Recovery of the liver after resection of the right lobe. Poisoning by fungi and drugs

A liver resection is an operation in which a part of an organ with pathology is removed. Modern technologies allow such operations to be carried out without complications. The liver is an important organ in the human body, responsible for many different functions. That is why her diseases must be treated.

Some of the liver pathologies can only be eliminated with the help of surgery. So what is a "resection", and in what cases is it performed?

There are two types of resection - anatomical (typical) and atypical. During an anatomical operation, a part of the liver is removed, but its segmental structure is observed, and in case of atypical removal, it is not the structure of the organ that is taken into account, but the spread of the pathology.

The liver is represented by two lobes: left and right. The right lobe is also subdivided into the quadrate and caudate lobes. All segments are separated from each other by connective tissue bridges. At the same time, they have their own blood supply system and bile ducts.

Such a structure provides the main advantage during liver surgery, reducing blood loss to minimum volumes. In addition, it allows not to destroy the biliary system of the liver.

The patient's ability to work and further prognosis after resection depend on the disease.

This method of surgical treatment is used in more than half of cases of hepatic pathologies. In most cases, the surgical intervention itself is easily tolerated. And the rehabilitation period lasts on average up to six months.

Classification

The operation to remove part of the liver is divided into several types:

Resection is also classified according to anatomical features:

• Sectionectomy, in which several hepatic segments are removed;
• segmentectomy, implying the removal of one affected segment;
• Mesohepatectomy, i.e. removal of entire sections or segments in the center of the liver;
• Hemihepatectomy (hepatolobectomy)- surgical intervention, in which the entire share is removed;
• Extended hemihepatectomy, which consists in cutting off a share and another section or segment of an organ.

An atypical operation is divided into types, taking into account the form of removal:

• planar- excision of the pathology located near the diaphragmatic surface of the liver;
• marginal resection, in which the parenchyma is removed near the upper or lower surface of the organ;
• Transverse removal, in which the affected parenchyma located on the side of the liver is excised;
• wedge operation, i.e. cutting off the part that is located on the anterior wedge-shaped edge or diaphragmatic surface.

Anatomical liver resection according to the American classification:

Indications for surgery

It can also be used in the presence of the following pathologies:

• Benign formations(adenoma, or foci of nodular hyperplasia);
• Malignant formations(hemangioendothelioma, hepatocellular, squamous or cholangiocellular type cancer, fibrosarcoma, hepatoblastoma, mesothelioma, angiosarcoma, teratoma and tumor of the gallbladder).

Part of the liver can also be removed with. This condition appears as a result of cancer cells entering other organs through the circulatory system.

In this case, several different stages of metastasis may develop, requiring removal:

Resection is one of the methods for treating injuries, injuries and, i.e. cavities with pus resulting from bacterial infection or septic infection.

Another reason for the excision of part of the organ is hereditary Caroli disease, in which cystic formations develop in the intrahepatic bile ducts.

Stages of preparation for surgery

The first step in preparing for resection is physical medical examination by different specialists.

Next are instrumental methods examinations, which include chest X-ray, ultrasound, ECG and computed tomography. Angiography of the hepatic vessels, carried out using a radiopaque substance, is also prescribed.

A few days before this, a special unloading diet, excluding from the diet foods that can cause fermentation processes. And on the day of the operation itself, it is recommended not to eat or drink at all..

anesthesia

With abdominal resection of the liver, anesthesia of the endotracheal type is used. It also uses the device artificial respiration and intravenous injections sleeping pills and sedatives.

For radiofrequency ablation, spinal anesthesia is used. It is carried out with a puncture needle inserted between the 3rd and 4th vertebrae. Such anesthesia eliminates the sensitivity of the body below the waist in the patient, which makes it possible to perform operations without feeling pain.

Also, the patient may be given sleeping pills, thanks to which he will sleep through the entire operation. Local anesthesia is used for chemoembolization and alcoholization.

Operations

Abdominal resection of a part of the liver is of two types. They differ in access to the body.

The course of this operation consists of the following steps:

1. Incision of the skin and muscle tissue of the anterior abdominal wall.
2. Examination of the liver.
3. The final determination of the size of the focus of pathology.
4. Cut off the affected lobes or segments of the liver.
5. Bandaging the severed bile ducts and vessels.
6. Aspiration of blood from abdominal cavity.
7. Treatment of the liver with an antiseptic solution, and then its further aspiration.
8. Stitching the wound, but leaving a small gap for the drainage tube.

In the postoperative period, maintenance therapy is prescribed, including:

• painkillers analgesics from the narcotic family (morphine or omnopon);
• antibacterial agents a wide range actions (ceftriaxone, amikacin and carbapenems);
• physiological saline intravenously to normalize metabolic processes;
• platelet and erythrocyte preparations for large blood loss;
• anticoagulants to prevent hepatic thrombosis.

RF ablation

Radiofrequency ablation refers to endoscopic surgery. It is carried out through 3-4 incisions on the anterior abdominal wall ( laparoscopic methods operations). Their length is a maximum of 3 cm.

The operation is performed using a light fixture, a camera, an RF knife, and a manipulator with tweezers. The entire procedure is monitored by ultrasound. With the help of a radiofrequency knife, a segment of the liver with a pathological focus is cut off, and the affected vessels are also cauterized.

Chemoembolization

Chemotherapy drugs and cytostatics are injected into the artery that supplies the tumor with blood. Next, this artery is clogged to disrupt its blood supply and prevent the injected drug from getting into other segments. Medicines are administered through a catheter in a vein responsible for blood supply to the pathological focus.

Rehabilitation

Recovery after liver resection depends on the type of operation and the size of the pathology. The duration of the rehabilitation period is from 10 days to six months. At the same time, patients must comply with the rest regimen and diet, perform therapeutic exercises and undergo physiotherapy. Medical therapy is also prescribed.

To make sure that the liver is recovering normally, it is necessary to regularly undergo instrumental and laboratory examinations by a doctor.

After resection, the following complications may occur:

The liver after resection is able to quickly recover and perform its functions again. It also restores lymphatic and vascular system organ. This ability to regenerate in most cases excludes serious consequences after the operation.

Judging by the fact that you are now reading these lines, victory in the fight against liver diseases is not on your side yet ...

Have you thought about surgery yet? It is understandable, because the liver is a very important organ, and its proper functioning is the key to health and well-being. Nausea and vomiting, yellowish skin tone, bitter taste in the mouth and bad smell, dark urine and diarrhea ... All these symptoms are familiar to you firsthand.

But perhaps it is more correct to treat not the consequence, but the cause? We recommend reading the story of Olga Krichevskaya, how she cured her liver...

The liver (hepar) is the largest gland in the human body, which is divided into 4 lobes or 8 segments. Fail and liver disease can be very dangerous and in particularly difficult cases, there is only surgical treatment of the liver. What diseases of the liver are distinguished by doctors? What methods of surgical treatment of the liver exist today?

Liver: structure and functions

The liver is the largest gland in the human body, which is divided into 4 lobes or 8 segments. From unpaired abdominal organs deoxygenated blood through the portal vein to the liver. Together with blood they enter the liver nutrients from the intestine. The main functions of the liver include: bile secretion, bile secretion, accumulation of sugar in the form of glycogen (animal starch), production of autogenous proteins, accumulation of vitamins or processing of toxic substances (eg ammonia, alcohol) and medicines. Due to its wide functional spectrum, the liver plays a key role in metabolism.

Selected Liver Diseases: Hepatitis (inflammation of the liver)

Hepatitis is an inflammation of the liver, which in most cases is caused by viruses (hepatitis A, B and C). Hepatitis B and C can become a chronic disease, which can later lead to liver cancer. Vaccines are currently available for hepatitis A and B.

A characteristic feature of this liver disease is yellowing of the skin and sclera (the white of the eye). It is not enough to call the disease simply "jaundice", as it is often called colloquially, because. jaundice (icterus) can also occur without a viral infection, for example, as a result of bile stasis due to cholelithiasis or in newborns in the first weeks of life.

