In which cases are prescribed by the liver? Metastases in the liver is curable removal of metastases in the liver.

28.06.2020

Conducting operation on the liver during metastases is not always effective, therefore appoint it only after careful consideration of the situation, assessing the condition of the body and possible risks for the patient. Since this body is permeated with a large number of vessels, among whom large portal vein includes, almost all people with oncological diseases There is a secondary neoplasm of malignant character.

Metastasation for cancer

Metastases - secondary cancer, formed from the cells of the primary tumor, which do not allow fully operating internal organs, Provocate the increase in the liver. Under late treatment and the absence of the required activities, there is a gradual destruction of hepatic tissue. Pathological processes lead to the death of the patient.

Types of liver metastasis

Through blood, cancer cells apply to healthy organs.

Depending on the localization and quantitative indicators, the following types of metastases in the liver are distinguished:

Unilobaric. In this case, one share of the liver is affected.
Bilobaric. Negative changes are subjected to both share of the organ.
Single. 2-3 tumor nodes are formed.
Multiple. Several dozen nodes are found.

Causes of occurrence

Metastases appear as a result of penetration of tumor cells into the liver through blood. The remote defeat testifies to the final stage of oncology, when it is impossible to stop the pathological process. Secondary cancer is a consequence of diseases and states as:

melanoma;
cancer stomach, esophagus, intestines;
neoplasms in the pancreas;
cancer lungs, kidney;
the propagation of cancer cells in the breast.

With primary cancer skin cover, gastrointestinal bodies, pulmonary fabric, kidneys and chest metastases in the liver detect in 50% of patients.

Last Stage of Liver Cancer

The last stage destroys the entire body.

The possibility of full cure with a malignant cancer process 4 and metastases in the liver is absent. Patients pronounced symptoms of the disease, the size of the tumor is inconspicuously increasing, cancer cells move through all organs and systems. Termination of the liver work leads to a fatal outcome.

Pathological cells in the pancreas

When neoplasia is formed in the gland, tumor cells break the operation of the lungs, damage the hepatic tissue and do not allow fully functioning to the kidneys, which significantly reflects on general condition organism. There is a certain connection between these authorities, they closely interact with each other than and the flowing processes are explained.

Cancer lesions of the straight and blind intestine

Colorectal cancer is not accompanied by severe symptoms, on initial stages It can be confused with disorder digestive system. Metastases appear mainly in the liver. After successful assigned activities, about 35% of patients survive. Exact predictions are formed depending on the volume of damaged tissue.

Danger of metastasis

Intervention is carried out in the shortest lines.

Secondary tumors violate the structure of the tissue of the organ, which is reflected in its functions. Patients detect failures in the work of the body, the vulnerability to the negative impact and the risk of developing severe complications is increased. There are pronounced pain, which significantly worsen the quality of life. In such cases, patients need emergency surgery.

Efficiency of operational treatment

When identifying in one of the stakes of the liver, single neoplasms makes sense in performing the operation. Surgery Allows you to remove metastases, overcome the disease and extend the life of the patient. However, with multiple lesions, the development of cirrhosis and a reduction in healthy tissues up to 20%, the operation can be carried out, since it will not be possible to obtain the necessary results.

The liver is one of the most vulnerable organs in terms of damage to cancer pathologies in the process of secondary metastasis.

As a rule, the primary source of the disease serve as tumors developed in the breast, gastrointestinal departments, pancreas and pulmonary systems.

Under metastases, the secondary focal malignant neoplasms are understood, which are formed from the main, primary tumor, when its motherly cell fragments are broken and migrate through the body through the blood or lymphatic vessels, hitting its main departments. So atypical cells fall into the liver.

At the initial stages of development of the symptomatic pathology, the symptoms are extremely blurred, but as the secondary liver cancer progressing, the signs of the disease are carried out extremely difficult, and its health condition deteriorates sharply. Without timely spent therapy, the lethal exodus occurs quite quickly.

Goal

The specificity of the therapy of the disease under consideration in this article is that the chance of full cure in such patients, even with its timely, it is rather small.

