Qaraciyər rezeksiyalarından sonrakı ağırlaşmaların proqnozlaşdırılması və profilaktikası

The aim of this study was to evaluate liver resection techniques, increase regeneration and to predict complication after hepatectomies. Results of liver resection in the 165 patients and of the different treatment modalities in the 70 rabbits were analysed. Indication for liver resection was hepatocellulary carcinoma (87), metastasis (27), living-related liver transplantation, hemangioma (17), hydatid cysts (4) and others. Of these 165 patients 59 had concomitant cirrhosis and 54 had chronic hepatitis. A comparative studies of the methods of parenchyma dissection, such as clamp-crashing- CC (in the 45 patients), ultrasonic dissector – CUSA (in the 64 patients) and combined use of the CUSA and argon beam coagulation –CUSA+AC (in the 56 patients) were carried out. Results showed that in patients with associated parenchyma disease the CUSA have no advantage over the CC technique in terms of resection time. CUSA+AC decreased blood loss, operation time, transfusion requirements, portal clamping time and morbidity (from 51,7% to 19,5%) in comparison to the CC and CUSA. So, CUSA+AC seemed to be an effective technique for parenchyma dissection in the both normal and fibrotic livers. Comparative study of the different modalities of the He-Ne laser irradiation (irradiation of the liver, portal blood and intravascular blood) and dalargin in the hepatecomized animals showed that combined use of the intravascular blood laser irradiation and dalargin (BLI+D) increase liver regeneration, decrease hepatocyte injury and restore hepatic function abnormalities. The BLI+D method was used in the 76 hepatectomized patients. Results showed that BLI+D increase regeneration rate, decrease time for restoration of the postresectional functional abnormalities, hepatocyte injury and morbidity from 39,6% to 25,4%. Multivariate analyses showed that four of the 58 studied values have independent prognostic significance only: cirrhosis, preoperative bilirubin, parenchyma resection rate, and intraoperative indocyanin green index (ICG). The ICG test was designed for measurement of functional capacity of the remnant liver before resection. This test showed high sensitivity (91,3%) and specificity (77,8%) rate in the prediction of postoperative complications.