Selected Liver Diseases: Progressive cysts and abscesses of the liver

Selected Liver Diseases: Echinococcosis

Echinococcosis takes its name from tapeworms (Echinococcus spec.). The eggs of these tapeworms are transmitted by the fecal-oral route, i.e. humans become infected through fruits growing close to the ground that contain traces of dog or fox feces. Larvae are hatched from the eggs, which penetrate, most often, into the liver and lead to the formation of cysts. Echinococcosis can develop for several years without any symptoms. Depending on the size of the echinococcosis cyst, a person first has a feeling of pressure in the upper right side of the abdomen. Due to the fact that the cyst disrupts the liver and can even lead to blockage of the bile ducts, jaundice (icterus) occurs. The danger arises when, due to the large size of the cyst, it bursts. In this case, echinococcus larvae enter the abdominal cavity and can cause serious inflammation of the peritoneum (acute abdomen). It is recommended to remove the endococcosis cyst surgically before it bursts.

Selected Liver Diseases: Fatty Hepatosis

Fatty liver is a progressive deposition of adipose tissue in the liver. An important symptom of this liver disease is a feeling of pressure in the right upper abdomen, as well as a greatly enlarged liver, which can be felt with a simple palpation with the fingers. With an increase in fat cells in the liver, its functions deteriorate. As a result, there is a threat of fatty inflammation of the liver, which can lead to complete destruction of the liver (liver cirrhosis). Especially often fatty hepatosis occurs in conjunction with the following diseases: alcoholism, diabetes and overweight(obesity, overweight). The sooner you begin to eliminate the factors that contribute to the development fatty hepatosis, the more likely it is that your liver will return to normal.

Selected Liver Diseases: Cirrhosis of the liver

What is cirrhosis of the liver liver disease, in which healthy functioning liver cells irreversibly turn into dysfunctional connective tissue ("scars"). In the process of loss of liver function, symptoms of poisoning occur, such as brain damage due to ammonia (= hepatic encephalopathy), as well as bleeding disorders and congestion in the blood vessels. This contributes to the accumulation more fluid in the abdomen (= ascites) and leads to the appearance of multiple edema in the body.

The cause of cirrhosis, like its symptoms, is very diverse. The most important cause, along with infection with the hepatitis virus or chronic inflammation that can lead to scarring of the liver is alcohol abuse for several years. It is not particularly necessary to hope that you will be able to overcome this disease in a therapeutic way. But it can be controlled by treating infectious and inflammatory diseases, finally giving up alcohol and avoiding getting toxic substances and drugs harmful to the liver into your body. In more complex stages of liver cirrhosis, only liver transplantation remains.

Selected Liver Diseases: Liver Cancer

The most important risk factors for the development of liver cancer are chronic infections liver caused by hepatitis viruses, inflammation and cirrhosis of the liver at complex stages. In addition, mold fungi, the so-called aflatoxins, are considered carcinogenic.

Most often, liver cancer makes itself felt only when there is a feeling of pressure in the right upper abdomen and a partially hardened liver can be felt. Typical for liver cancer is rapid weight loss, jaundice, due to bile accumulation, because. the enlarging tumor puts pressure on the bile ducts, as well as ascites (fluid in the abdomen), as blood flow through the liver is increasingly impaired. The symptoms of liver cancer are similar to those of other diseases, such as those of acute hepatitis, cholelithiasis, cyst or cirrhosis of the liver. So accurate diagnosis should be set only by a doctor, using a special visualized diagnosis, in order to exclude all sorts of other diseases. It depends on the size of the tumor and the number of metastases whether chemotherapy can be dispensed with or whether it is necessary to think about partial removal of the liver. In particularly difficult cases, only complete removal liver (hepatectomy) with simultaneous transplantation of a new liver.

Poisoning by fungi and drugs

In general, all substances after entering the human body pass through the liver for the purpose of further splitting or fermentation. Some medications and toxic substances cannot be fermented by the liver due to the limited amount of enzymes. Such substances are very harmful to the liver and entail serious consequences. Alkaloids, cocaine, halogenated hydrocarbons or dioxane cause the death of liver cells and lead to the formation of large foci of necrosis in its tissues. Aflatoxins (mycotoxins), arsenic, copper compounds, alcohol and vitamin A hypervitaminosis (= excess vitamin A) cause the liver tissue to become nonfunctional connective tissue. This process, called cirrhosis of the liver, is irreversible. Particularly dangerous substances are aflatoxin, anabolic steroids, vinyl chloride, and many contraceptives, due to the fact that they can cause liver cancer.

Liver damage

Depending on the cause of the damage, liver injuries are divided into closed blunt and open penetrating. Blunt injury to the liver results from hard hit in the abdomen, for example, after being hit by the steering wheel of a car or bicycle. The main problem with such injuries is small or large internal bleeding in the area of ​​the liver. They cannot be seen with the naked eye and can lead to lethal outcome. Thanks to modern visualization methods of examination, for example, computed tomography, it is possible to clearly observe internal damage without surgical intervention. For more severe injuries with direct bleeding into the abdominal cavity, such as a rupture of the liver (liver rupture), the first step is to stop the bleeding. The same applies to open penetrating injuries, such as stab wounds.

Rupture of the liver

Liver rupture (liver rupture) is a serious complication of accidents. Depending on the size of the crack a short time very large amounts of blood may leak out. In this regard, an operation is needed to stop the bleeding. Small cracks are sewn up with the so-called parenchymal suture. For large ruptures, special abdominal pads are used to stop bleeding and stabilize the liver. Along with this surgery, the largest blood supply vessels are narrowed in order to temporarily reduce the blood supply to the liver. This gives the surgeon more time to suture the fissure.

Budd-Chiari Syndrome

Budd-Chiari syndrome is a very rare liver disease in which progressive blockage of the hepatic veins occurs. The cause of this disease is unknown, but it most often occurs in women between 30 and 40 years of age. Patients often suffer from hematopoietic disorders and increased risk development of thrombosis. Rapid occlusion of the hepatic veins with acute liver failure is rather an exception Budd-Chiari syndrome. Much more often, obstruction occurs gradually and thereby increases the risk of hemorrhoids, bleeding of the esophagus, fluid in the abdominal cavity (ascites) or portal hypertension contributing to the enlargement of the spleen and liver. Often these phenomena are accompanied by pain in the abdomen. Computed tomography and liver biopsy help identify Budd-Chiari Syndrome. To the most frequent methods treatments include shunting (bypass) and surgery with partial removal of diseased segments of the liver. In particularly difficult cases, it is worth considering a liver transplant.

Liver Surgery: Liver Biopsy

Liver biopsy is still the most appropriate method for diagnosing diffuse and obscure liver diseases such as hepatitis. Unlike the biopsy of earlier years, today it is no longer performed blindly, but with the help of imaging techniques. Using a special needle, the doctor receives a piece of tissue for further histological examination. This process is carried out under local anesthesia at the puncture site and can be performed in outpatient settings. Due to possible bleeding on the day of the procedure, bed rest is recommended.

Liver Surgery: Abdominal Puncture for Ascites

Puncture is a minimally invasive procedure performed under local anesthesia. After disinfection of the puncture site, an anesthetic is injected. As soon as the anesthesia has worked, the doctor again disinfects the puncture site, after which a puncture needle is inserted. The fluid accumulated in the abdominal cavity, under sterile conditions, flows out of the abdominal cavity through the needle. When puncturing, no more than 5 liters of fluid is taken, which is then sent for microbiological research. At the end of the procedure, the doctor removes the needle, if necessary, sutures, and finally makes the dressing with a sterile material.

Liver Surgery: Liver Transplant

During a liver transplant or liver transplant, the surgeon removes the diseased organ and replaces it with a donor liver within 16-24 hours.

The skin incision is most often made along the costal arch or in the right upper abdomen. After that, the abdominal muscles are moved apart and the abdominal cavity opens. The open cavity is protected by surgical drapes and a special frame. The diseased liver is removed in the same way as described in paragraph hepatectomy. After transplantation of a donor organ, its vessels (hepatic artery, hepatic vein, portal vein, bile duct) join the recipient's vasculature. Drainage helps stabilize the liver and prevent postoperative bleeding. At the end of the operation, the surgeon sews up the abdominal wall and applies a sterile bandage.