The main goals that doctors try to achieve, providing a patient medical careand applying various methods And the techniques of exposure to the tumor, it is:

maximum extension of life - without intensively conducted chemotherapy in combination with other methods of treatment, the life of the patient is very limited and is often not more than 1 - 2 months;
slowing necrosis - the motion of the liver tissues in the damage to metastases occurs rapidly, and the disintegration products of dead tissues have a strong toxic effect on the patient's weak body;
reducing the intensity of pain syndrome - Secondary liver cancer proceeds extremely painful and without potent drugs it is very difficult to do.

Radiation therapy

Radiation impact on secondary manifestations of tumor malignant neoplasms Showing only at the initial stages of disease progression, since their function is rather prophylactic than therapeutic orientation.

This type of treatment relates to conservative ways to eliminate pathology and is able to reduce the intensity of symptoms, reduce pain. At the same time, such treatment, unfortunately, does not affect the deadlines for extending the life threshold.

SRS-therapy

The essence of the technology consists in removing single abnormal formations by directed focused radiation stream of high power. At the same time, only cancer fragments of tissues are affected, healthy cells fully retain their integrity.

The effectiveness of the method is not more than 40%, therefore such treatment is carried out only comprehensively, in combination with more radical options.

The procedure is made by courses, each includes a certain number of sessions, between which there is a break of about three weeks. If necessary, the course of treatment is repeated. A single dosage of radio flows is determined individually.

Sirt-therapy

It is prescribed against the background of chemotherapy in the case of weak performance, or with the complete absence of positive dynamics. The shunting method is carried out when a special catheter is introduced through the inguinal zone into a large artery of the organ.

In it millions of the smallest capsules with the radioactive components in them fall into the blood And delay in small vessels in tumors through which the pathology is saturated with blood.

Thus, it turns out to be amazing effect on atypical cells, their growth is suspended, and the processes of formation of new cancer cells slow down significantly.

Large expectations for this procedure are not imposed - its task is somewhat improving the clinical picture of the course of the disease, which is possible already a few days after the start of the Sirt therapy.

Cyber-knife

A sufficiently effective technology that is capable of amazing metastases, the value of which does not exceed 1 mm. The pathological effect of radioisotopes is carried out by small point flows of photons.

If metastasis is diagnosed in the initial stages, the effectiveness of such radiation influence can reach 55% provided comprehensive application. Unfortunately, the technique is used infrequently because the disease is diagnosed, as a rule, when the tumor is actively progressing and increases rapidly.

Local hyperthermia

The technique is new, it is urgent rarely due to the weak study of its effectiveness and limited availability of special equipment necessary for its implementation.

The essence of treatment is to effect on the cancer temperature of the order of 700 degrees, in which the patients inevitably die. The main goal of hyperthermia is the elimination of recurrent processes, in which on the background of the treatment of therapy has been observed an increase in new atypical cells of malignant formation.

Chemotherapy

Special chemotherapeutic drugs are introduced into the liver through blood system, vessels and artery of which nourish the body.

The choice of the drug is carried out taking into account the age of the patient, the stage of the disease and the specifics of its progression. The diagram of drugs, their dosage, the number of courses is all individually.

Today, chemotherapy is the most effective tool eliminating metastasis from all existing methods of conservative impact on tumor processes.

The main drugs used in modern oncology for metastasis therapy in the liver:

Gemcitabine - The main component component - fluoropyrimidine. It has an overwhelming effect on the propagation of cancer cells, their division processes and prevents the germination of well-hazing fabric fragments.

It is introduced intravenously throughout the first three days of coursework therapy. Then there is a break and after 21 days, if necessary, the procedure is repeated. Cost - from 800 rubles per 10 mg;

Mitomycin - refers to the group of antibiotics of the directional spectrum of action. His goal is to minimize the risks of development inflammatory processes At the time of therapy, reduce the chances of recurrence, and when it appears - to stop these processes in a timely manner.

The composition is the component of nitrosooca. Served by intravenous administration for seven days. Recommended at least 4 courses. Price - from 4000 rubles per 20 mg;

Embolization of microspheres

The chemophymbolization procedure of microspheres is able to guarantee a deeper and long-term contact of cytostatic components, which are the basis of chemotherapeutic agents with decadaneous fabric fragments, providing dense contact with them at the cellular level.

