Хирургический взгляд на лечение билиарных кист печени и поликистоза
Аннотация
Цель обзора. Представить современную тактику ведения больных с билиарными кистами печени и поликистозом.
Основные положения. Мнения хирургов различаются в вопросах, кого и когда оперировать, а также в выборе методики вмешательства. При поликистозе лечению подвергаются пациенты с кистами печени II типа (по классификации J. Gigot). При наличии кист III типа , когда имеет место массивное поражение паренхимы (>70%), трансплантации печени альтернативы нет. На данный момент не существует единой лечебной тактики в зависимости от диаметра кист, что приводит к применению различных методов терапии. Выделяют следующие варианты: 1) чрескожная пункция и дренирование кист с введением склерозирующих веществ; 2) лапароскопическое удаление свободных стенок кист с воздействием на оставшийся эпителий; 3) удаление кист из лапаротомного доступа. Наиболее оптимальным способом считается лапароскопическое иссечение кист, что обусловлено малой травматичностью, низкой частотой рецидивирования (0–4%) и минимальным сроком госпитализации.
Заключение. Всего 5–10% больных с непаразитарными (билиарными) кистами печени подлежат хирургическому лечению, остальные должны наблюдаться либо у гастроэнтеролога, либо у хирурга амбулаторно-поликлинического отделения.
Об авторах
М. П. Кочиева
Российский научный центр хирургии им. Б.В. Петровского РАМН
Россия
Россия
Н. Н. Багмет
Российский научный центр хирургии им. Б.В. Петровского РАМН
Россия
Россия
А. Г. Абдуллаев
Российский научный центр хирургии им. Б.В. Петровского РАМН
Россия
Россия
О. Г. Скипенко
Российский научный центр хирургии им. Б.В. Петровского РАМН
Россия
Россия
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Рецензия
Для цитирования:
Кочиева М.П., Багмет Н.Н., Абдуллаев А.Г., Скипенко О.Г. Хирургический взгляд на лечение билиарных кист печени и поликистоза. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2010;20(1):30-37.
For citation:
Kochieva M.P., Bagmet N.N., Abdullayev A.G., Skipenko O.G. Treatment of biliary cysts of the liver and polycystic liver disease: a surgical view. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2010;20(1):30-37. (In Russ.)
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