Liver Surgery: Segmental Resection, Hemihepatectomy and Hepatectomy

Up to 75 percent of the liver can be removed surgically (segmental resection, hemihepatectomy). If we are talking about the replacement of the entire organ (= hepatectomy, liver resection), then a donor organ is needed (= liver transplant, liver transplant). Common to all these liver operations is the procedure itself and the removal a large number liver tissue.

The operation begins with a skin incision along the costal arch or in the right upper abdomen. After the muscles have been parted, the surgeon opens the abdominal cavity. Surgical drapes and a special frame give stability and protection to the open abdominal cavity. After that, the surgeon exposes the desired lobe of the liver or its segment. First, the doctor separates the blood vessels from the part of the liver that is planned to be removed and controls the bleeding. The open ends of the vessels overlap and part of the liver is gradually withdrawn from the circulation. At the end, the bile ducts and branches of the portal vein leading to the removed part of the liver are cut. Now it is possible to make incisions on the liver itself and remove the desired segment or desired lobe of the liver. Often, the remaining portion of the liver must be refixed and stabilized with drainage. At the end of the operation, the abdominal wall is sutured and a sterile dressing is applied to the wound.

A special form of segmental resection is the wedge-shaped section. During this operation, without respecting the boundaries of the liver segments, a cancerous tumor is removed from a healthy liver tissue. The operation process is the same as in classical segmental resection.

Transjugular intrahepatic portosystemic shunt surgery

In the case of portal hypertension or in preparation for liver transplantation, this operation switches the blood supply to collateral circulation. In this case, part of the blood entering through the portal vein does not flow through the liver, but directly into the inferior vena cava.

Under general anesthesia pierced jugular vein(Vena jugularis interna) and an angiographic catheter is installed leading through right atrium to the superior vena cava. From here, the catheter passes through the inferior vena cava into the hepatic vein. Through a cannula passing through the catheter, an incision is made in the liver tissue and the cannula approaches the portal vein. Thanks to the balloon catheter, the portal vein can eventually be permanently connected to the hepatic vein (=shunt; "two-vessel short circuit"). Finally, the doctor removes the angiographic catheter and a sterile dressing is applied to the puncture site on the neck.

Photo: www. Chirurgie-im-Bild.de We thank Prof. Dr. Thomas W. Kraus, who kindly provided us with these materials.

The liver is a unique organ of the human body, with an incredible variety of vital important functions. The most famous of them are the removal of toxins from the body, participation in metabolism, in particular in the processing of fats and carbohydrates, participation in the processes of hematopoiesis.

Wherein known fact is that many pathological processes that affect the liver require surgical intervention. In this case, the most common operation is liver resection. But this category is currently surgical operations is not limited to one execution technique. There are various options for resection, depending on the required volume of the procedure and the pathology that caused this need.

Varieties

In surgical practice, there are two categories of operations, the purpose of which is resection:

1. Anatomical, central or typical resection. It is aimed at removing a part of an organ, taking into account its segmental structure. These include right and left hemihepatectomy, right and left lateral lobectomy, right and left paramedian lobectomy, and segmentectomy.
2. Peripheral or atypical resection. It is the removal of a part of an organ that is not based on anatomical structure, but concentrated on the spread of the pathological phenomenon in the liver. This group includes wedge-shaped, planar, marginal and transverse resections.

In fact, these two groups include operations of different volumes. So, segmentectomy consists in removing only one segment of the liver, sectionectomy - several segments, hemihepatectomy - lobes, mesohepatectomy - central segments or sections, and an extended version of hemihepatectomy - lobes together with a segment or section.

In the case of typical operations, dressing becomes an important technical part. main vessels and ducts in the gates of the liver, and the dissection of the parenchyma of the organ is carried out in areas poorly supplied with vessels - portal fissures. Atypical operations are somewhat simpler, due to the absence of the need to strictly observe the architectonics of the organ.

Wedge-shaped resection is performed near its anterior edge or on its diaphragmatic surface, as far as possible from the place on which the vascular-secretory legs are projected. To do this, U-shaped sutures with catgut or Kuznetsov-Pensky sutures located 1.5 cm apart along the line of future removal are first applied. About 0.5 cm recede from these sutures and cut off part of the organ. Already after the section localized between the hemostatic sutures located in two rows has been dissected, the surgeon gently brings the edges together with U-shaped sutures, thereby stitching the tissues of both the upper and lower surfaces at once.

There is another classification of resection, depending on the equipment used:

1. Abdominal surgery using a scalpel.
2. Radiofrequency ablation when using a laparoscope. This option allows you to prevent possible bleeding by excising the parenchyma under the influence of radiofrequency radiation.
3. Chemoembolization is an option applicable only if there is a malignant process in the organ segment detected on early stages. At the same time, a large dose of drugs such as cytostatics and hipopreparations is injected into the vessel that supplies the segment affected by the tumor. They are needed to block tumor growth and cell death. After this manipulation, an embolizing agent is also injected into the same vessel, which blocks the outflow of drugs from the segment.
4. Alcoholization. It is carried out under the control of an ultrasound machine, by injecting ethanol into the segment of the liver with a syringe, followed by destruction.

Indications for carrying out

The need for surgical intervention in the form of removal of a part of the liver is determined by the presence of any of the strict indications for surgery:

Like any other surgical intervention, liver resection carries certain risks, in the form of possible postoperative complications and complications during the operation. These include:

• Internal bleeding.
• Rupture of the hepatic veins, when air enters them.
• Cardiac arrest due to anesthesia.
• Formation of an abscess due to infection.
• Inflammation of the gallbladder.
• Inflammation of the bile ducts (cholangitis).
• Infection in the postoperative wound and its subsequent suppuration.
• A number of disorders of the digestive system, occurring chronically and accompanied by bloating, unstable stools and pain.

Preparing for the operation

The preparatory period starts with a series of physical examinations, which require visits to several doctors, including an internist, a cardiologist, a gastroenterologist, and an oncologist.

Simultaneously with these examinations, tests are required to process them and obtain additional results about the state of health and the functioning of the body. in the mandatory group laboratory research includes:

• General analysis of blood and urine.
• A biochemical blood test, which should include the determination of the level of urea, creatinine, certain electrolytes, alpha-amylase, alkaline phosphatase and glucose.
• liver tests.
• Assessment of the blood coagulation system - coagulogram.
• Lipidogram.
• Determination of blood group and Rh factor.
• Blood test for HIV, AIDS and Wasserman reaction (for syphilis).
• Oncological markers in the blood.
• Markers for viral hepatitis B and C.

The patient also needs instrumental diagnostic methods, such as:

• X-ray of the chest organs.
• Electrocardiogram.
• Ultrasound, CT or MRI of the liver.
• Angiography of the liver (examination of the vascular bed of the organ by introducing a contrast agent).
• Fine-needle biopsy of the organ (it is used for neoplasms and is the introduction of a long needle into the liver parenchyma under the control of an ultrasound machine).

In addition, approximately 3-4 days before the scheduled operation, the patient is recommended a diet that excludes the use of foods that promote fermentation processes in the intestines and constipation. And directly on the day when the intervention will be made, complete fasting and refusal to drink is necessary.

Postoperative period

The postoperative period in case of removal of the liver requires careful patient care. This is necessary so that the body can normally restore its own structures and forces. It is divided into two parts, the first - the patient is in the hospital, and the second - at home.

Hospital recovery lasts about 10–14 days after open surgery or 3–4 days after laparoscopy and includes:

• Parenteral nutrition (delivery of the necessary elements through a dropper) during the time that the attending physician determines.
• Bladder catheterization on part of the patient's bed rest to normalize urine output without the patient's ability to independently cope with a small need in the restroom.
• The use by the patient of a number of painkillers, as well as some antibacterial and anti-inflammatory drugs prescribed at the discretion of the doctor.

Already at home, no less strict care is needed for the sick:

• Regular dressings using sterile dressings.
• Taking a bath or shower is prohibited until the postoperative wound is completely healed, until this moment the patient can only be washed without getting water on the bandages and the wound.
• Strict adherence to the schedule prescribed by the doctor for taking painkillers.
• A scheduled visit to the doctor to examine and evaluate the healing and recovery process of the body.

