hepatoАнналы хирургической гепатологииAnnaly khirurgicheskoy gepatologii = Annals of HPB Surgery1995-54642408-9524НЭИКОН ИСП10.16931/1995-5464.2022-4-47-56hepato-936Research ArticleСОВРЕМЕННЫЕ ТЕНДЕНЦИИ В ХИРУРГИИ ПЕЧЕНИCURRENT TRENDS IN LIVER SURGERYСложные резекции очаговых новообразований гепатикокавального конфлюенса у детейComplex resections for focal neoplasms of hepatico-caval confluence in childrenhttps://orcid.org/0000-0002-1387-209XАхаладзеД. Г.AkhaladzeD. G.

Ахаладзе Дмитрий Гурамович – канд. мед. наук, руководитель отдела торакоабдоминальной хирургии

117997, Москва, ул. Саморы Машела, д. 1

Тел.: 8-905-587-89-92 

Dmitry G. Akhaladze – Cand. of Sci. (Med.), Head of the Department of Thoracoabdominal Surgery

1, Samory Mashela str., Moscow, 117997

Phone: +7-905-587-89-92 

d.g.akhaladze@gmail.comhttps://orcid.org/0000-0002-5691-2522РабаевГ. С.RabaevG. S.

Рабаев Гавриил Савельевич – врач – детский хирург отделения онкологии и детской хирургии 

117997, Москва, ул. Саморы Машела, д. 1

Gavriil S. Rabaev – Physician, Pediatric Surgeon, Department of Oncology and Pediatric Surgery

1, Samory Mashela str., Moscow, 117997

rabaevgesha@gmail.comhttps://orcid.org/0000-0003-0404-6420МеркуловН. Н.MerkulovN. N.

Меркулов Николай Николаевич – врач – детский хирург отделения онкологии и детской хирургии

117997, Москва, ул. Саморы Машела, д. 1

Nikolay N. Merkulov – Physician, Pediatric Surgeon, Department of Oncology and Pediatric Surgery

1, Samory Mashela str., Moscow, 117997

dr.mernich@yandex.ruhttps://orcid.org/0000-0001-5150-1436ТвердовИ. В.TverdovI. V.

Твердов Иван Вадимович – врач – детский хирург

117997, Москва, ул. Саморы Машела, д. 1

Ivan V. Tverdov – Physician, Pediatric Surgeon of the Department of Pediatric Oncology and Surgery

1, Samory Mashela str., Moscow, 117997

twerdov.iwan@yandex.ruhttps://orcid.org/0000-0001-9424-1646УсковаН. Г.UskovaN. G.

Ускова Наталья Геннадьевна – канд. мед. наук, врач – детский хирург отделения онкологии и детской хирургии

117997, Москва, ул. Саморы Машела, д. 1

Natalya G. Uskova – Cand. of Sci. (Med.), Physician, Pediatric Surgeon, Department of Oncology and Pediatric Surgery

1, Samory Mashela str., Moscow, 117997

nataliyauskova@gmail.comhttps://orcid.org/0000-0002-5308-6544ТалыповС. Р.TalypovS. R.

Талыпов Сергей Римович – канд. мед. наук, врач – детский хирург отделения онкологии и детской хирургии

117997, Москва, ул. Саморы Машела, д. 1

Sergey R. Talypov – Cand. of Sci. (Med.), Physician, Pediatric Surgeon, Department of Oncology and Pediatric Surgery

1, Samory Mashela str., Moscow, 117997

riumych@yandex.ruhttps://orcid.org/0000-0002-2636-0675КривоносовА. А.KrivonosovA. A.

Кривоносов Анатолий Андреевич – врач – детский хирург  

117997, Москва, ул. Саморы Машела, д. 1

Anatoliy A. Krivonosov – Physician, Pediatric Surgeon of the Department of Pediatric Oncology and Surgery

1, Samory Mashela str., Moscow, 117997

bronh.m.d@gmail.comhttps://orcid.org/0000-0002-4451-3233ГрачевН. С.GrachevN. S.

