AEåë÷íûå ïóòèЦель: изучить влияние внутрипротоковой фотодинамической терапии на продолжительность и качество жизни неоперабельных больных воротной холангиокарциномой (опухолью Клацкина). Материал и методы. В 2008-2015 гг. проведено 118 сеансов (от 1 до 10, медиана 2,0) внутрипротоковой фотодинамической терапии 39 больным опухолью Клацкина (тип IV по Bismuth) 34-75 лет, не подлежащих хирургическому лечению. У всех больных было от 1 до 4 чрескожных чреспеченочных холангиостомических дренажей. Использовали фотосенсибилизаторы второго поколения (радахлорин, фотолон, фотодитазин), вводимые за 2-4 ч до воздействия лазером. Пошаговое облучение пораженных протоков осуществляли с помощью введен ного под рентгентелевизионным контролем гибкого световода по разработанному в клинике оригинальному методу. Лазерное облучение проводили в импульсном режиме, дозу облучения подбирали индивидуально в зависимости от объема поражения протоков. Диагностику опухоли и динамический контроль осуществляли с помощью морфологического исследования, холангиографии и МРТ. Результаты. Срок наблюдения составил 2-47 мес. Послеоперационной летальности не было. У 3 пациентов развились осложнения, потребовавшие миниинвазивных вмешательств, -абсцессы печени (n = 1) и эмпиема желчного пузыря (n = 2). Внутрипротоковая фотодинамическая терапия позволила уменьшить частоту обострений холангита и улучшить качество жизни. Медиана выживаемости составила 16 мес (2-47 мес) от первого сеанса внутрипротоковой фотодинамической терапии и 31 мес (5-69 мес) со времени установления диаг ноза. Одно-, двух-, трех, четырех-, пятилетняя актуриальная выживаемость от момента установления диагноза составила 88, 68, 39, 14,8 и 5%. Заключение. Внутрипротоковая фотодинамическая терапия представляется перспективным способом увеличения продолжительности и улучшения качества жизни неоперабельных больных.

Purpose: to present different modalities of biliary decompression and specific antitumor treatment of hilar cholangiocarcinoma (Klatkin tumor). material and methods. The review was based on 318 publications available from Pubmed, Medline, Elibrary, etc. in the interval time between 19212018. results. Hilar cholangiocarcinoma is a rare hepatobiliary malignancy with dismal prognosis demonstrating slow periductal infiltrative growth, late metastasis and causing death mainly due to local complications. Percutaneous transhepatic biliary drainage (PTBD) is the optimal way of biliary decompression for malignant hilar strictures nowadays. PTBD is the safest, technically accessible technique with reproducible results. Transpapillary decompression in Klatskin tumor patients is technically feasible in 40 % of cases only. Biliary resection accompanied by major hepatectomy is considered the only curative modality to the date, but its results aren’t satisfactory a well as the majority of patients aren’t seemed the surgical candidates. Thus the locoregional technologies, i.e. radiation therapy, radiofrequency ablation and photodynamic therapy (PDT), are widely spread. PDT should be preferred over other local modalities due to safety, efficiency, possibility of reinterventions, technical and economic accessibility. conclusion. Modern approaches to the management of Klatskin tumor do not differ much from the those proposed by the first researchers in the middle of the xxth century and comes down to the biliary stricture dilatation and the sustenance of the normal bile passage as long as possible. However, despite the strategic stagnation, significant tactical successes were achieved thus allowing significant prolongation of survival in previously considered incurable patients.

Objective. To compare liver function assessments using Gd-EOB-DTPA-enhanced MRI and the gold standard hepatobiliary scintigraphy (HBS) in patients with bile duct diseases.Material and methods. The investigation enrolled 18 patients (male/female = 11/7; age, 29–70 years, Klatskin tumor (n=16), bile duct epithelial dysplasia (n=1), intrahepatic cholangiolithiasis (n=1)) after biliary decompression, who underwent 21 paired MRIs and 99mTc-mebrofenin HBS at a study interval of no more than 3 days. In the same regions of interest with a size of 30–50 pixels located in liver segments II–III, IV, V–VIII, and VI–VII, a MRI signal was measured before MR contrast agent (MRCA) injection into the standard vascular phases and at 10, 20, 30 and 40 minutes, then the signal was expressed as a percentage of intensity compared to the precontrast series. After MR volumetry, the functional volumes of the left and right liver lobes were also defined as the area under the MRCA accumulation curve, which was multiplied by the lobe volume and expressed as a percentage of the similarly calculated function of the entire liver. Similar intensity parameters and functional volumes were estimated for a HBS study.Results. The lobe functional volumes measured by the two methods were highly correlated (R=0.8; p<0.001) and did not show a significant difference at all when comparing with the Mann–Whitney test (p>0.3). The excretion rate of 99mTc-mebrofenin was also highly correlated with MRI findings (R=0.5–0.9; p<0.05). Conclusion. Gd-EOB-DTPA-enhanced MRI revealed a high correlation with the gold standard; however, additional studies are needed to clarify the possibilities and limitations of replacing one method with another one.><0.05).Conclusion. Gd-EOB-DTPA-enhanced MRI revealed a high correlation with the gold standard; however, additional studies are needed to clarify the possibilities and limitations of replacing one method with another one.