The first signs of improvement are felt by the patient a month after the operation. And after the improvement of the state of health and the almost complete healing of the wound, he receives further recommendations. They include:

• Diet prescription. It is recommended to eat food in small portions, about 6 times a day. The patient should not consume spicy and fatty foods, as well as alcohol.
• Selection of a number of exercises from the category of exercise therapy. The doctor prescribes breathing exercises to the patient and walks are not short distances.
• Lifestyle correction. Refusal of drugs and smoking.

Taking certain medications as needed. It is recommended to take vitamins and light sedatives. At the discretion of the doctor, some hepatoprotectors may also be prescribed.

Removal of the right or left lobe in medicine is called liver resection. Through development modern technologies became possible such a complex surgery. The liver is an internal human organ that is responsible for over 500 different functions. Any liver disease requires treatment. Part of the deviations are cured only surgically. Resection helps to get rid of benign and malignant tumors, blood flow disorders and developmental anomalies.

Removal of a part of the liver due to any pathology in surgery is called resection.

Indications for liver resection

The patient is prescribed liver resection in the following clinical cases:

• mechanical damage to liver tissues (accidents or household injuries);
• detection of a benign tumor on the organ;
• cancerous neoplasms (regardless of the degree of the disease);
• detection of inconsistencies in size and shape (developmental anomalies);
• if necessary, an organ transplant from a donor;
• diagnosis of seals on the liver (cyst).

For the purpose of resection, the patient requires a thorough diagnosis. Be sure to take a blood test, urine and liver tests. If malignant tumors are suspected, the doctor prescribes an analysis for tumor markers. Ultrasound makes it possible to assess the size and condition of the internal organ. With the help of this procedure, a puncture became available - taking a small amount of liver tissue. Only after receiving all the results of the examination, the doctor establishes an accurate diagnosis and prescribes surgical intervention.

Types of surgery

There are two types of liver resection:

• atypical (wedge-shaped, planar, transverse and marginal);
• typical - left-sided or right-sided lobectomy (resection of a segment or the entire liver).

Regardless of the type of resection, the patient is dissected the liver into parts. It is important during the surgical intervention not to disrupt the blood supply to healthy areas of the liver. Both a small affected area of ​​the organ, and the entire liver (during transplantation) can be removed. When metastases are found in cancer removal of the left or right lobe liver.

Modern medicine uses two types of surgical intervention:

• laparoscopic method - the doctor makes several small incisions in the abdominal cavity to insert the necessary sensors and instruments;
• laparotomy method - surgery occurs by cutting a large area of ​​\u200b\u200bthe abdomen.

Various types of liver resections suggest the choice of the optimal method of surgical intervention in order to reduce the duration postoperative period for a person. For resection of small areas of the liver, it is not necessary to make an extensive incision in the abdominal cavity. This reduces the risk of complications after resection and blood loss in the patient.

The dangers of resection

The liver recovers quickly after resection. It can completely return to its original size and perform its functions. Patients who are medical indications are prescribed to remove a lobe of the liver, they may be afraid of an operation. It is believed that if an organ is partially removed, a person will be disabled for the rest of his life. However, this is not the case. Liver tissues have a unique opportunity to regenerate. When the liver is restored, the vessels and the lymphatic system also perform the functions assigned to them. Due to the ability of the liver to heal itself, doctors are able to perform extensive liver resections.

Dangerous consequences of resection:

• the most dangerous condition of the patient is the occurrence of internal bleeding;
• air enters the hepatic veins, which can lead to their rupture;
• in some cases, cardiac arrest may occur (response to anesthesia);

Preparing for the operation

As already mentioned, it is important to undergo a thorough examination before surgery. At the first appointment, the doctor primary inspection palpation and discharge necessary tests. Additionally, ultrasound diagnostics, computed tomography (examination of tissue structures in the abdominal cavity) and MRI may be needed. Before the operation, a week before the operation, it is worth refusing to use certain medications: Aspirin, Clopidogrel and thinning drugs. They may interfere with the resection.

Liver resection is performed under general anesthesia. The drugs used help to block pain and the development of pain shock in the patient. Anesthesia makes it possible to support a person during surgery. After a certain time, the patient is taken out of the sleep state. In the future, if necessary, painkillers are used.

How is the surgery and how long does it take?

Liver resection lasts no more than 7 hours, and the patient is in intensive care for 24 hours.

Depending on the type of resection, the doctor makes several small incisions or one large incision in the abdominal cavity. The specialist removes the tumor. After the lobe of the liver is removed, a gallbladder resection may be required. To make sure that the tumor has been removed, the doctor uses an ultrasound probe. In some cases, the use of drainage tubes is required at the resection site. They will help remove excess blood and fluid after surgery. After the doctor makes sure that all the necessary manipulations have been carried out, the patient is stitched (staples).

After surgery, the patient stays in the ward for a day intensive care(resuscitation) under the close supervision of doctors. Sensors are connected to a person that show pressure and pulse. The body temperature and the general condition of the patient are monitored. The operation itself lasts from 3 to 7 hours, depending on the degree of development of the disease. After the first day in intensive care, the patient is transferred to the general ward, where he stays for a week. If there are complications after surgery, a longer stay in the hospital is required.

Postoperative care

Care in the hospital

Postoperative care in surgical department consists of the following steps:

• Nutrition is delivered to the patient through a drip. As soon as the doctor allows you to get food on your own, the dropper will be removed.
• After surgery, a catheter is required. It is inserted into the bladder to remove urine.
• In the postoperative period, it is necessary to prescribe painkillers. They help the patient get rid of acute pain.

Home care after resection

After discharge, a person will need special care:

• according to the instructions of the doctor, the bandage is periodically changed;
• a shower is taken only after the wound has completely healed;
• the patient takes painkillers only in a strictly specified order;
• a person feels improvement a month after liver resection;
• a scheduled medical examination is required.

Rehabilitation

Rehabilitation of the patient after resection includes several main points:

• diet;
• sport;
• right way of life;
• taking medications to help you recover.

Diet food

Food is best taken in small portions. It is desirable that this be 6 times a day. This helps avoid stress on digestive tract. In order not to burden the body, spicy and fatty foods, alcohol intake in any doses are completely excluded from the diet. It is contraindicated to use drugs and cigarettes. Sweets and pastries also negatively affect liver recovery. It is best to make a menu with dishes that contain proteins, carbohydrates and vitamins. Diet food prescribed by the physician at the time of discharge. After the postoperative period has passed, the specialist reviews the patient's diet and makes adjustments.

Sports and physical activity

Doctors recommend refraining from heavy sports after surgery. Running, jumping and strength exercises are also contraindicated. They cause increased pressure inside the abdominal cavity, which is fraught with complications. Blood flow may be interrupted and hemorrhage may occur. The patient is advised to take moderate walks and breathing exercises. This will help you recover faster after the resection. Fresh air helps to saturate the body with oxygen.

Lifestyle Correction

Liver resection disrupts the functioning of the entire human body and immune system. Therefore, it is necessary to give Special attention restoration of the body's defenses. Doctors recommend taking vitamin complexes for rapid recovery of the liver after resection. They contain antioxidants and resveratrol. It is important to take sedatives. They help improve the state of the nervous system and normalize sleep. The doctor prescribes after examination necessary drugs, their route of administration and dosage.

Preparations for the rapid recovery of the liver

Rehabilitation is successful if at least one of the above recommendations is followed. Some patients require courses of chemotherapy. This significantly weakens the body. In this case, it is recommended to take drugs that help the body quickly restore its functions. They are called hepatoprotectors. They contain ingredients of plant origin. The most popular of them are: Karsil, Folic acid, Essentiale and Galstena. The method of application and dosage is prescribed by the doctor, depending on the patient's state of health.

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Operations on the liver

The liver is one of the most unusual and multifunctional organs. human body- the number of functions performed by it is approaching five hundred. So, she participates in:

• cleansing the body of toxins - blood containing decay products that are toxic to the body is collected from the organs into the vena cava, passing through the liver parenchyma, cleansed by its cells and sent to the heart;
• transformation of carbohydrates and fats necessary for full life person;
• production of enzymes, proteins and immune bodies;
• hematopoiesis.

Failure of the liver is fraught with serious problems, which can sometimes be solved only by surgical intervention.