Грачев Николай Сергеевич – доктор мед. наук, заместитель генерального директора

117997, Москва, ул. Саморы Машела, д. 1

Nikolay S. Grachev – Doct. of Sci. (Med.), Deputy Director

1, Samory Mashela str., Moscow, 117997

nick-grachev@yandex.ruФГБУ “Национальный медицинский исследовательский центр детской гематологии, онкологии и иммунологии им. Дмитрия Рогачева” Минздрава РоссииРоссияDmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology Ministry of Health of Russian FederationRussian Federation2022151220222744756Copyright © Ахаладзе Д.Г., Рабаев Г.С., Меркулов Н.Н., Твердов И.В., Ускова Н.Г., Талыпов С.Р., Кривоносов А.А., Грачев Н.С., 20222022Ахаладзе Д.Г., Рабаев Г.С., Меркулов Н.Н., Твердов И.В., Ускова Н.Г., Талыпов С.Р., Кривоносов А.А., Грачев Н.С.Akhaladze D.G., Rabaev G.S., Merkulov N.N., Tverdov I.V., Uskova N.G., Talypov S.R., Krivonosov A.A., Grachev N.S.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/936

Цель. Анализ результатов резекции печени по поводу новообразований гепатикокавального конфлюенса без реконструкции печеночных вен у детей.Материал и методы. С июня 2017 г. по апрель 2022 г. хирургическое лечение выполнено 5 пациентам с опухолями в гепатикокавальном конфлюенсе, потребовавшими резекции правой печеночной вены и (или) срединной печеночной вены.Результаты. Двум детям выполнили бисегментэктомию VII, VIII, одну из них – лапароскопически. Одному ребенку выполнили лапароскопически ассистированную субсегментэктомию IVа, VIII. Двум детям выполнили трисегментэктомию I, IVа, VIII с атипичной резекцией SII, III, а также трисегментэктомию IVа, VIII, VII с сегментэктомией I. Медиана продолжительности оперативного вмешательства составила 445 мин (315–785), медиана кровопотери – 400 мл (150–3000). В послеоперационном периоде осложнения развились у 2 пациентов (IIIa и IIIb по Clavien–Dindo), нарушения венозного оттока от нижних сегментов печени не было. В 1 наблюдении получен сосудистый край резекции R1.Заключение. В большинстве наблюдений при опухолях гепатикокавального конфлюенса у детей при тщательном планировании резекции печени не требуют протезирования правой и (или) срединной печеночной вены и не сопровождаются нарушением венозного оттока от нижних сегментов печени за счет коллатералей к сохранным печеночным венам.

Aim. To analyze the results of liver resection for neoplasms of hepatico-caval confluence without hepatic vein reconstruction in children.Materials and methods. From June 2017 to April 2022, surgical treatment was performed in 5 patients with tumors in hepatico-caval confluence requiring resection of the right hepatic vein and/or median hepatic vein.Results. Two children underwent VII, VIII bisegmentectomy, one of them – laparoscopically. One child underwent laparoscopically assisted IVa, VIII subsegmentectomy. Two children underwent I, IVa, VIII trisegmentectomy with atypical SII, III resection, as well as IVa, VIII, VII trisegmentectomy with I segmentectomy. The median duration of5surgery was 445 min. (315–785), the median blood loss was 400 ml (150–3000). In the postoperative period, complications developed in 2 patients (IIIa and IIIb according to Clavien-Dindo classification), no disturbance of venous outflow from the lower segments of the liver was detected. Vascular margin of R1 resection was obtained in case 1.Conclusion. In the majority of cases of hepatico-caval confluence tumors in children, liver resection, when carefully planned, does not require prosthetics of the right hepatic vein and/or middle hepatic vein and is not accompanied by venous outflow disturbance from the lower liver segments by means of the collaterals to the preserved hepatic veins.

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