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Эволюция концепции лапароскопической резекции печени по материалам международных согласительных конференций

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Представлен анализ итогов трех наиболее важных международных согласительных конференций (2008, 2014, 2017), посвященных освоению, распространению, оценке возможностей и безопасности лапароскопической резекции печени. Анализ мирового опыта продемонстрировал медленное, но уверенное повсеместное распространение новой технологии. Доказано, что ближайшие результаты лапароскопической резекции превосходят результаты открытой резекции, а отдаленные не отличаются при наиболее распространенных доброкачественных и злокачественных новообразованиях при условии отбора пациентов. В отличие от лапароскопической хирургии других органов брюшной полости, многие вопросы, касающиеся технологии, безопасности и воспроизводимости операции, не получили окончательного решения в силу медленного набора данных и других объективных препятствий, связанных прежде всего со сложностью хирургической анатомии печени. Существенным достижением работы экспертов следует считать четкое определение стратегии освоения технологии лапароскопической резекции, а также отбора пациентов, позволяющих избежать серьезных ошибок и дискредитации метода. Все конференции оставались в русле первоначально наметившихся тенденций, добавляя более доказательные исследования для подтверждения и детализации возможностей технологии. Сохраняется дефицит проспективных рандомизированных исследований и крупных национальных и международных регистров. Дальнейший анализ опыта позволит скорректировать полученные ранее результаты, более четко обозначить роль и место лапароскопической резекции печени в арсенале современной хирургической гепатологии.

Ключевые слова:
печень, лапароскопическая резекция, рекомендации, консенсус, liver, laparoscopic resection, recommendations, consensus

Литература:
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The evolution of the concept of laparoscopic liver resection based on materials of international conciliatory conferences

The article presents an analysis of the results of the three most important international consensus conferences on the development, dissemination, assessment of the efficacy and safety of laparoscopic liver resection (2008, 2014 and 2017). An analysis of world experience has demonstrated the slow but steady diffusion of the new technology. It is proved that the immediate outcomes of laparoscopic liver resection are superior to those for open resections, and the long-term results do not differ in the treatment of the most common oncological and benign liver tumors in selected patients. Unlike laparoscopic surgery of other organs of the abdominal cavity, many issues regarding the technology, safety and reproducibility of the operation did not receive a final solution due to the slower data set and other objective obstacles associated primarily with the complexity of the surgical anatomy of the liver. In this regard, a clear achievement of the expert’s work should be considered a clear definition of the strategy for mastering the technology of laparoscopic liver resection, as well as selection of patients to avoid serious errors and discrediting the method. All conferences remained in line with the initially emerging trends, adding more evidence-based research to confirm and refine the capabilities of the technology. There is still a shortage of prospective randomized trials and large national and international registries. Further analysis of experience in this direction will allow us to correct the previously obtained data and more clearly indicate the role and place of laparoscopic liver resection in the arsenal of methods of modern surgical hepatology.

Keywords:
печень, лапароскопическая резекция, рекомендации, консенсус, liver, laparoscopic resection, recommendations, consensus