It is carried out under local anesthesia in a specially equipped office through puncturing. The patient should not experience pain sensationsBut at the same time be fully conscious to adequately respond to what is happening and answering the questions of the doctor. After the puncture, the special tool is fed to the localization zone metastasis.

The manipulation of small-acting and practically devoid of complications. Efficiency is slightly higher than the standard method of administration of drugs.

Oil embolization

Chemopholisate has an oil structure, which allows him, penetrating into the neoplasm, decaying the many smallest oily droplets. They block small blood vessels, damping the power anomaly. Against this background, the dosage suspension gradually stands out in patients with fabric.

The lack of a method in the briefness of the preparation in the area of \u200b\u200bthe defeat. Technology of conducting similar to the procedure of microspheres.

Surgical intervention

Most often, with lesions of the liver, the essence of operational intervention is to carry out resection when along with the secondary tumor, a fragment of the organ, and the main hepatic artery is tied up.

The main indication for its implementation is the relatively normal functioning of the body and already remote primary malignant education.

The method is justified with small single manifestations of metastasis. Such a method of surgery is resorted to no more than 12% of cases of detected disease.

The method is characterized by frequent relapses - repeated metastasis appear after a few months in each second case of resection.

More about the choice of tactics of treatment, depending on the features clinical picture, You can learn from this video:

Folk remedies

In treating folk methods It is important to understand that the reception of medicinal plants and informations of them cannot be the only means of eliminating the problem - ethnoscience Can provide some positive effect Only with a comprehensive combination of it with traditional medicine.

In addition, almost all such recipes contain poisons - it is precisely on this that the processes of getting rid of metastasis are constructed, therefore it should be strictly observed the concentration of compositions and the frequency of their reception.

To such means include:

celandine - Rinse fresh herbs, chop finely. Pour alcohol in a 1: 1 ratio. Inspiration, after which you drink 1 teaspoon for 5 days, then - by the dessert as much as, then - on the dining room for three more weeks. Effectively when combined with radiation therapy and after surgery;
boligols.- 0.5 liters of vodka you need to take 25 g of plant seeds. Interest 12 days, after which it is strain. To drink an empty stomach, starting with one drop, gradually bringing their number to 40. The first 12 days the composition is bred in 100 ml of water, then in 200. With a constant use, the tumor ceases to grow, the symptomatics is somewhat smoothed;
flowers potatoes - 1 spoon of inflorescence is poured with two glasses of boiling water and insisted in a thermos 5 hours. Drink as tea at 100 g three times a day. Course - 3 weeks. Inhibits the processes of division of cancer cells;

Supporting diet

Since the organ struck by metastases is not able to fully fulfill its function, blood does not have time to undergo the necessary cleaning from the products of toxic decay. A specially selected diet is capable of somewhat support the liver and facilitate its work.

The following principles should be based on food:

abundant drink;
fractional and frequent number of meals;
sparing methods of cooking dishes;
at least 60% of the daily diet should be fruits and vegetables, preferably seasonal. Otherwise, doctors recommend to pre-soak them;
preferences need to be given to whole grain bread, limiting the consumption of flour and confectionery dishes;
control over sugar content;
the use of dairy products - at the same time they must contain a minimum amount of fat;
meat products replace marine fish.

Alcohol, acute, salted food and fast food - under the full ban.

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Is a metastatic one from other organs. An exception is African countries where the high proportion of primary liver cancer is due to hepatitis and other infections. It is characteristic that men fall into liver cancer 2 times more often than women.

On the localization of metastases from various organs, the liver ranks first. This is due to abundant blood circulation in the organ, a large number of narrow capillaries, where cancer cells are settled.

Metastases in the liver life expectancy is reduced significantly, therefore it makes sense to tell about metastasis in the liver more.

Symptoms and first signs of development metastasis in the liver

The big problem is that the oncology of the liver is often found on recent stages Diseases. On average, patients seek help 3 months after the first symptoms of the disease.

Main complaints (75%) are as follows:

anorexia;
darkening urine, lightweight;
pain in the right hypochondrium or in the stomach.

Less often such signs are mentioned:

weakness, fatigue, lethargy;
jaundice;
heat;
increase in the size of the abdomen;
diarrhea;
nausea or vomiting;
bleeding from the nose;
developing edema.

