В статье представлен клинический случай цирроза печени класса С по классификации Чайлда – Пью в исходе хронического гепатита С с развитием первичного рака печени. Показано, что ранняя диагностика первичного рака печени и своевременное начало терапии препаратом прямого противовирусного действия привели к компенсации цирроза печени, несмотря на перенесенный COVID-19. Течение новой коронавирусной инфекции осложнилось печеночно-клеточной недостаточностью и энцефалопатией, что потребовало наблюдения и лечения в отделении реанимации. Проведена интенсивная терапия с восстановлением функционального состояния печени. Однако у пациента развился острый психоз, в связи с чем он был переведен в неврологическое отделение. Больной выписан в удовлетворительном состоянии с компенсацией цирроза печени. В дальнейшем проведено лигирование варикозно расширенных вен пищевода, что снизило риск развития кровотечения. После компенсации цирроза печени назначена терапия препаратами прямого противовирусного действия. Через 4 недели от начала противовирусной терапии РНК вируса гепатита С не определялась. Однако после завершения курса лечения вирус гепатита С вновь был выявлен ультрачувствительным методом полимеразной цепной реакции, что потребовало продления противовирусной терапии off-label, назначенной врачебной комиссией еще на 8 недель. Адекватная противовирусная терапия способствовала излечению от хронического гепатита С, а трансартериальная химиоэмболизация опухоли позволила стабилизировать процесс для этапа ожидания трансплантации печени. По данным контрольной магнитно-резонансной томографии через 6 месяцев сохраняется стабилизация опухолевого узла в печени, других опухолевых узлов не выявлено. Учитывая сохраняющийся положительный эффект, проведение второго курса трансартериальной химиоэмболизации не показано. Продолжается дальнейшее наблюдение пациента инфекционистом и онкологом, рекомендуется консультация трансплантолога, контрольные исследования путем магнитно-резонансной томографии органов брюшной полости с внутривенным контрастированием и контроль уровня альфа-фетопротеина каждые 3 месяца. The article presents a clinical case of cirrhosis of the liver of class C according to Child – Pugh in the outcome of chronic hepatitis C and with the development of primary liver cancer. It is shown that early diagnosis of primary liver cancer and timely initiation of antiviral therapy with a direct antiviral drug led to compensation for cirrhosis of the liver, despite the COVID-19. The course of the new coronavirus infection was complicated by hepatic cell insufficiency and encephalopathy, which required observation and treatment in the intensive care unit. Intensive therapy was carried out with the restoration of the functional state of the liver. However, the patient developed acute psychosis, and therefore he was transferred to the neurological department. The patient was discharged in a satisfactory condition with compensation for cirrhosis of the liver. Subsequently, ligation of varicose veins of the esophagus was performed, which reduced the risk of bleeding. After compensation for cirrhosis of the liver, therapy with direct antiviral drugs was prescribed. After 4 weeks from the start of antiviral therapy, HCV RNA was not detected. However, after completing the course of treatment with an ultra-sensitive polymerase chain reaction method, the hepatitis C virus was again detected, which required the extension of antiviral therapy off-label by the medical commission for another 8 weeks. Adequate antiviral therapy contributed to the cure of chronic hepatitis C, and transarterial chemoembolization of the tumor allowed to stabilize the process for the waiting stage of liver transplantation. According to the control magnetic resonance imaging, after 6 months, the stabilization of the tumor node in the liver remains, no other tumor nodes were detected. The alpha-fetoprotein level is normal. Given the continuing effect, the second course of transarterial chemoembolization is not shown. Further observation of an infectious disease specialist, oncologist continues, a consultation with a transplant specialist is recommended, control magnetic resonance imaging of abdominal organs with intravenous contrast and alpha-fetoprotein every 3 months.

Background. The results of local destruction methods in locally advanced pancreatic cancer (LAPCa) are contradictory. Radiation therapy is the most commonly used. Other methods are used much less frequently, irreversible electroporation (IRE) is one of them. Most authors indicate an acceptable level of complications and mortality, but without an improvement in long-term results. The results of two meta-analyses have been published, the authors indicate the possibility of using the IRE in selected patients. The authors also point out that minimally invasive methods of using the IRE be preferred. Some experience has been gained in the use of percutaneous access for IRE in LAPCa. Computed tomography, ultrasound guidance can be used for navigation. The level of complications can reach 50 %. Mortality with percutaneous access, as a rule, is absent or does not exceed 5 %. Long-term results are the same with the results of open IRE.Aim. To share authors experience of using percutaneous irreversible electroporation in pancreatic cancer, because there are no references to the use of percutaneous IRE in LAPCa in Russia.Materials and methods. The IRE was performed for 53-year female patient with LAPCa after successful induction therapy. A step-by-step pulse effect of electrodes installed under ultrasound control on the tumor infiltrate was carried out. Magnetic resonance imaging, computed tomography and other types of studies were used for diagnostic purposes.Results. The involvement of the common hepatic artery and portal vein remained after the induction therapy, which did not allow performing pancreatoduodenal resection. Ultrasonic navigation and flat-detector computed tomography allowed to install the electrodes adequatly and safely. The impact zone almost completely blocked the infiltrate zone, a more optimal location of the electrodes was limited by the wide network of venous collaterals. Magnetic resonance imaging data performed before and after the procedure showed no progression of the disease within more than three months after the procedure, including in the affected area. Tumor shrinkage was noted as a partial response.Conclusion. The first experience confirmed the safety and the absence of subsequent complications when using the percutaneous access method of IRE for LAPCa. Follow-up monitoring of the patient will allow to say more correctly about the possibility of the method to provide long-term local control.

Hepatocellular carcinoma is the fifth most common cancer worldwide and the approaches to treatmentdiffer due to the stage of the disease. According to BCLC classification, B stage patients are recommendedto be underwent transarterial chemoembolization. However, BCLC B integrates patients with differentintrahepatic tumor burden and with different liver deterioration. There are many staging classifications thatdetermine the treatment and survival rates due to heterogeneity of this patient cohort. The aim of this studyis to review the existing ones and to describe their prognostic value.

Complete liver and bile ducts resection with negative margins (R0) in the only possible radical treatment of Klatskin tumor. Even after R0 resection, the recurrence rate is as high as 50–76 %. Neoadjuvant endobiliary photodynamic therapy (PDT) may potentially improve their results and long­term survival. The authors present their own first experience of endobiliary PDT performing before liver and bile ducts resection (R0) in Klatskin tumor patient.

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