surgical treatment of hepatic tumors are presented. Results of hepatic resection conduction in 220 patients were analyzed. The indications are substantiated, the main diagnostic methods in hepatic tumors are suggested, and issues on surgical tactics and technique of extended resection performance are put on light. New methods of combined resection of liver and main vessels are elaborated. Their introduction has permitted to lower mortality, to raise the tumors resectability, and to enhance the patients' survival indices.

[Hepatic transplantation from living relative donor].

Modern approaches for hepatic transplantation in adults and children are enlighten. Analysis of 34 transplantation operations of hepatic part from living relative donor was conducted. Data on need for hepatic transplantation performance are adduced, indications for its conduction are determined. There are also suggested the main methods of hepatic transplantation from living relative donor, together with immunosuppression issues, and the justice and deontological problem aspects.

[Peculiarities of splanchnic hemodynamics after performance of partial portosystemic shunting].

Complex hemodynamical investigations were conducted in 1985-2004 yrs in 60 patients with hepatic diseases before the operation, in 6-8 and 12-24 months after performance of portosystemic shunting operation (in 26 patients was formed H-like mesentericocaval anastomosis, in 10--central splenorenal anastomosis, in 14--splenorenal anastomosis side-to-side, in 10--H-like splenorenal anastomosis). Performance of shunting operation had promoted the lowering of volumetric speed of blood flow and pressure in portal vein, her diameter reduction, the general hepatic blood flow lowering. The lowering of blood flow in the portal vein system after the shunting have caused enhancement of arterial hepatic blood flow.