An objective sign of the liver disease is its increase (hepatomegaly). The lower limit border is reduced by 5-10 cm, the top - rises to the level of the fourth rib. When palpation, the liver is solid, dense, in sensations like a stone, usually with a smooth surface and a sharp front edge. Tumors often pressed the branches of the portal vein, because of this, portal hypertension develops, the spleen increases, sometimes the veins of the esophagus are expanding.

The pain in the right hypochondrium is caused by a rapid increase in liver and stretching the glisson capsule of the organ, which passes many nerves. First, the pain is periodic, it appears when walking, physical Loads. Later it becomes constant moderate intensity. In the right hypochondrium, there is no passing feeling of gravity.

Jaundice is registered in 50% of cases, but usually this symptom is not expressed brightly. The cause of mechanical liver injury is to increase the tumor, and since hepatic beams cannot be stretched, they break from voltage. However, jaundice is not a criterion for assessing the state of the body.

Ascites ( abdominal Vodka.) It appears due to the pressing of the portal vein, which increased in the size of the liver. Due to the increase in pressure in the abdominal veins, part of the blood plasma is seeping through the wall of the vessels in abdominal cavity. Blood and cancer cells remain in the vascular bed.

The temperature rises from most patients, but not always the complaints about hyperthermia. This is due to a slight increase in temperature - only 0.5-1 about C. The temperature rises due to disruption of the purification function of the liver and intoxication of the body.

What is dangerous for metastases in the liver?

The liver is a cleaning plant of the body, blood is filtered through it, the product of the breakdown of proteins is disinfected here - ammonia. The liver produces a lot of vitamins, albumin and globulin, it is in it that glucose is created - the main source of energy for humans. Finally, the liver produces bile - an important eminency for digestion of food. No liver person will not live and a few minutes.

The main problem of metastases is hidden in that surgical method Treatment and chemotherapy are ineffective. Chemotherapy is not effective, as the liver performs cleaning and disinfecting functions.

Surgical treatment methods provide a greater effect, but operations are carried out only in the presence of single tumors. If the whole liver is amazed, then the expediency of intervention is called.

All this leads to the fact that it often ends fascinating.

What do you need to examine?

All surveys are appointed for advice with the attending physician. Consultations will have to go through somewhat (with the head of the department, therapist, etc.).

Ultrasound:

Since the liver affected by metastases changes its consistency, then ultrasound procedure Need to be carried out. This is not the most informative research method, but it is prescribed first due to low trauma.

Radioisotope examination:

As markers used radioactive iodine or gold. The radioactive element is transferred by erythrocytes. The nature of their movement and deviations from the norm allow you to establish even the metastases that did not show themselves.

MRI:

Used necessarily, since the method allows you to get a layer layer layer. Based on magnetic resonance tomography, you can make a 3d liver portrait. To improve the effect, a person can introduce radioisotopes.

In difficult cases, laparoscopy with a tumor biopsy or is carried out. If it does not give accurate information about the liver condition, then prescribe diagnostic laparotomy.

What tests will I have to pass?

The patient must pass a whole series of analyzes that will give detailed information about the liver condition:

general analysis blood;
general urine analysis;
vasserman reaction;
determination of the presence of antibodies to HIV;
definition of the Australian Antigen;
determination of the replication of the hepatitis virus;
reaction to antibodies to hepatitis of all kinds;
study of urine according to the Zimnitsky method;
biochemical analysis of blood on bilirubin, protein, a / g coefficient, alt, asthma, potassium, sodium, creatinine, urea, alpha-amylase, alkaline phosphatase;
blood test on sugar;
biochemical coagulography;
histological study of the liver puncture;
measuring tumor blood markers.

In addition, the blood group is determined and the rhesus factor. The overall blood test is taken at least 5 times - before, during, after treatment. In addition, the overall analysis is done once a week during chemotherapy. Also 3 times the general analysis of urine is taken (before, during, after treatment).

The feasibility of treatment

Despite the seeming hopelessness, the feasibility of treatment is. Five-year survival rate is quite low - only about 5-10%, and most patients do not live up to a year.

However, in practice, survival has a kind of funnel, 10% of men and 15% of women live, but after the first year, survival is already 50%. Up to 5 years live 5% of men and 7% of women.