And, of course, a failure in the work of this organ is fraught with serious problems, which in some cases can only be solved by surgical intervention. Consider what are and how operations on the liver are performed.

Indications for liver surgery are situations that threaten the life of the patient:

Varieties of operations

Today there is great amount methods of surgical treatment of hepatic diseases.

Consider what kind of liver operations are performed, what are their consequences, how they prepare for them and how they recover after them.

Liver resection (removal of a small or large part of this organ) is an operation on the liver prescribed in the treatment of cysts, chronic abscesses, metastatic and hepatocellular liver cancer, formations that are benign in nature.
Depending on the method of the operation, liver resection is divided into:

• typical (anatomical);
• atypical (wedge-shaped, marginal and transverse), carried out if intervention is required on the marginal sections of the organ.

Depending on the quantitative volume of the tissue to be removed, resection is divided into:

• segmentectomy, which involves the removal of a single segment of the organ;
• sectionectomy, which involves the removal of one section of the organ;
• mesohepatectomy, which is a central resection;
• hemihepatectomy, which involves the removal of one lobe of the organ;
• extended hemihepatectomy, which involves the joint removal of a lobe, as well as a section of an organ.

In addition, it is worth mentioning the combined resection - an intervention, which is a resection of the liver, carried out in conjunction with the removal of one of the organs located in the abdominal cavity or part of it (for example, in conjunction with the Whipple operation). In the vast majority of cases, such operations are performed in the presence of metastatic cancer and are carried out in conjunction with the removal of the underlying formation.

Laparoscopy

Laparoscopy is a surgical manipulation aimed at removing cysts and treating organ abscesses and performed through previously made two or three centimeter incisions in the abdominal cavity.
As a rule, stones in the liver are removed in this way (a stone is a formation consisting of bile components).

Laparoscopy is a surgical procedure performed through pre-made incisions in the abdominal cavity.

Puncture drainage

Puncture drainage is a surgical action prescribed in the treatment of abscesses and cysts. Manipulations are performed under the control of an ultrasound machine and are performed as follows. A needle is inserted inside the neoplasm, which allows, in the first case, to clear the cavity of purulent contents and drain it, and in the second case, to pump out the fluid from the cyst and replace it with a sclerosant drug.

Other operations

For liver cancer, in some cases, specific surgical interventions are performed. So, patients can be assigned:

• radiofrequency ablation - an operation consisting in the removal of a neoplasm with radiofrequency radiation;
• chemoablation - an operation consisting in the administration of a certain medication into a vessel responsible for the blood supply to the area with the tumor;
• alcoholization - an operation consisting in the introduction of ethylene into the neoplasm.

In addition, in diseases of the common bile duct, the following can be produced:

• removal of cysts with anastomosis between the small intestine and the organ;
• removal of stones in the liver in an open way;
• plastic, which allows you to get rid of the narrowing formed due to scarring of tissues;
• extended resections used in the treatment of malignant neoplasms;
• stent placement.

Many people wonder, how dangerous is the removal of liver tissue? So, the removal of liver tissue is absolutely safe for the body - almost immediately after the operation, the organ is completely restored.

This is explained by the fact that the parenchyma of the organ has a strong ability to regenerate, and it restores not only its primary dimensions, but also the volume of functions performed.

Even a third of the organ remaining after resection is able to restore it in full in a few weeks.

Liver transplant

A liver transplant is a radical liver transplant operation. widely used in the treatment of patients suffering from:

• diseases of this organ in the last stages;
• liver cancer;
• fulminant hepatitis;
• acute liver failure;
• cirrhosis of the liver.

Moreover, cirrhosis of the liver is one of the main indications for its transplantation.

Organ donors in this case can be:

• persons who, for one reason or another, received a brain injury in the presence of written consent their close relatives;
• blood relatives with their written consent (in this case, a part of the organ taken during the life of the donor is used).

A variant of organ transplantation is heteroscopic transplantation of an additional liver, which involves transplanting tissues of a donor organ without removing one's own and is prescribed for high chances of regeneration of the latter (in case of liver cirrhosis, such an operation is not prescribed).

Preparatory activities

Operations on the liver are serious abdominal interventions that require meticulous preparation of the patient. Moreover, the plan for this training is developed on the basis of general condition the patient, the nature of his disease, its accompanying conditions and the risk of complications. So, with liver cancer, chemotherapy is prescribed before the operation, which allows to reduce the size of the organ.

The duration of the stationary postoperative period ranges from three to four days to two weeks.

A week before transplantation, the reception is canceled:

• drugs that affect blood clotting;
• non-steroidal anti-inflammatory drugs.

Rehabilitation

Recovery after surgery includes two periods:

• inpatient (treatment in a hospital);
• late (treatment after discharge).

The duration of the stationary period ranges from three to four days (for laparoscopic operations) to two weeks (for traditional operations). During this period, the patient is assigned:

• drugs aimed at preventing complications;
• rehabilitation measures;
• diet.

After discharge from the hospital main goal rehabilitation is the normalization of impaired liver function. For this purpose, the operated person is assigned:

• certain nutrition;
• compliance with the mode of physical activity;
• activities aimed at strengthening immunity and improving overall well-being;
• means that accelerate the regeneration of the body.

Diet in the postoperative period

The diet after liver surgery involves fractional meals in small portions. Food is taken five to six times a day for a quarter of the usual portion - this avoids overloading the body. At the same time, the following are excluded from the diet:

• alcoholic drinks;
• spicy, spicy and fatty foods;
• sweets.

After the operation, alcohol, spicy, spicy and fatty foods are excluded from the diet.

The foods you eat should be high in protein, vitamins, carbohydrates, and fiber.

Compliance with the mode of physical activity

Until complete recovery and the return of the liver to working capacity, the following are excluded:

• lifting heavy objects;
• excessive physical exercise;
• jumping;

This is explained by the fact that these actions increase the pressure inside the abdominal cavity and disrupt the nutrition of growing tissues.

And here breathing exercises, dosed walking with a gradual increase in load and general hygiene exercises can speed up recovery.

General strengthening measures

Patients who have undergone liver surgery are usually prescribed:

• vitamin-mineral complexes containing biotin and beneficially affecting the liver;
• herbal immunostimulants;
• antioxidants;
• sedatives and sleep aids.

Attention! Medications are prescribed exclusively by a doctor. Self-medication in the postoperative period is unacceptable.

Drugs that accelerate liver regeneration

In the vast majority of cases, the above measures are enough to quickly and completely restore the liver. However, occasionally organ regeneration slows down (for example, in the elderly or in the treatment of liver cancer through chemotherapy).

In this case, patients are prescribed hepatoprotectors of plant origin - Heptral, LIV-52, Essentiale, Karsil, Folic acid, Galstena.

Competently performed operations on the liver can significantly increase the patient's life and reduce mortality from many liver diseases, including liver stones and liver cirrhosis.

Post Author:
Syropyatov Sergey Nikolaevich
Education: Rostov State Medical University (RostGMU), Department of Gastroenterology and Endoscopy.
Gastroenterologist
Doctor of Medical Sciences

When is liver resection indicated?

The liver is the most unique multifunctional organ of our body. Doctors jokingly, but quite rightly, call it a multi-station machine, the number of its functions is approaching 500. Firstly, this is the body's most important "cleaning station", without which it would inevitably die from toxins. All blood from organs and tissues with toxic metabolic products is collected in the portal vein, passes through the entire organ, is purified by hepatocyte cells, and already purified is sent through the inferior vena cava to the heart. Further, it is participation in digestion - in the digestion of fats and carbohydrates, in hematopoiesis. The synthesis of proteins, various enzymes, and immune bodies also occurs in the liver. Now you can imagine what the diseases of this organ are fraught with when its functions are violated. Many of these diseases are treated with surgery.

When is a Liver Resection Needed?

Liver resection of various sizes is performed in the following cases:

• in case of damage with crushing of the liver tissue;
• with benign tumors;
• with cancer (carcinoma);
• with cancer metastases from other organs;
• with various hepatic anomalies of development;
• with echinococcal cysts (helminthic invasion);
• for the purpose of transplantation (organ transplantation).

Before the intervention, a thorough study of the structure and function is carried out. If necessary, a diagnostic puncture of the liver is performed during ultrasound (under the control of an ultrasound scanner). Only then are the indications for intervention and its method determined.

