Search

Pilot experience with "Radionics Cool-Tip RF System" appliance for radio-frequency ablation (RFA) in hepatic resection in the patients with focal lesions of the liver is presented. Advantages of RFA as an alternative method for hemostasis are demonstrated. With this technique bisegmentectomy (II - III) was performed in 4 patients, right-sided hemihepatectomy - in 2 patients. RFA permitted to minimize intraoperative blood loss without increase of surgery time. There were no severe complications during surgery and in early postoperative period. The method permits to perform combined surgeries without a significant increase of surgical risk.

Experience with 75 major anatomic resections of the liver in patients with high surgical risk due to low functional reserve of the liver, spontaneous disruption of hepatic tumor, chronic purulent infection in patients with hepatic abscesses, posttraumatic sequestration of the liver with hemobilia, giant hepatic hemangiomas, old age and severe concomitant diseases was analyzed. General postoperative lethality was 14.7% which was determined mainly by unfavorable outcomes in postoperative patients in spontaneous disruption of tumor and massive intraabdominal bleeding, and also by severe postoperative hepatic insufficiency in patients after right-sided hemihepatectomy for hepatocellular carcinoma with postnecrotic cirrhosis of the liver. Immediate results of surgery in patients with obstructive jaundice and biliary hepatic cirrhosis were better that ones of patients with postnecrotic cirrhosis. There were no lethal outcomes in group of patients after surgery for giant hemangiomas, abscesses and posttraumatic sequestration of the liver. Thorough selection of patients based on detailed study of functional hepatic reserves and also volume of removed hepatic parenchyma is necessary for improvement of immediate results of surgical treatment. It is valid to perform portal venous embolization before right-sided hemihepatectomy in patients with postnecrotic, biliary cirrhosis, and also in old patients to decrease the risk of postresection hepatic insufficiency. Roentgenondovascular occlusion of the hepatic artery, Cell-Seiver use for intraoperative blood reinfusion and in some cases--use of methods of complete vascular isolation of the liver are indicated for patients with giant hepatic hemangiomas.

Application of ultrasound surgical aspirator promotes rapid formation of major cavities with dry inner surface in the depth of hepatic parenchyma. Filling of the latter with sutured copolymer of monovinyl ether of ethyleneglycol in the ratio of one filler volume to three cavity volumes results in the formation of cysts with the given stable dimensions. Good aspiration of necrotic tissues promotes rapid formation of thin-walled cysts. The given hepatic cyst model may be used in the development of new surgical and puncture methods of treatment, as well as testing of new drugs.

The article analyses the results of antibiotic prevention of postoperative infectious complications and the use of special techniques and operative manipulations in 60 patients with localized affections of the liver. It was found that the most effective method of antibiotic prevention of complications is a purposeful transport of antibiotics in autologous erythrocytic shadows, which are infused intravenously once before the operation and, in extensive resection of the liver, on the second or third postoperative day. With the use of special techniques and operative manipulations in combination with purposeful transport of antibiotics the frequency of infectious complications reduces and the results of treatment in surgery of localized affections of the liver improve.