If the patient is survived for the first year, his chances of living 5 years after the disease increase significantly. Of course, the chances depend not only on the chance, but also on the state of the body, age, the relationship of a person to treatment, as well as on its cash capabilities.

The most optimal methods of treating metastasis in the liver

The only truly optimal method of treatment is the operation. The radiation therapy of the primary cancer and metastases is not carried out. Chemotherapy is not used as an independent method of treatment, applies only after surgical treatment.

Surgical intervention on the liver is a complex procedure, as due to abundant blood supply, it is necessary to very carefully be hemostasis. On the other hand, the liver has a huge regenerative ability, which helps in the postoperative period.

The following operations apply to the treatment of hepatic cancer:

atypical economical liver resection;
resection of the liver segment;
a biseling resection;
segmentectomy;
hemigepatectomy;
extended hemigepatectomy;
hepatogastropanratodododenal resection;
liver transplantation.

What factors affect the lifespan during metastases in the liver?

The lifetime is influenced by the following factors:

cancer stage;
tumor location;
the magnitude of the damage to the organ;
the level of expression of pathology;
state of immunity patient;
timely detection of pathology;
therapy methods, their effectiveness;
the presence of concomitant diseases;
emotional stability, patient's psyche.

First of all, the impact has the existence of related metastases. Since the liver cancer is a metastatic disease, then tumors can be found in the lungs, brain, other organs. In addition, the life expectancy is influenced by the influence of the floor and the patient's age.

The survival of women is higher than in men. Until the first year after the diagnosis, there are only 10-13% of men and 13-17% of women. Up to 3 years lives 6-9% of men and 10-14% of women. And up to 5 years old - 4.5-7% of men and 10-13% of women.

At the stage of the stage, the annual survival rate of women is located in the area of \u200b\u200b80%, and the five-year-old - about 50%, in 2 stages - 20% and 17%, respectively, at 3 stages - 21% and 13%, at 4 stages - 18% and 16%. In men, survival is somewhat lower. At 2 stages - 15% and 11%, at 3 stages - 11% and 5%, at 4 stages - 9% and 5%.

From age, survival depends not so much. The annual survival in people of 40-49 years is 20-25%, people have 50-69 years old - 10-16%, and people over 70 years old - 13-14%.

How many patients live and how to extend life?

The average life expectancy with a diagnosis is 12-18 months. However, you need to understand that medium statistics For a particular case carries little useful information For several reasons:

Some people live no more than a few months or even weeks, and others after treatment live long years.
The probability of survival is devoid of accident rate. The lifetime of life depends on the volume of damage, the skill of the surgeon, the age and gender of the patient, his psychological state.
Since the liver cancer usually has a metastatic nature, the localization of the primary tumor has a very big effect.
Statistics are collected over the past period, sometimes after statistics takes 10-15 years, which is very long for medicine. Thanks to new drugs and medical equipment, you can live longer.

Without treatment, patients live on average about six months. Thanks effective treatment, unloading diet, life is extended until a year or a year and a half. For example, a successful operation increases five-year survival to 30-40%.

Although chemotherapy directly for the treatment of metastases in the liver is not carried out, but it is impossible to refuse it, since it is necessary to eliminate the initial focus of the propagation of cancer cells. Thus, chemotherapy acts on survival, extending it for 1-2 years.

In addition to treating, the survival is influenced by the peculiarity of metastasis. If, after treatment, the primary focus of cancer cells is removed along with metastase in the liver, then the chances of living 5 years and more people have a lot. With the development of recurrence, the chances of survive are very small.

How to extend your life?

Chances will increase some folk recipes:

25 g is poured 500 ml of 40% vodka. It is necessary to insist for 40 days in a deprived of light. Periodically tincture must be shaken. After the expiration, the remedy is filtered and drinking according to the scheme: the first day - a drop, then 2, later 3 and so on the increasing up to 40 drops. Dissolve in 100 grams of water.
Pour 0.5 liters in the thermos (not boiling!) Water. There is a tablespoon of potato flowers. It is necessary to insist for 4-5 hours. Then you need to strain and drink 100 ml 3 times a day. Keep the tincture is not in the thermos, but in a cold place.
Wipe the head cleanly and fill with 500 ml of 70% alcohol. It is necessary to insist during the day, then strain and take 25 ml times a day, and after - 50 ml per day for 20 days.

red fruits and vegetables, especially grenades, blueberries;
green tea;
berries: Raspberry, strawberry, strawberries.