Advice. if, after the examination, the specialist offers surgical treatment, one should not refuse it or hesitate to make a decision. A long period of reflection does not work in favor of the patient, because at this time the disease progresses.

Types of Liver Operations

The volume of interventions can vary from the removal of a small area to the complete removal of the organ (hepatectomy). Partial hepatectomy or liver resection can be economical (marginal, transverse, peripheral), and called atypical. With typical interventions, the anatomical segmental branching of the vessels is taken into account, a segment or the entire lobe can be removed - lobectomy. Their volume depends on the nature of the pathological focus.

For example, with cancer metastases, a lobe is completely removed - right or left. In case of cancer with germination into the pancreas, resection of the tail of the pancreas is performed along with the left lobe. In cases where there is an extensive lesion of a tumor or cirrhosis, a total hepatectomy (complete removal) is performed and orthotopic liver transplantation is immediately performed - a transplant from a donor.

There are two types of intervention:

• laparotomy or open - by an extensive incision in the skin of the abdomen;
• laparoscopic or minimally invasive - by introducing a laparoscope with a video camera and special instruments into the abdominal cavity through small skin incisions.

The choice of method is carried out individually. For example, laparoscopic removal of a benign liver tumor of a small size can be performed, but with cancer and metastases, a laparotomy is needed.

Is partial liver removal a health risk?

The liver is capable of as soon as possible after resection, restore its previous volume and function

It is quite possible to understand a patient who does not decide on an operation, believing that the removal of part of this organ will entail a lifelong health disorder. It would seem that such an opinion is logical, but, fortunately, in reality it is erroneous.

The liver tissue, like no other in the body, has amazing abilities to restore, both of its original size and of its functions. Even the remaining 30% of the volume of liver tissue after injury or surgical removal able to fully recover within a few weeks. Gradually, it sprouts with lymphatic and blood vessels.

The causes and mechanisms of such properties have not yet been fully studied, but they allow expanding the scope of surgical interventions. Due to the rapid recovery, partial organ transplantation from a living donor has become a widespread practice. On the one hand, the patient does not waste precious time waiting for a cadaveric liver, on the other hand, both the donor and the patient fully recover to their normal size within 4-6 weeks.

Practice has established that even after removal of 90% of the liver, with skillful management of the postoperative period, it completely regenerates.

Advice. it is not necessary to stay in the hospital for the entire period of recovery of the organ. It is also possible to restore the liver at home when following the doctor's prescriptions and under his control.

Postoperative period

After surgery, a stationary period is distinguished and late period- after discharge. In the hospital after an open intervention, the patient stays for 10-14 days, after a laparoscopic one - 3-4 days. During this period, he receives all appointments for the prevention of complications, postoperative rehabilitation, and diet therapy.

After discharge from the hospital, the main goal is to restore the liver. This is a set of measures aimed at creating conditions for the regeneration of liver tissue, which includes:

• diet food;
• compliance with the regime of physical activity;
• general strengthening activities;
• drugs that accelerate liver recovery.

Diet food

Don't Forget the Benefits of Eating Right

The diet provides for frequent meals 5-6 times a day in small quantities, in order to avoid functional overload. It is necessary to completely exclude alcohol, extractives, spices, spicy, fatty foods, confectionery. Food should be saturated with proteins, carbohydrates, vitamins, fiber. Such a diet should be followed throughout the recovery period, and only after a follow-up examination with a doctor to decide whether to expand the diet.

Compliance with the regime of physical activity

Until the body is fully restored, heavy physical exertion, weight lifting, running and jumping are excluded. They lead to an increase in intra-abdominal pressure and circulatory disorders in the "growing" parenchyma. Recommended dosed walking with a gradual increase in load, breathing exercises, general hygiene exercises.

General strengthening measures

This includes measures to increase the protective properties of the body, increase immunity, and normalize neurovegetative functions. These are immunity stimulants of plant origin, vitamin and mineral complexes with biotin, antioxidants (vitamin E, resveratrol), sedatives and normalizing sleep. All of them are also prescribed by a doctor. Very useful honey containing required by cells easily digestible carbohydrates, vitamins, minerals and biostimulants.

Drugs that accelerate liver recovery

Accept medicines only by doctor's prescription

In most cases, these measures are sufficient for the natural and complete restoration of the organ. However, when the body is weakened in the elderly, as well as after chemotherapy, radiation therapy, regeneration slows down and needs to be stimulated.

In principle, the same preparations for the liver after removal of the gallbladder can also be used after resection. These are the so-called hepatoprotectors, most of them are of natural plant origin: LIV-52, heptral, carsil, Essentiale, galstena, folic acid and others.

Advice: in addition to pharmaceutical hepatoprotectors, various companies offer supplements today, which the marketing market is oversaturated with. These are griffola, and Japanese reishi, shiitake mushrooms and others. There is no guarantee of the authenticity of their contents, therefore, in order not to harm your health, you need to consult a specialist.

Modern interventions, robotic liver surgery

Today, liver surgery is no longer limited to the scalpel and laparoscope. New technologies have been developed and applied, such as ultrasonic resection, laser, electroresection. Operational robotics is widely used.

So, to remove areas affected by the tumor, FUS technology (high-frequency focused ultrasound) is used. This is the Cavitron apparatus, which destroys and at the same time aspirates (suctions) the removed tissue, with simultaneous “welding” of the crossed vessels.

A high-energy green laser is also used, which is most suitable for removing tumors and metastatic nodes by vaporization (evaporation). More recently, the method of electroresection (IRE) or nano-knife has been introduced, based on the removal of affected tissue at the cellular level. The method is good in that it is possible to remove the tumor even near large vessels without fear of damaging them.

Finally know-how modern surgery– robotics. The most common use of the operating robot "Da Vinci". Such an operation is performed minimally invasively, by the “hands” of a robotic surgeon, under the navigation of a tomograph. The doctor monitors the process on the screen in a three-dimensional image, controlling the robot remotely. This ensures maximum accuracy, minimum errors and complications.

The modern level of medicine and surgical technologies allows you to safely perform operations on such a delicate organ as the liver, up to the removal of large volumes of it, with subsequent recovery.

Attention! The information on the site is provided by experts, but is for informational purposes and cannot be used for self-treatment. Be sure to consult a doctor!

Operations on the liver: is it possible to do with hepatitis?

Sometimes, in the treatment of liver diseases, drug treatment is ineffective. In such cases, surgery may be used.

Operations on the liver are very diverse in technique and scope.

The amount of intervention depends mainly on the disease for which surgery is required. Comorbidities, risk of complications, and other factors also play a role.

Preparing for the operation

Before any abdominal operation, a thorough preparation of the patient is carried out. The plan for this preparation is developed individually for each patient, depending on the nature of the underlying disease, comorbid conditions and the risk of complications.

All necessary laboratory and instrumental research. For example, in a malignant tumor shortly before surgical intervention chemotherapy may be prescribed to reduce its size.

Be sure to inform your doctor about the medications you are taking. Especially those that are taken constantly (for example, antiarrhythmic, hypotensive, etc.).

Stop taking 7 days before surgery:

• non-steroidal anti-inflammatory drugs;
• blood thinners;
• antiplatelet drugs.

When performing liver surgery, it is always performed morphological study removed tissue for the purpose accurate diagnosis character pathological process and assessment of the correctness of the choice of the volume of surgical intervention.

Types of Liver Operations

As already mentioned, there are currently a lot of different methods surgical treatment liver diseases. Let's consider the most common of them.

Liver resection

It happens typical (anatomical) and atypical (marginal, wedge-shaped, transverse). Atypical resection is done if there is a need to excise the marginal sections of the liver.

The volume of liver tissue removed varies:

• segmentectomy (removal of one segment);
• sectionectomy (removal of a section of the liver);
• mesohepatectomy (central resection);
• hemihepatectomy (removal of a lobe of the liver);
• extended hemihepatectomy (removal of a lobe and section of the liver at the same time).

A separate type is combined resection - a combination of any type of liver resection with the removal of part or all of the abdominal organ (stomach, small or large intestine, pancreas, ovary, uterus, etc.). Typically, these operations are carried out metastatic cancer with removal of the primary tumor.

