hepatoАнналы хирургической гепатологииAnnaly khirurgicheskoy gepatologii = Annals of HPB Surgery1995-54642408-9524НЭИКОН ИСП10.16931/1995-5464.20174109-115hepato-134Research ArticleКЛИНИЧЕСКОЕ НАБЛЮДЕНИЕCASE REPORTОстрое повреждение почек после операции ALPPS (клиническое наблюдение)Acute Kidney Injury after ALPPS Procedure (Case Report)ВосканянС. Э.VoskanyanS. E.

Восканян Сергей Эдуардович – доктор мед. наук, заместитель главного врача по хирургической помощи – руководитель Центра хирургии и трансплантологии, заведующий кафедрой хирургии с курсами онкохирургии, эндоскопии, хирургической патологии, клинической трансплантологии и органного донорства.

123098, г. Москва, ул. Маршала Новикова, д. 23, Российская Федерация

Voskanyan Sergey Eduardovich – Doct. of Med. Sci., Deputy Chief for Surgery, Head of Surgery and Transplantation Center, Head of the Chair of Surgery with the Courses of Oncology, Endoscopy, Surgical Pathology, Clinical Transplantation and Organ Donation.

СушковА. И.SushkovA. I.

Сушков Александр Игоревич – канд. мед. наук, заведующий лабораторией новых хирургических технологий Центра хирургии и трансплантологии.

Sushkov Alexander Igorevich – Cand. of Med. Sci., Head of New Surgical Technologies Laboratory, Surgery and Transplantation Center.

sushkov.transpl@gmail.comЖурбинА. С.ZhurbinA. S.

Журбин Алексей Сергеевич – младший научный сотрудник лаборатории новых хирургических технологий Центра хирургии и трансплантологии, аспирант кафедры хирургии с курсами онкохирургии, эндоскопии, хирургической патологии, клинической трансплантологии и органного донорства.

Zhurbin Alexey Sergeevich – Junior Researcher, New Surgical Technologies Laboratory, Surgery and Transplantation Center; Postgraduate of the Chair of Surgery with the Courses of Oncology, Endoscopy, Surgical Pathology, Clinical Transplantation and Organ Donation.

НайденовЕ. В.NaydenovE. V.

Найденов Евгений Владимирович – канд. мед. наук, врач-хирург хирургического отделения, старший научный сотрудник лаборатории новых хирургических технологий Центра хирургии и трансплантологии.

Naydenov Evgeny Vladimirovich – Cand. of Med. Sci., Surgeon at the Department of Surgery; Senior Researcher of the New Surgical Technologies Laboratory, Surgery and Transplantation Center.

23, Marshal Novikov str., Moscow, 123098, Russian Federation

Государственный научный центр Российской Федерации – Федеральный медицинский биофизический центр им. А.И. Бурназяна ФМБА России;РоссияState Research Center – A.I. Burnasyan Federal Medical Biophysical Center of the Federal Medical Biological AgencyRussian Federation201715012018224109115Copyright © Восканян С.Э., Сушков А.И., Журбин А.С., Найденов Е.В., 20182018Восканян С.Э., Сушков А.И., Журбин А.С., Найденов Е.В.Voskanyan S.E., Sushkov A.I., Zhurbin A.S., Naydenov E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://hepato.elpub.ru/jour/article/view/134

Острое почечное повреждение (ОПП) является одним из серьезных осложнений при обширных резекциях печени и помимо других причин может быть проявлением пострезекционной печеночной недостаточности (ППН). Операция ALPPS (Associating Liver Partition and Portal vein Ligation for Staged hepatectomy) – эффективный метод профилактики ППН при малом остаточном объеме паренхимы или билобарном поражении печени, однако риски ОПП после такого вмешательства в настоящее время не изучены.Мы приводим описание и анализ клинического наблюдения за пациентом 23 лет, которому по поводу альвеококкоза печени была проведена операция ALPPS. Несмотря на отсутствие до- и интраоперационных факторов риска, в течение ближайших часов после первого этапа операции у пациента развилось ОПП (RIFLE-F), потребовавшее заместительной почечной терапии в течение трех недель и разрешившееся на фоне инфузии комбинации терлипрессина и альбумина.Почечная дисфункция не повлияла на скорость регенерации будущего остатка паренхимы печени, что позволило выполнить второй этап ALPPS через шесть дней после первой операции. В послеоперационном периоде не наблюдалось значимого ухудшения синтетической функции печени, коагулопатии, желтухи или энцефалопатии.Механизмы развития ОПП, характер изменений портального и системного кровотока после первого этапа ALPPS и при гепаторенальном синдроме I типа представляются схожими. В качестве мер профилактики почечной дисфункции следует рассматривать поддержание физиологических показателей гемодинамики как во время, так и после операции, в том числе за счет использования норадреналина и/или терлипрессина.

Acute kidney injury (AKI) is a serious complication after major liver resection. It may be caused by post-hepatectomy liver failure (PLF). ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy) procedure is an effective way for PLF prevention in cases of small future remnant volume or bilobar liver lesions, but the risk of AKI following this procedure is unknown.Herein we present and discuss the case of a 23-year-old man with hepatic alveococcosis who underwent ALPPS procedure. Despite absence of any risk factors AKI (RIFLE-F) followed by renal replacement therapy (RRT) has occurred within few hours after the first surgical stage. Only the combination of albumin and terlipressin resulted function improvement and RRT with drawal after three weeks of AKI onset.Renal dysfunction didn’t affect the liver regeneration and the second stage of ALPPS has been performed in six days after the first one. There were no signs of serious liver synthetic function deterioration, coagulopathy, jaundice or encephalo pathy.The mechanisms of AKI progression as well as the portal and systemic circulatorychanges after the first stage of ALPPS seem to be similar with hepatorenal syndrome type I. Intra- and postoperative maintenance of physiologic hemodynamics may be the key point for AKI prevention. Norepinephrine and/or terlipressin could be considered as the drugs of choice.

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The authors declare that there are no conflicts of interest present.