It is forbidden to use such products:

meat and greasy dishes;
mushrooms;
beans, peas, other legumes;
confectionery;
canned;
chocolate and cocoa;
bakery products;
quashed, salted, pickled cucumbers and cabbage;
fat milk;
fried oil and smoked foods.

conclusions

As can be seen, metastases in the liver life expectancy, although they are reduced, but are not a sentence. It makes sense to fight. Therefore, it is necessary, first of all, to normalize its own power to give the liver "unloading". Also, you need to use all possible modern methods Treatment. If you do not despair and do everything you need, you can live for many years. Good luck and be healthy!

IN modern medicine Under metastases, the secondary growth of malignant neoplasms in another site of the body is understood. Metastases are formed due to the transition of tumor-shaped cells on the blood vessels and lymphatic nodals. As the cells increase the metastases form malignant education. Metastases in the liver occur after the gastric cancer, pancreas and lungs. According to statistical data, in the event of a disease of the stomach cancer and light metastases, approximately half of the patients are detected in the liver.

Forecast of the treatment of hepsy metastases

At the initial stage of detection, doctors are not able to give any forecasts. The effectiveness of treatment of tumor metastases depends largely on the nature of the new formation itself, its location and the degree of harm. After metastases in the liver area were revealed for the first time, the duration of the course of treatment is 12-16 months. More favorable forecasts are established after conducting a cytotetuctive operation with straight and colon tumors. The use of combined treatment of metastases contributes to an increase in life expectancy.

It is important to note that patients suffering from malignant colon formations have top scores After removing their metastases in the liver.

At the first stage of the diagnosis of metastasis, it is important to adhere to the criteria refraining from surgical intervention In case the patient has metastases in each of the liver. In such a situation, treatment starts with antitumor therapy.

Extraked metastasis in general worsen favorable forecasts, but are not contraindicated to surgical intervention. In the event that the liver is amazed by metastases of malignant lights of light and pancreatic gland, then treatment is precisely as an independent treatment method is ineffective.

Complications for liver metastasis

The most serious complications are the compression of large blood vessels Metastic formations in the liver. Among them, compression of the lower hollow and the rowed veins of the liver. In addition, due to the compression of the gall duct, the patient may form the so-called "mechanical jaundice". The symptoms of a mechanical jaundice is a sharp change of color of the skin, mucous membrane and scool eyes due to increased level Bilirubin.

It is important to notice that in case of illness mechanical jaundice It is forbidden to carry out surgical interference and chemotherapy courses to remove metastasis.

Liver restoration after removing metastatic tumors

To restore the familiar functioning of the liver after removing malignant growths, it is important to comply with the diet and stick healthy nutrition. Depending on the individual indicators, doctors choose various power options. However, there are some general rulesThat must be followed to quickly restore the liver after a course of treatment after metastasis removed:

- It is strictly forbidden to eat rarely in large quantities. The most optimal power mode: small portions, 5-6 times a day.
First take raw foods (fresh fruits and vegetables), after which you can eat products that have been thermal processing.
It is very important to use a large number of fresh vegetables and fruits. With it, it is not recommended to eat tomatoes.
In a daily diet, a large number of fermented milk products should be present (kefir, ryazhenka, yogurts).
You can use fats vegetable origin (linen or olive oil is necessarily cold pressed).
Meat and fish should only be in the event that they are cooked for a pair and not very fat.
An important role in restoring the liver is played by freshly squeezed juices. The most effective in this case is carrot Fresh.

Liver resection is a partial removal. The operation is an incomplete hepatectomy, during which the body is retrieved completely. The resection is performed by 55% of patients who need surgical treatment of liver diseases. In most cases, they are diagnosed benign tumors, cysts or abscesses of different origins. The liver is characterized by high ability to regenerate, and after removing its site, the remaining parenchyma continues to perform its functions fully. That is why the removal of a part of the liver does not worsens the quality of the patient's life, and, subject to all recommendations, you can quickly return to the usual way of life.