Laparoscopic operations

They are carried out through small (2-3 centimeters) incisions on the skin. Typically, these methods are performed operations for the removal cavity formations(for example, cysts - fenestration) and treatment of liver abscesses (opening and drainage).

Also, operations on the gallbladder (cholecystectomy and choledocholithotomy) with laparoscopic access have become widespread.

Puncture drainage

It is carried out with abscesses and sclerosis (for example, with cysts). The operation is done under ultrasound guidance. A needle is inserted into the formation. In the first case, pus is emptied and drained, in the second, the contents of the cyst are aspirated and a sclerosant drug is injected: sulfacrylate, 96% ethyl alcohol, 1% solution of ethoxysclerol, etc.

Other operations

For cancerous lesions of the organ, some specific surgical interventions are sometimes used: radiofrequency ablation (removal of a tumor using radiofrequency radiation), chemoablation (introduction of a chemical into a vessel supplying the affected area), alcoholization (introduction of ethyl alcohol into the tumor).

In diseases of the common bile duct, the following are performed: resection of cysts with the imposition of an anastomosis between the liver and the small intestine; plastic surgery for cicatricial narrowing; stent placement, extended resections for malignant lesions.

In cholelithiasis, in addition to the aforementioned cholecystectomy and choledocholithotomy by laparoscopic access, a similar amount of intervention is performed with traditional (laparotomy) access. Sometimes papillosphincterotomy, choledocholithoestraction with an endoscope is indicated.

Liver transplant

It is the most effective and sometimes the only treatment for patients with end stage chronic diseases liver, cancerous tumors, fulminant hepatitis, acute liver failure and some other diseases.

Every year the number of successful operations is increasing all over the world.

Organ donors can be persons who have received a brain injury incompatible with life, subject to the consent of their relatives.

In children, it is possible to use a part of the liver of an adult donor due to the difficulties in obtaining appropriate small sizes of donor organs. However, the survival rate for such operations is lower.

And finally, sometimes a part of an organ from a living donor is used. Such transplants are most often carried out again for children. The donor may be a blood relative (with the same blood type) of the patient in case of his informed consent. The left lateral segment of the donor organ is used. As a rule, this type of transplantation gives the least number of postoperative complications.

In some diseases, when there is a high probability of regeneration of one's own organ, heterotopic transplantation of an additional liver is used. At the same time, healthy tissue of the donor liver is transplanted, and the recipient's own organ is not removed.

Indications for liver transplantation and predicted results (according to S. D. Podymova):

After liver transplantation, patients are prescribed immunosuppressive therapy for a long time to prevent rejection.

Nutrition in the postoperative period

In the first days of the postoperative period, nutrition is exclusively parenteral. Depending on the volume and complexity of the surgical intervention, this type of nutrition lasts approximately 3-5 days. The volume and composition of such nutrition is determined individually for each patient. Nutrition should be fully balanced in terms of proteins, fats, carbohydrates and have sufficient energy value.

Then there is a combination of parenteral-enteral (tube) nutrition, which should continue for at least 4-6 more days. The need for a smooth transition from parenteral to enteral nutrition is dictated by the fact that normal functioning of the liver is disrupted during surgical trauma. small intestine, the rehabilitation of which takes an average of 7-10 days. Enteral nutrition is introduced gradually increasing the amount of food. This allows you to develop the adaptation of the organs of the gastrointestinal tract to food loads. If this is neglected, then as a result of impaired bowel function, the patient will quickly develop a protein-energy imbalance, a deficiency of vitamins and minerals.

7–10 days after the operation, they switch to diet No. 0a, combining it with parenteral nutrition. In the absence of complications, enteral nutrition is gradually expanded in the form of diet No. 1a, and then No. 1. However, some adjustments are made to these diets: for example, they exclude meat broths and egg yolk, replacing them with slimy soups and steam protein omelettes.

After 17–20 days, a transition to diet No. 5a is possible. If the patient does not tolerate it well and complains about the appearance of flatulence, diarrhea, discomfort in the abdomen, then you can use a more benign option - diet No.

Diet No. 5 is prescribed approximately one month after the operation and, as a rule, after the patient is discharged from the hospital.

The specified terms can be reduced by 3-5 days with small volumes of surgical intervention.

Postoperative period and recovery

The course of the postoperative period depends on many factors: the nature of the underlying disease, the presence or absence of concomitant pathology, the volume of surgical intervention, and the presence of complications during or after surgery.

According to L. M. Paramonova (1997), the postoperative period is divided into three conditional parts:

1. early postoperative period - from the moment of operation to three days;
2. delayed early postoperative period - from four to ten days;
3. late postoperative period - from the eleventh day until the end inpatient treatment(discharge of the patient).

During the early postoperative period, the patient is in the intensive care unit. In this department, active therapy and round-the-clock monitoring are carried out on the first day, which ensure the maintenance of vital body functions.

Adequate pain relief and cardiovascular support must be provided.

During the first 2–3 days, hemodilution with forced diuresis is performed to detoxify the body. It also allows active monitoring of kidney function, since one of the early signs of a possible development of acute liver failure is a decrease in daily diuresis (oliguria) and a change in biochemical indicators blood. The volume of transfused liquids (Ringer's solution, ionic mixtures, etc.) usually reaches two to three liters per day in combination with diuretics (lasix, mannitol).

Peripheral blood parameters are also monitored for the purpose of timely diagnosis of uncompensated blood loss or the development of postoperative bleeding. A complication in the form of postoperative bleeding can also be diagnosed in the process of monitoring the secreted fluid through the drains. Separated hemorrhagic contents, which should not exceed 200-300 ml per day, followed by a decrease in the amount and without signs of "fresh" blood.

Drainages usually function up to 6 days. In the case of liver transplant operations or the presence of bile in the separated fluid, they are left for up to 10–12 days or more.

In case of detection of uncompensated blood loss, a single-group blood transfusion or its components (erythrocyte mass) is performed, based on the levels of “red” blood indicators.

To prevent infectious complications, broad-spectrum antibiotics are prescribed. Hepatoprotectors (Essentiale, Heptral) and multivitamins are also prescribed.

The blood coagulation system is also monitored for the purpose of timely diagnosis of the syndrome of disseminated intravascular coagulation (DIC). A particularly high risk of developing this syndrome is with large intraoperative blood loss and massive blood transfusion. Medicines are prescribed to improve rheological properties blood (dextrans).

Due to increased protein catabolism on the first day after surgery, it is necessary to correct its content in the body in the form of infusion of protein preparations (plasma, albumin).

Possible Complications

It is necessary to remember the risk of respiratory disorders and timely prevent their occurrence. One of effective methods This prevention is the early activation of the patient, breathing exercises.

According to scientific studies, reactive pleurisy sometimes develops after extensive right-sided hemihepatectomy. The causes of this complication are: violation of lymphatic drainage from the liver as a result of surgery, accumulation and stagnation of fluid in the subdiaphragmatic space, insufficient drainage.

It is very important to promptly identify emerging postoperative complications and carry out their correction and therapy. The frequency of their occurrence according to different authors is 30–35%.

The main complications are:

• Bleeding.
• The accession of infection and the development of inflammation, up to septic conditions.
• Liver failure.
• Thrombosis.

In case of postoperative complications associated with prolonged hypotension and hypoxia - allergic reaction, bleeding, cardiovascular failure- is fraught with the development of liver failure of the liver stump, especially if there are initial lesions of the organ tissue (for example, fatty hepatosis).

For the prevention of purulent-septic complications antibiotic treatment continue up to ten days after the operation. Also during this period, infusion therapy continues. Nutrition should be rational high content squirrel.

From the eleventh day, in the absence of postoperative complications, the volume of therapy is reduced as much as possible and the rehabilitation process begins, which continues after the patient is discharged from the hospital.

The duration of the recovery period depends, first of all, on the volume of the surgical intervention and the nature of the main and possible concomitant diseases. The course of the postoperative period is also important.

In the recovery period, diet No. 5 is prescribed for a long time, and in some cases for life.

The complex of necessary therapy and measures during the rehabilitation period is selected and established by the attending physician individually for each patient.

