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Introduction: Frequency of primary hepatic cancer makes 3-5 persons per 100 000, metastatic cancer is 20-30 times higher. Metastatic lesions of the liver are diagnosed in 20-50% of patients during primary visit to a doctor. Operability of hepatic cancer is not more than 15-20% that dictates usage of radio-frequency ablation (RFA) in combined treatment. Methods: Two hundred thirty five patients with primary and metastatic tumours of the liver were treated from 2012 till 2017. The mean age was 63, 6AE7, 1. Metastases of colorectal cancer were diagnosed in 143 (60,8%) patients, hepatocellular carcinoma-in 30 (12,8%), cancer metastases of the other organs-in 62 (26,4%). Size of liver foci varied from 1,5 to 6 sm. Atypical liver resections were performed to 86 patients, RFA was fulfilled to 149 patients. Size of tumours in RFA was not more than 5 sm. Chemotherapy was applied to all the patients. Results: Postoperative complications after atypical resections of the liver occurred in 5, 81% (n=5) cases: bleeding-in 2 (2, 33%), biloma-in 1 (1, 16%), subdiaphragmatic abscess-in 1 (1, 16%), pleuritis-in 1 (1, 16%) case. After RFA complications were observed in 4 (2, 68%) cases: hematoma, biliary fistula, subdiaphragmatic abscess, reactive pleuritis. Survival rate after atypical liver resections during 3-5 years was 44, 6% and 26, 8% respectively, after RFA-42, 4% and 22, 9%. Conclusion: Usage of atypical resections is rational for small subcapsular located tumours. For intraparenchymatous located tumours RFA is recommended.

Objective. To improve the results of treatment of patients with liver echinococcosis and carry out a comparative assessment of techniques of surgical treatment depending on the nature of postoperative complications, hospital stay and antirecurrent efficacy. Materials and methods. The experience of complex examination and treatment of 65 patients with liver echinococcosis for the period of 1999-2019 was analyzed. Open echinococectomy was performed in 21 patients, atypical liver resection in 18 patients, anatomical liver resection in 14 patients, pericystectomy in 10, laparoscopic echinococectomy in 1, percutaneous puncture of an echinococcal cyst under ultrasound control in 1 patient. Results. The time of inpatient treatment of patients after open echinococectomy was 23.5 4.3 days, after pericystectomy 19.8 1.4 days, after liver resection 14.4 2.7 days, after laparoscopic echinococcectomy 6, after percutaneous puncture echinococcal cyst 7 days. Postoperative complications were observed in 52.4 % of patients who underwent open echinococectomy, in 20 % of patients after pericystectomy, and in 15.6 % after liver resection. There were no relapses of liver echinococcosis in all the groups. Mortality was 1.5 % and was recorded after open echinococectomy. Conclusions. The most effective techniques for preventing postoperative complications are pericystectomy and liver resection. The duration of surgery and the average length of hospital stay with minimally invasive methods of treatment are shorter. However, the use of these methods of treatment remains controversial due to the possibility of intra-abdominal spread of the parasite. Patients with parasitic liver cysts after surgical treatment are subjected to dynamic follow-up observation (ultrasound examination of the liver, enzyme-linked immunosorbent assay, computed tomography of the abdominal organs) after 3-6 months for at least 5 years.

Кафедра факультетской хирургии № 2 с курсом гематологии и трансфузиологии (зав. -проф. М. Ф. Заривчацкий), ФДПО ФГБОУ ВО «Пермский государственный медицинский университет им. акад. Е. А. Вагнера» Минздрава России ЦЕЛЬ ИССЛЕДОВАНИЯ. Улучшить результаты хирургического лечения больных с циррозом печени с угрозой кровотечения из варикозно-расширенных вен пищевода. МАТЕРИАЛ И МЕТОДЫ. В исследование включили 90 больных с варикозным расширением вен пищевода (ВРВП). Портокавальное шунтирование выполнено 21 пациенту, прямые вмешательства на венах пищевода и желудка -29, эндоскопическое лигирование вен пищевода -40. РЕЗУЛЬТАТЫ. Показатель кумулятивной выживаемости больных после портокавального шунтирования до 1 года составил (93,3±6,4) %, до 3 лет -(66,7±12,2) % и 5 лет -(60±12,7) %, после прямых вмешательств на венах пищевода (92,9±6,9) 5±18,5) % соответственно. ЗАКЛЮЧЕНИЕ. Для профилактики кровотечений из варикозно-расширенных вен методом выбора являются курсы эндоскопического лигирования вен. Ключевые слова: цирроз печени, портальная гипертензия, варикозное расширение вен пищевода, рецидив кровотечения OBJECTIVE. The authors would like to improve the results of surgical treatment of patients with threat of bleeding from esophageal varices. MATERIALS AND METHODS. The study included 90 patients with esophageal varices on the background of liver cirrhosis. Portocaval bypass was performed on 21 patients. The direct interventions on the stomach and esophageal varices were carried out in 29 patients. The endoscopic ligation of esophageal varices was used in 40 cases. RESULTS. The rate of cumulative survival after portocaval bypass was 93,3±6,4 % (up to1 year), 3-year survival rate counted 66,7±12,2 % and 5-year rate was 60,0±12,7 % , respectively. The rate of survival after direct interventions on the stomach and esophageal varices consisted of 92,9 %±6,9 %, 76,0±12,2 % and 65,1±14,5 %, respectively. The survival rate after the endoscopic ligation of esophageal varices class A and B in Child-Pugh numbered 100 %, 91,0±8,7 % and 54, 6±20,6 %, but in case of the class C survival rate counted 60,0±20,4 %, 45,0 %±18,8 and 22,5±18,5 %, respectively. CONCLUSIONS. The authors recommend to apply the long-term courses of endoscopic ligation of esophageal varices in order to prevent bleeding from them. The methods of portcaval bypass or direct intervention should be used in case of lack of effect of endoscopic ligation method.