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вce журналы << Анналы хирургической гепатологии << 2017 год << №4 <<
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Радикальное хирургическое лечение рака желчного пузыря

Ахаладзе Д. Г., Алиханов Р. Б., Ефанов М. Г.
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Ахаладзе Дмитрий Гурамович - канд. мед. наук, старший научный сотрудник отделения гепатопанкреатобилиарной хирургии ГБУЗ МКНЦ им. А.С. Логинова ДЗМ, ГБУЗ Московский клинический научно-практический центр им. А.С. Логинова Департамента здравоохранения г. Москвы, d.akhaladze@mknc.ru, 111123, г. Москва, шоссе Энтузиастов, д. 86, Российская Федерация
Алиханов Руслан Богданович - канд. мед. наук, заведующий отделением гепатопанкреатобилиарной хирургии ГБУЗ МКНЦ им. А.С. Логинова ДЗМ, ГБУЗ Московский клинический научно-практический центр им. А.С. Логинова Департамента здравоохранения г. Москвы, 111123, г. Москва, шоссе Энтузиастов, д. 86, Российская Федерация
Ефанов Михаил Германович - доктор мед. наук, руководитель отдела гепатопанкреатобилиарной хирургии ГБУЗ МКНЦ им. А.С. Логинова ДЗМ, ГБУЗ Московский клинический научно-практический центр им. А.С. Логинова Департамента здравоохранения г. Москвы, 111123, г. Москва, шоссе Энтузиастов, д. 86, Российская Федерация

Аденокарцинома желчного пузыря составляет 30-40% от всех злокачественных опухолей желчных протоков. Опухоль характеризуется агрессивным течением и низкой чувствительностью к химиотерапии, что обусловливает плохие отдаленные результаты лечения. Залогом улучшения выживаемости является достижение резекции R0. Стандартный объем хирургического лечения, включающий помимо холецистэктомии резекцию IV, V сегментов печени и лимфаденэктомию D2, является адекватным вмешательством лишь при ранних стадиях болезни. Нет единого мнения о целесообразности расширения объема операции за счет резекции внепеченочных желчных протоков, сосудов и прилежащих органов у пациентов с местнораспространенной опухолью, в том числе после предшествующих вмешательств по поводу механической желтухи и холангита. В связи с этим остаются нерешенными ряд вопросов хирургической тактики при раке желчного пузыря, освещение которых с учетом последних литературных данных представлено в настоящем обзоре.

Ключевые слова:
печень, желчный пузырь, ракжелчного пузыря, радикальноехирургическое лечение, лимфаденэктомия, панкреатодуоденальная резекция, механическая желтуха, метастазы, liver, gallbladder, gallbladder cancer, radical surgery, lymphadenectomy, pancreatoduodenectomy, obstructive jaundice, metastases

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Curative Surgery for Gallbladder Cancer (Review)

Akhaladze D. G., Alikhanov R. B., Efanov M. G.

Gallbladder adenocarcinoma is 30-40% of all malignant tumors of the bile ducts. The tumor is characterized by an aggressive course and low sensitivity to chemotherapy, that leads to poor long-term outcomes. The key of improved survival is R0-resection. Standard surgicalvolume including IV-V liver segments resection and D2-lymphadenectomybesides cholecystectomy is an adequate intervention only at the early stages of disease. There is no consensus for advisability of advanced surgery with resection of extrahepatic bile ducts, vessels and adjacent organs in patients with locally advanced tumors including those after previous interventions for mechanical jaundice and cholangitis. In view of this there are various unresolvedissues of surgical tactics for gallbladder cancer which are discussed in this review.

Keywords:
печень, желчный пузырь, ракжелчного пузыря, радикальноехирургическое лечение, лимфаденэктомия, панкреатодуоденальная резекция, механическая желтуха, метастазы, liver, gallbladder, gallbladder cancer, radical surgery, lymphadenectomy, pancreatoduodenectomy, obstructive jaundice, metastases

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ООО Издательский дом ВИДАР-М, 2016