Liver resection

Liver resection

A liver resection is an operation to remove part of the liver.

Reasons for liver resection

Liver resection is most commonly used to treat cancer in the liver. It can also be done for the following reasons:

• To treat other liver tumors (including benign [non-cancerous] lesions);
• Treat cancer that has spread to the liver (most commonly seen in patients with colon cancer);
• Selection of a part of the liver for transplantation;
• Treatment of liver injury.

Possible complications of liver resection

If you are planning a liver resection, you need to be aware of possible complications, which may include:

• increased bleeding;
• Reaction to anesthesia;
• Infection;
• Nausea and vomiting;
• low blood sugar;
• Liver failure.

Factors that may increase the risk of complications:

• Smoking;
• Diabetes;
• Pre-existing liver disease (eg, cirrhosis, cholestasis);
• Drinking large amounts of alcohol before or after surgery.

Long term side effects are rare because the liver is able to recover and function normally within a few months. But recovery may be slower in older patients.

You should discuss these risks with your doctor before surgery.

How is liver resection performed?

Preparation for the procedure

• You may be given chemotherapy. to reduce liver swelling;
• You may be seen by a doctor who specializes in liver surgery;
• The doctor may do some tests to determine the exact location of the tumor:
  • An abdominal ultrasound is a test that uses sound waves to take pictures of the organs inside the abdomen;
  • Computed tomography, a type of x-ray that uses a computer to take pictures of structures in the abdomen
  • PET scan - a test that uses a small amount of radiation to find areas of the body with abnormal metabolic activity, such as cancerous tumors;
  • An MRI is a test that uses magnetic waves to take pictures of structures in the abdomen.

Talk to your doctor about your medications. A week before your surgery, you may be asked to stop taking certain medications:

• Aspirin and other non-steroidal anti-inflammatory drugs (eg ibuprofen, naproxen);
• blood-thinning drugs such as warfarin;
• Antiplatelet drugs such as clopidogrel.

General anesthesia is used. which blocks any pain and keeps the patient asleep during the operation.

Description of the Liver Resection Procedure

The doctor makes an incision in the right upper abdomen, under the chest.

The doctor removes the tumor on the liver and some of the surrounding healthy tissue. Sometimes also needs to be removed gallbladder. The doctor may use an ultrasound to examine the liver during surgery to make sure all of the tumor has been removed. Temporary drainage tubes may be placed around the surgical site to drain accumulated fluids and blood. The doctor closes the incision with stitches or staples.

Immediately after the procedure

You will be placed in the intensive care unit for 24 hours. Hospital staff will monitor vital signs.

How long will a liver resection take?

Liver resection - will it hurt?

Anesthesia prevents pain during surgery. Pain or soreness during recovery is reduced with pain medication.

Average time in hospital

This procedure is carried out in a hospital setting. Usually the length of stay is 4-8 days. If there are complications, the length of stay may be longer.

Care after liver resection

Care in the hospital

• You will be fed through a drip. It will be removed as soon as you can eat and drink on your own;
• Drainage tubes will help speed up tissue healing. The drain is usually removed before leaving the hospital;
• You may need to place a catheter in your bladder to drain urine. The catheter will be removed after a few days;
• Painkillers are prescribed. They can be given by injection, drip, or through a pump and a needle in the arm;
• Medicines are prescribed to prevent nausea.

home care

When you get home, follow these steps to ensure a smooth recovery:

• Change the bandage as directed by your doctor;
• Ask your doctor when it is safe to shower, bathe, or expose the surgical site to water;
• Take pain medication as needed;
• You will start to feel better within six weeks of your surgery;
• Be sure to follow your doctor's instructions.

Communication with the doctor after liver resection

After discharge from the hospital, you should consult a doctor if the following symptoms appear:

• redness, swelling, increased pain, bleeding, fever, or swelling at the incision site;
• Nausea and/or vomiting that does not disappear after taking prescribed medications and persists for more than two days after discharge from the hospital;
• severe pain in the abdomen;
• signs of infection, including fever and chills;
• cough, shortness of breath, or chest pain;
• Pain and/or swelling in the legs, calves, and feet;
• Pain, burning, frequent urination or persistent bleeding in the urine;
• Feeling weak or dizzy.

Cancer is a real scourge of our society. They affect people of different ages and different social strata, they cannot be foreseen and prevented. Fortunately, the level of development of modern medicine makes it possible to cope with this terrible disease, but one of the main conditions for this is timely diagnosis. That is why it is tedious for every person to have information about how oncological diseases. Today we will talk about one of these ailments - liver cancer.

If liver cancer, what are the symptoms?

Unfortunately, the manifestations of this disease at the initial stage of development are very insignificant. At the same time, the disease progresses very quickly, so it is often detected only in the later stages. Most patients see a doctor about three months after the very first symptoms of liver cancer appear. The most common complaints are:

Pain localized in the area of ​​the right hypochondrium;
- loss of appetite and some weight loss;
- appearance pronounced weakness and lethargy, as well as fairly quick fatigue;
- the abdomen increases in size;
- increase in temperature indicators;
- the occurrence of nosebleeds;
- the appearance of yellowness on the skin;
- the occurrence of vomiting, nausea and other dyspeptic phenomena.

If a patient is diagnosed with primary liver cancer, then in ninety percent of cases he has hepatomegaly (as the enlargement of this organ is called). In this case, the lower part of the liver can increase up to ten centimeters, its upper zone can reach the fourth rib. This situation also leads to an increase in the volume of the chest.

What is the course of the disease when liver cancer?

The course of the disease leads to an increase in all the described symptoms. Cancer causes the liver to become easily palpable over time. The patient himself can feel the bottom of the organ at the level of the navel, and sometimes even lower. Palpation is accompanied by slight pain. The development of processes leads to the fact that the liver becomes bumpy and more dense. In addition, an isolated tumor node can be determined.

As the bile ducts become compressed, jaundice begins to develop. Over time, the patient develops symptoms of liver failure, which is expressed in the processes of general intoxication of the body. tumor cells sometimes they begin to synthesize hormone-like substances, which is fraught with endocrine disorders. Sometimes fluid begins to accumulate in the patient's peritoneum, this phenomenon is called ascites.

Can surgery cure liver cancer?

Liver cancer therapy is exclusively operational methods, because the probability of a complete cure is possible only with resection of the tumor. At the same time, surgery can be performed only in large clinics, since it is quite traumatic and difficult. If a patient is diagnosed with a malignant tumor, as well as metastases, a liver resection is performed, removing those tissues that the tumor has affected. Sometimes only a fraction of the organ is eliminated, and sometimes half. Such surgery is not dangerous, because the body has the ability to recover. After about six months, the size of the liver becomes almost the same, and the patient is completely healthy ...

Treatment options such as chemotherapy or radiation therapy, in most cases are not used, because the oncological lesion of this organ is not sensitive to any of the antitumor agents developed to date, and it also does not respond to radiation.

In the event that the tumor cannot be removed, for example, due to an unfortunate location near large vessels or a particularly large size, the doctor may resort to restorative therapy, which is aimed at alleviating the patient's condition and prolonging his life. The patient is provided with the maximum comfortable conditions, namely, good nutrition, vitamin support, the introduction of special nutritional components intravenously, as well as the use of painkillers.

In large research centers, they may resort to the introduction of chemotherapy drugs directly into large vessels located near the tumor. Such measures help to somewhat reduce the size of the formation, having a minimum effect on the entire body. In some cases, such therapy leads to a cure, in other situations it prolongs life.

Forecast at malignant formations in the liver

For patients diagnosed with liver cancer, survival depends on many factors. These include the size and number of tumor nodes, as well as the presence of metastases in the liver itself. An important role is played by the volume of surgical intervention, the qualitative characteristics of the tumor (the presence or absence of a capsule, germination in the vessels of the liver), as well as the presence of a history of viral hepatitis or cirrhosis.

So, with single tumor nodes, fifty percent of patients can survive, if the number of nodes reaches two - thirty to thirty-five percent. In the event that three tumor nodes are diagnosed, recovery occurs in twelve to eighteen percent of cases. At the same time, the given statistics are based on patients who survived for five years after surgery.

At timely handling for doctoral help, the likelihood of a favorable outcome increases markedly.