Testimony

Some liver pathologies can be cured without surgery. These include hepatitis, hepatosis and other diseases of infectious and unsuccessful origin. The indication for surgical intervention becomes the focal incurable lesion of the hepatic tissue site, while there is a clear boundary with a healthy cloth. The presence of intact parenchyma is a prerequisite for a successful operation. The intervention is directed not only to the removal of the pathological focus, but also to prevent its distribution to healthy areas.

Most dangerous diseasewhich may require surgical intervention - this is a liver cancer. Unlike benign neoplasmsThese tumors have a tendency to metastasis in separated bodies. If the formation in the liver is a metastasis for cancer of other organs, resection is carried out in conjunction with the removal of the main focus. After the operation, constant observation is necessary for the timely detection of relapse and the formation of new metastases.

Other reasons (injuries, cysts, including echinococcal) less dangerous for the patient. After the operation from the pathological focus, it is possible to get rid of completely. The problem of their diagnosis is that liver diseases often proceed asymptomatic. Since her parenchyma does not have pain receptors, the first symptoms occur only with its significant increase in the tissue pressure on the body capsule.

Figure schematically indicates basic methods of liver resection (darker color - removed area)

Types of resection

The liver consists of the left and right sharewhich are divided into lobes. Such a structure is an advantage in carrying out operations, since it is possible to remove the damaged slices or a share with minimal injury to healthy tissues and blood vessels. The liver is connected functionally and anatomically with a gall bubble. In some pathologies, it may be necessary and its complete deletion.

Depending on the method of performing operation

Liver operations are performed in several ways. Previously, the removal of the organ was a full-fledged extensive operation followed by seam imposing and long rehabilitation period. Modern surgery does not refuse this method, but other, less invasive techniques have already been developed.

Several methods of liver resection are distinguished depending on the method of obtaining operational access:

extensive operation during which there is a cut abdominal wall scalpel;
laparoscopic intervention - to gain access to several small punctures, and the liver section is cut off by a radion.
chemophymbolization - a method for treating malignant tumors by introducing cytostatics and other drugs to the hepatic vessel, which cause gradual death of cancer cells (the method applies only during oncology in the early stages);
alcoholization is the introduction of ethanol into a certain area of \u200b\u200bthe liver, as a result of which its fabrics are destroyed.

For the patient, minimally invasive techniques are preferred - those that pass without cutting the abdominal wall. The efficiency and quality of such operations is no less high, and the recovery period lasts much less. It is also possible to significantly reduce the risk of developing complications in the form of the suppuration of postoperative seams.

Depending on the volume of removable tissues

The liver anatomically consists of 2 pieces: right (large) and left (small). The right contains two additional shares: square and tail. These shares, in turn, are divided into smaller components and form 8 segments.

Operations on partial liver removal are divided into 2 types:

anatomical - are carried out with the preservation of the segmental structure of the organ;
atypical - they are based on not a liver division into segments, but the characteristics of the spread of the pathological focus.

Each liver lurch is an independent area. They are separated from each other with jumpers from connective tissue, have their own circulatory system, lymph and bile outflow. Such a structure is favorably distinguished by the liver of parenchymal organs, since it allows you to remove its plot with minimal blood loss.

Endoscopic operations are less dangerous for the patient and do not require long-term rehabilitation, but for their implementation requires special equipment and skills. Surgeon

Anatomical resection

Anatomical liver resection is the preferred option for both the patient and the surgeon. During such an operation, the shares or segments located nearby are removed, and the rest of the organ continues to function. Depending on which areas it is necessary to remove, several varieties of anatomical resection are distinguished:

segmentsectomy - the easiest option, the removal of one segment;
sectionectomy - resection of several liver segments;
hemigepatectomy - removal of hepatic lobe;
mesogapatectomy - an operation to remove shares or sites that are located in the central part of the organ;
extended hemigepatectomy - resection of a share with the adjacent segment.

If in the course of surgical intervention, the integrity of at least one segment is preserved, the body will continue to perform its functions. The processes of secretion and reduction of bile will also not be broken.

