Топографо-анатомическое и клиническое обоснование использования доступа Мерзликина-Парамоновой при операциях на печени

The purpose of the study was to assess results of Merzlikin-Paramonova's approach in liver surgeries.Material and Methods. The topographical-anatomical and spatial relationships were studied on 20 corpses, taking into account assessment criteria according to A.Yu. Sozon-Yaroshevich. In clinical settings, Merzlikin-Paramonova's approach was applied in the treatment of 81 patients with hepatic diseases (cancer, hemangioma, alveococcosis), who underwent radical and palliative surgeries. Short-and long-term treatment outcomes during a 5 year follow-up were analyzed. Merzlikin-Paramonova's approach provided a sufficient overview of the liver, easy manipulation in the area of large bile ducts and blood vessels, as well as the ability to perform lymphodissection and combined operations.Results. The Merzlikin-Paramonova's approach to liver surgeries has significant advantages over traditional surgical approaches, providing a good overview for revision of both primary and recurrent liver lesions. This surgical approach allowed the number of postoperative complications to be reduced due to less wound tension, rapid relief of pain and reduction in intra-abdominal hypertension, thus shortening the treatment time for patients. In the long-term postoperative period, the incidence of postoperative hernias decreased due to less damage to the nerve terminals of the anterior abdominal wall.Conclusion. Merzlikin-Paramonova's approach is slightly traumatic due to innervation and muscle structure of the abdominal wall, is more physiological for the patient, and has a low rate of complications. This approach provides a good access to the organ requiring surgery and is able to perform radical cytoreductive surgeries. Merzlikin-Paramonova's approach to liver surgeries can be recommended for active implementation in clinical practice.Целью исследования является изучение результатов внедрения в клиническую практику доступа Мерзликина-Парамоновой.Материал и методы. В эксперименте на 20 трупах проведено изучение топографо-анатомических, пространственных взаимоотношений в ране с учетом критериев оценки по А.Ю. Созон-Ярошевичу. В клинике доступ Мерзликина-Парамоновой применен в лечении 81 пациента с очаговой патологией печени (рак, гемангиома, альвеококкоз), которым выполнены радикальные и паллиативные оперативные вмешательства. Прослежены ближайшие и отдаленные результаты в сроки до 5 лет после лечения. При всех перечисленных вмешательствах предлагаемый доступ обеспечивал достаточный обзор печени, свободу манипуляций в области крупных желчных протоков, сосудов, в том числе и криоинструментами, возможность выполнения лимфодиссекции и комбинированных операций.Результаты. Предложенный доступ для оперативного вмешательства на печени имеет значительные преимущества перед традиционными, обеспечивает хороший обзор для ревизии оперируемого органа как при первичном, так и рецидивном поражении. Использование доступа позволило провести более раннюю активизацию больных, снизить количество послеоперационных осложнений за счет меньшего натяжения раны, скорейшего купирования болевого синдрома и снижения внутриабдоминальной гипертензии, что позволило сократить сроки лечения больных. В отдаленном послеоперационном периоде снижалась частота развития послеоперационных грыж за счет меньшего повреждения нервных окончаний передней брюшной стенки.Заключение. Доступ Мерзликина-Парамоновой малотравматичен за счет того, что учитываются иннервация и мышечное строение стенки брюшной полости, а также более физиологичен, что подтверждается низкими показателями осложнений. Хорошая доступность оперируемого органа, возможность для расширения и выполнения радикальных и циторедуктивных операций показали, что доступ создает достаточный простор для ревизии и оперативного вмешательства как в случае первичного, так и метастатического поражения органа. С учетом этого заявленный способ доступа может быть рекомендован для активного внедрения в клиническую практику

The history of the development of cryosurgery in Siberia

The purpose of this work was the need to highlight the significance of the works of Professor Boris I. Alperovich and his students in creating unique cryosurgical instruments and the development of modern cryosurgical operations on the liver and pancreas. The article used documents confirming the priority of the authors in the creation of cryotherapy equipment and methods of cryosurgical treatment of diseases of the liver and pancreas

