СОВРЕМЕННЫЕ МЕТОДЫ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ РАСПРОСТРАНЕННОГО АЛЬВЕОКОККОЗА ПЕЧЕНИ

Aim . To improve the efficiency of treatment of advanced liver alveococcosis using modern surgical techniques including transplantation. Material and Methods. It was analyzed surgical treatment of 25 patients with advanced liver alveococcosis for the period 2008–2014.  Operations  were performed  in  21 cases. Lung  metastasis  were diagnosed  in  two of them.  Long-term obstructive jaundice was observed in 5, portal hypertension  – in 2. 1 patient with associated HBV had liver cirrhosis. Results . Surgical interventions  had extended volume and included liver resection “in situ” in 16 cases, orthotopic  liver transplantation (OLT) in 3 patients. Invasion into IVC was detected in 9 cases. In 6 patients IVA was made a prosthetic appliance using PTFE-prosthesis including 1 case with left hepatic vein orifice repair and 3 cases with partial resection. Resection and reconstruction of portal vein were required in 6 cases. 9 patients underwent resection of the extrahepatic bile ducts. Resection of the right dome of the diaphragm was made in 4 cases. In one case explorative laparotomy  was performed. All patients after surgery receive antiparasitic therapy. There was 1 death in the early postoperative period due to  multiple  organ  failure.  There  were  no  recurrences   within  7-year  follow-up.  Antiparasitic  therapy  after  liver transplantation did not require adjustment of immunosuppressive therapy. Conclusion . Surgical interventions  for liver alveococcosis have advanced volume and are combined with reconstruction of great vessels and bile ducts. Maximum tendency to resection is caused by potential risk of immunosuppressive therapy after transplantation for the progression of the disease, that justifies difficult resections “ex situ”.