Rationale. Alveococcosis is a rare disease, its diagnosis and treatment depend on surgical techniques, equipment and clinical experience. The aim. To develop a diagnostic algorithm and compare the results of surgical treatment of patients with liver alveococcosis in different periods of time.Materials and methods. At the first stage, we carried out a retrospective analysis (1995–2007) of 33 patients with alveococcosis (a comparison group). At the second stage, a prospective clinical study (2008–2021) was performed on 39 patients (the main group). The number of patients was determined in accordance with the inclusion and exclusion criteria, and the study groups were comparable in age, sex, parasite localization (p > 0.05). For the names of operations, the WHO classification of alveococcosis was used.Results. In the main group, there is an increase in the applicability of: enzyme immunoassay; ultrasound and computed tomography; biopsy. Complications decreased by 2.7 times from 54.6 % in the comparison group to 20.6 % in the main group (χ2 = 8.97; df = 1; p = 0.003). The average duration of operations, as well as the average volume of blood loss in the comparison group and the main group were, respectively: with atypical resection – 220.4 and 180.2 min (p = 0.003), 640.1 and 480.0 ml (p = 0.005); with anatomical resection – 296.2 and 247.2 min (p = 0.002), 1450.2 and 1150.3 ml (p = 0.018); with cytoreductive resection – 230.2 and 200.1 min (p = 0.004), 860.3 and 670.4 ml (p = 0.001). There were 13 (39 %) cytoreductive resections in the comparison group, and 3 (8 %) in the main group (χ2 = 4.74; df = 1; p = 0.029).Conclusion. Timely diagnosis of alveococcosis leads to an increase in the number of radical resections, and modern surgical technologies and equipment can reduce the time of surgery, blood loss and the number of complications.

Background. Postoperative failure is a major cause of adverse outcomes in extensive liver resection. Post-resection liver failure requires intensive, including extracorporeal, care. Issues in correcting liver failure warrant novel approaches to prevent severe cases.Materials and methods. A retrospective analysis of 228 various-extent liver resections included minor (55.7 %), major (26.8 %) and extended (17.5 %) operations for malignant, benign and parasitic liver lesions. The post-resection liver failure rate has ben graded according to ISGLS.Results and discussion. Postoperative hepatic failure developed in 58 (25.4 %) cases, including 5 of 127 minor (3.9 %) resections, 18 major (29.5 %) and 35 of 40 extended resections (87.5 %). Mild class A liver failures were reported in 12.3 %, and severe classes B and C — in 9.2 % and 3.9 % cases, respectively.CT volumetry in place of the number of resected segments is suggested as a criterion to grade the expected post-resection residual liver, with >70 % defining a minor, 36–70 % — major and 25–35 % — extended expected residual liver.A two-staged extended hepatic resection approach is proposed to reduce postoperative liver failure, with vascular radiology-guided right portal vein embolisation (RPVE) or associating liver partition and portal vein ligation (ALPPS) at stage 1.A comparison of extended hepatic resection outcomes (n = 40) showed a significantly higher rate and severity of liver failure in single- vs. two-staged operations (p < 0.05).Conclusion. Liver failure is a leading cause of death in major and extended hepatic resection. Preoperative CT volumetry allows a more accurate volumetric control of expected post-resection residual liver. Two-staged extended hepatic resection can reliably reduce the rate and severity of postoperative liver failure.

Introduction. There are several classifications of alveolar disease of the liver, but they do not provide complete information regarding all possible surgical interventions in terms of this pathology. Our study was aimed at identifying and structuring various approaches to staged surgical treatment of the disease, taking into account the current possibilities of minimally invasive surgery.Materials and methods. After carrying out a retrospective analysis of surgical treatment of 72 patients with alveolar disease of liver, we have developed a classification of the surgical interventions and 6 main staged approaches to surgical treatment for the disease. Results and discussion. The presented classification of surgical interventions for alveolar disease of the liver is entirely sufficient to divide all surgeries into the following groups: radical/ relatively-radical surgical interventions that make the patient free or nearly free of the disease, and palliative/diagnostic surgeries, that focus on alleviation of the patient’s condition. In addition, the volume and radicality of the liver resection as well as the drainage of the bile ducts and liver decay cavities can be clarified. Based on the developed classification of surgical interventions, we presented 6 main staged, case-centered approaches to the surgical treatment for liver alveolar disease and its complications.Conclusion. The presented classification of surgical interventions for alveolar disease of the liver is a way to explicitly divide the surgeries according to several criteria. Surgical treatment for alveolar disease of the liver includes various parts, which made it possible to develop 6 main options for a staged approach to surgical interventions, ensuring scientific and practical applications.

Опыт лечебных учреждений Нартайлаков Мажит Ахметовичд.м.н., член-корреспондент РАЕН, профессор, зав. кафедрой общей хирургии с курсом лучевой диагностики ИДПО, директор НИИ новых медицинских технологий Абдеев Рустем Раисовичк.м.н., врач-трансплантолог Салимгареев Ильдар Зуфаровичк.м.н., зав. отделением гастрохирургии Загитов Артур Раусовичд.м.н.