CRYOSURGERY OF LIVER TUMORS

Background. The incidence of both malignant and benign liver tumors is steadily increasing. Because signs and symptoms of liver cancer do not usually appear until the late stages, its curable rate remains low. To improve the treatment outcomes, preoperative chemoembolization, sclerobliteration of the vessels and cryoexposure are used. In cases with benign liver tumors, vascular embolization, various types of coagulation and ultra-low temperatures are applied to reduce blood loss and to prevent disease recurrence. Objective: to analyze the results of cryosurgery for malignant and benign liver tumors. Material and methods. The original cryosurgical equipment capable of producing a temperature of -196о C was used. It comprises a cryoultrasonic scalpel, cryodestructor and cryoapplicators from porous titanium nickelide adapted for laparoscopic surgery. Cryosurgery was performed on 81 patients with liver cancer, 6 patients with Klatskin tumor, 141 patients with a hemangioma, and 9 patients with hepatic adenoma. Results. Out of 81 patients with liver cancer, 9 underwent extended hemihepatectomy using a cryoultrasonic scalpel, while the remaining patients underwent liver resection using a conventional scalpel with cryodestruction of the liver stump. Decrease in blood loss by 25 % due to freezing of vessels up to 1 mm was noted. Four patients died after resection of the liver (5.1 %). Tumor recurrence was observed in 3.8 % of the patients. The 1-, 3, and 5-yaer survival rates were 74.6 %, 52 %, and 40 %, respectively. In cases with hemangiomas, 20 cryoresections were performed. There were 91 resections using a conventional scalpel with cryodestruction of the stump and 22 laparoscopic cryodestructions of small hemangiomas (3–5 cm). The use of cryoinstruments reduced intraoperative blood loss and caused aseptic necrosis followed by sclerosis of small hemangiomatous nodes. After resection of the liver, 3 people died (2.7 %), 1 relapse occurred. Concerning liver adenoma, 9 hemihepatectomies with cryodestruction of the stump were performed. There were no lethal outcomes and relapses of the disease. Conclusion. Cryosurgery for malignant and benign liver tumors can be performed as: 1) cryoresection; 2) conventional resections with cryodestruction of the stump 3) cryodestruction of small hemangiomas and metastatic nodes, including laparoscopic approach. The use of ultra-low temperatures reduces blood loss and improves surgical ablation outcomes

Topographical-anatomical and clinical aspects of the assessment of Merzlikin-Paramonova's approach to liver surgeries

The purpose of the study was to assess results of Merzlikin-Paramonova's approach in liver surgeries.Material and Methods. The topographical-anatomical and spatial relationships were studied on 20 corpses, taking into account assessment criteria according to A.Yu. Sozon-Yaroshevich. In clinical settings, Merzlikin-Paramonova's approach was applied in the treatment of 81 patients with hepatic diseases (cancer, hemangioma, alveococcosis), who underwent radical and palliative surgeries. Short-and long-term treatment outcomes during a 5 year follow-up were analyzed. Merzlikin-Paramonova's approach provided a sufficient overview of the liver, easy manipulation in the area of large bile ducts and blood vessels, as well as the ability to perform lymphodissection and combined operations.Results. The Merzlikin-Paramonova's approach to liver surgeries has significant advantages over traditional surgical approaches, providing a good overview for revision of both primary and recurrent liver lesions. This surgical approach allowed the number of postoperative complications to be reduced due to less wound tension, rapid relief of pain and reduction in intra-abdominal hypertension, thus shortening the treatment time for patients. In the long-term postoperative period, the incidence of postoperative hernias decreased due to less damage to the nerve terminals of the anterior abdominal wall.Conclusion. Merzlikin-Paramonova's approach is slightly traumatic due to innervation and muscle structure of the abdominal wall, is more physiological for the patient, and has a low rate of complications. This approach provides a good access to the organ requiring surgery and is able to perform radical cytoreductive surgeries. Merzlikin-Paramonova's approach to liver surgeries can be recommended for active implementation in clinical practice