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Комбинированные минимально инвазивные методы в лечении пациентов со злокачественными новообразованиями печени и желчных протоков

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Цель. Анализ опыта применения радиочастотной абляции в качестве самостоятельного метода лечения и в комбинации с другими рентгенхирургическими вмешательствами у пациентов со злокачественными новообразованиями печени и желчных протоков. Материал и методы. Радиочастотную абляцию применили в трех группах пациентов. В 1-й группе 111 больным метод применили чрескожно или в комбинации с резекцией печени. Во 2-й группе 3 больным абляцию комбинировали с внутриартериальной химиоэмболизацией. В 3-й группе 20 больным метод сочетали с эмболизацией ветвей правой воротной вены (RALPPES) для увеличения объема предполагаемого остатка паренхимы печени и последующей радикальной резекции. Результаты. Рецидива в зоне радиочастотной абляции после чрескожной или интраоперационной абляции не выявлено. При гепатоцеллюлярном раке двухлетняя выживаемость пациентов с циррозом печени составила 55%. При метастазах колоректального рака четырехлетняя выживаемость составила 55%. Сочетание радиочастотной абляции с внутриартериальной химиоэмболизацией позволило добиться полной деструкции у пациентов с гепатоцеллюлярным раком >4-5 см и получить стабилизацию у пациентки с прогрессирующим внутрипеченочным холангиоцеллюлярным раком. Гипертрофия после комбинации радиочастотной абляции и эмболизации ветвей воротной вены превысила 50% через 2 нед, что позволило выполнить второй этап 95% пациентов. Признаков печеночной недостаточности после гемигепатэктомии не отмечено. Заключение. Комбинация миниинвазивных и радиологических методов лечения позволяет добиться лучших результатов в лечении пациентов со злокачественными образованиями печени и желчных протоков.

Ключевые слова:
печень, желчные протоки, гепатоцеллюлярный рак, метастазы колоректального рака, радиочастотная абляция, эмболизация, liver, bile ducts, hepatocellular carcinoma, colorectal cancer metastases, radiofrequency ablation, embolization

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Combined minimally invasive treatment of liver and bile ducts malignancies

Aim. To analyze radiofrequency ablation per se and in combination with other X-ray surgical procedures in patients with liver and bile ducts malignancies. Material and methods. Radiofrequency ablation was used in three groups: percutaneous intervention or in combination with liver resection - group 1 (n = 111); ablation combined with intra-arterial chemoembolization (n = 3) - group 2; RFA followed by right portal vein embolization (RALPPES) in order to induce liver hypertrophy to enable liver resection - group 3 (n = 20). Results. There were no recurrences after radio frequency ablation. Two-year survival was 55% in patients with hepatocellular carcinoma and liver cirrhosis.Colorectal cancer metastases were followed by 4-year survival near 55%. RFA combined with intra-arterial chemoembolization were associated with complete tumor destruction in patients with hepatocellular carcinoma over 4-5 cm and stabilization in patients with progressive intrahepatic cholangiocarcinoma. Liver hypertrophy was over 50% in two weeks after RALPPES that enables liver resection in 95% of patients. Symptoms of liver failure after hemihepatectomy were not observed in any patients. Conclusion. Combination of interventional methods is able to improve outcomes in patients with liver and bile ducts malignancies.

Keywords:
печень, желчные протоки, гепатоцеллюлярный рак, метастазы колоректального рака, радиочастотная абляция, эмболизация, liver, bile ducts, hepatocellular carcinoma, colorectal cancer metastases, radiofrequency ablation, embolization