ULTRASOUND DETERMINATION OF THE VOLUME OF THE RIGHT LOBE OF KINDRED DONORS IN KINDRED LIVER TRANSPLANTATION
Y.R. KAMALOV, R.T. RZAYEV, M.A. TATARKINA, E.F. KIM, A.V. FILIN,
A.A. SEMENKOV, S.Y. KIM
Russian Scientific Center of Surgery named after Acad. B.V. Petrovskiy, RAMS, Moscow, RUSSIA
The aim of the work: To determine the accuracy of preoperative ultrasound determination of the volume of the right lobe of liver in kindred donors with kindred liver transplantation.
Materials and methods: In the preoperative period of 17 patients, which were examined as potential donors for kindred liver transplantation, ultrasound determination of the volume of the right lobe of the liver (RLL) was performed. To determine volumes of RLL, we used the following formula: 0.52 * latero-lateral size* upper-lower size* antero-posterior size (cm3). The examined patients were further performed resection of the right lobe of the liver for its further transplantation into relatives, suffering from terminal stage of hepatic disease, in which the only radical method is this type of surgery. Weight of RLL was determined intraoperatively by weighing on electronic scales (specific weight of liver 1g/sm3). Statistical processing was performed by using standard methods of MS Excel for the PC.
Results: The preoperative ultrasound volume of RLL constituted 675+129.5 cm3, intraoperative - 699.9+140.5 cm3. The correlation coefficient for PLL was r-0, 93.
Conclusions: The ultrasound method of determination of the volume of the right lobe of liver of kindred donors for kindred liver transplantation is accurate enough and can be used as an alternative to determine volumes of fragments of liver according to MSCT or MRT data.
EVALUATION OF VASCULAR INVASION IN CANCERS OF PANCREATIC HEAD AT PREOPERATIVE STAGE
Institute of Surgery named after Vishnevsky, Moscow, RUSSIA
Introduction. Expansion of indications for surgical treatment of patients with neoplasms of pancreatic head determines high requirements as to the accuracy of preoperative diagnosis. The main issue is the involvement of surrounding major vascular structures into the tumor process.
The aim of the study: to determine capabilities of ultrasound examination of identification of vascular invasion in a comprehensive assessment of resectability of pancreatic head tumors.
Materials and methods. Short-term analysis of 58 patients hospitalized from January 2010 to July 2011 at the Institute of Surgery named after A.V. Vishnevsky with the diagnosis – of cancer of the pancreatic head was conducted. Among them there were 25 men and 33 women, average age constituted 55,6±8,6 years. At the preoperative stage there was conducted comprehensive ultrasound examination of hepatopancreatoduodenal zone, which includes standard B-mode, color and power Doppler mapping, spectral analysis of blood flow, building of a three-dimensional reconstruction of ultrasound images. The degree of involvement of vessels of the basing of celiac artery, upper mesenteric artery, veins of the portal system into the pathological process.
Obtained results. According to the data of comprehensive ultrasound examination, in 45% of patients the tumor of the pancreatic head did not spread to adjacent vascular structures. The average size of formations in this group constituted 2,9 ± 0,3 cm. In 33% of cases there was observed involvement of the veins of portal system with an average size of tumors 3,95 ± 0,55 cm. into the pathological process. Invasion by the tumor of trunk arteries at the preoperative stage was found in 22% of patients with the size of tumor 5,2 ± 0,8 cm. Sensitivity of the method in the determination of vascular invasion was 90.3%, specificity - 74.0%, accuracy - 82.7%.
Conclusion. Comprehensive ultrasound examination is a highly sensitive diagnostic method of identification of vascular invasion in tumors of the pancreatic head, but has insufficient specificity, due to which overall diagnostic accuracy of the method remains low. Further developments of criteria for the involvement of the arteries and veins into the neoplastic process according to the ultrasound methods of study are necessary.