Atypical resection

With atypical resection, the division of the organ into segments is not taken into account. In the course of the operation, the Parenhim Parenhima section is removed in which the pathological center is located. There are several ways to intervene:

edge resection - removal of part of the organ at the lower or top edge;
wedge-shaped-pressure of the area on the front or upper surface in the form of a wedge;
plane - removing part of the liver from its diaphragmal surface;
transverse - extracting the part of the parenchyma from the side surfaces.

Such operations are characterized by more abundant bleeding and disruption of the function of individual segments. However, even if part of the liver is removed, it can gradually recover, provided that areas with healthy tissues are stored.

Preparation for surgical intervention

So that the operation has passed without complications, it is worth it to prepare for it and pass all the necessary analyzes. They are directed not only to the detection of the pathological focus, but also to assess the readiness of the patient for drugs.

During the preparation for resection of the liver, a number of studies are carried out:

Ultrasound abdominal cavity;
MRI or CT liver for more detailed visualization of the pathological focus;
ECG to assess the work of the cardiovascular system;
the liver angiography is the study of hepatic blood flow with a contrast agent;
in neoplasms - biopsy with subsequent bioptate microscopy.

It is also necessary to hold a number of laboratory studies:

general blood and urine tests;
biochemical analysis of blood with the assessment of the activity of hepatic enzymes;
blood clotting test;
analyzes for viral infections;
oncological markers.

A few days before the operation, the patient must adhere to a special diet. During this period, all products that have a load on the liver are removed from the diet gall-bubbleand can also cause increased gas formation. On the day, the procedure is assigned to take food is prohibited.

Anesthesia

The type of anesthesia and means for anesthesia are selected depending on the type of operation. Surgical resection with abdominal wall dissection is performed under general anesthesiaEndoscopic - with epidural anesthesia. Minimally invasive techniques, including chemomicolization and alcoholization, pass with local anesthesia. At the request of the patient, sleeping pills and sedatives can be used.

The operation examines not only the patient's liver, but also other organ systems

What happens during the operation?

Liver resection can be carried out in several ways. The operation method is chosen by the surgeon. It also matters the exact diagnosis and the possibility of visualizing the pathological center during the preparation period for the removal of the liver site.

With surgical removal of the liver

Operational access is obtained by dissection of the abdominal wall by the scalpel. During the operation, it is necessary to impose ligatures on the vessels and biliary ducts, that is, to tie them and thereby prevent the expiration of blood or bile into the abdominal cavity. The segment or the proportion of the liver is cut off, then cleaning with solutions of antiseptics is performed. The abdominal wall layerly stroke, the seam is treated with drugs that contain antibiotics. They can be shot on the 10th day after the operation.

Minimally invasive methods

You can access the liver in different ways, while not performing the cut of the abdominal wall. There are several methods:

with endoscopic resection, 3-4 punzes or a 2-3 cm noise are performed, through which the devices for visualization and lighting are introduced, as well as radionogue;
in case of chemomacolization, drugs are injected into the vessels that blood supply to the liver - you can access them through catheters installed on the lower or upper limbs;
during alcoholization, ethanol is introduced into the desired plot of percutaneously, the procedure is under the control of the ultrasound.

Less invasive techniques do not require long-term rehabilitation, are not accompanied by massive blood loss and reduce the risk of complications. However, their conduct is not possible for all patients. In some cases, the surgeon prefers to perform traditional laparoscopy.

Postoperative period and rehabilitation

Regardless of the method of operation, the patient cannot immediately return to the usual way of life. In addition, it hurts postoperative woundHis body must adapt to changes. The period of rehabilitation can continue from the week to six months or more. There are several basic conditions. successful recovery After resection liver:

a gentle diet with the exception of fatty and calorie products, sweet, carbonated drinks and soluble coffee;
rejection of bad habits;
normalized physical exertion;
reception of hepatoprotectors;
physiotherapy.

The patient needs to regularly undergo a survey in the hospital. The doctor must assess the rate of regeneration of the organ, the activity of its enzyme systems and the ability to perform their functions. Especially in surveys there are patients who are removed from the liver due to the presence of a neoplasm.

Possible complications

All complications that may occur during liver resection are divided into early and late. The first include massive bloodwest during surgery, heart rate disorders or other organism reactions. During the rehabilitation, complications may also develop:

bleeding from ligated vessels in the abdominal cavity;