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1. .., .. : by Basil Haigh, Consultants Bereau, New York, 1962.


.- : 21. Eck N.V." voprosu perevyazkie vorotnois veni:
, 1995.-108 . Predvaritelnoye soobschjenye"// Voen Med J 130(1877):
2. .., .. - l-2( translated by C.G.Child in
- Surgery,Gynecology,and Obstetrics 96(1953):375-76.
22.FosterJ. History of liver Surgery. Arch.Surg. 1991-
. // .-1986.-17.- .3-9. Vo.126-P.381.
3. .. 23.Gluck T. Ueber die Bedeutung physiologisch
. - . - 1960 - chirurgischer Experimente an der Leber.//
4. A.M. " ". 1955.- 4: 117- Arch.Klin.Chir.-1883.- vol.29.-P.139
119 24.Goldsmith N.A.,Woodburne R.T. The surgical
5. .., .. anatomy pertaining to liver resection.//
.- .- .- 1975.- 200 . Surg. Gynecol. Obstet.- 1957.-Vol.105.-P.310.
6. .. 25.Hjortsjo C.H. The topography of the intrahepatic
.-.- 1986.-214 . duct system.//Acta Anat.(Basel).-1951-Vol.il.- 1951.
7. .. 26.Healey J.E., Schroy P.C. Anatomy of the biliary
.// 1996.-2. 147-149. ducts within the human liver: analysis of the prevailing
8. .., . pattern of branchings and the major variations of the biliary
.-1894.-10-11: 711-731; 12: 841-887 ducts.//Arch. Surg.-1953.-Vol.66.-P.599.
9. .. . 1890,27:594-595 27. Hardy J. Liver Surgery: Ihe past 2000 years.//
10. . . . AustN.ZJ.Surg.- I990.-Vol. 115.-P.8I2.
. - . - 1967.- 239 28. Iwatsuki S.,Sheahan D.,Starzl T. The changing face
. B.C. - 1967- of hepatic resection.// Current problems in Surgery. -
299 1989.-Vol.25.-N5.-P.281-379.
12. ..* .- 1929.- 8.- . 29.Kusnetzoff M., Pensky J. Sur la resection partielle
68. du foie.// Rev.Chir.-1896-Vol.16 -P.501.)
13. Bismuth ., Houssin D. Reduced-size orthotopic 30. Langenbuch C. Ein Fall von Resection eines
liver graft in hepatic transplantation in children.//Surgery.- linksseitigen Schnurlappens der Leber . // Heihing. Berl.
1984.-VoI.95.-P.367-370. Klin. Chir. Wochenschr. 1888-25:37.
14. Bismuth H., Kunstlinger F., Castaing D. A text 31.Lortat-Jacob J.L..Robert H.G.Hepatectomie droite
and Atlas of liver ultrasound .- 1991.- 140 p. reglee.//Presse Med.-1952.-60.-549.
15.BroeIsch C.E.,Emond J.C., Thistlethwaite J.R.,ei 32.Launois ., Jamieson G.G. Modern Operative
al. Liver transplantation with reduced-size donor organs. Techniques in Liver Surgery.- Churchhiil Livingstone.-
// Transplantation.-1988.-Vol.45.-P.519-523. 1993.- 152 p.
16. Cantlie J. On a new arrangement of the right and left 33. Mays E.T. Vascular occlusion.// Surg.Clin.Am.-
lobes of the liver .// Proc.Anat.Soc. Great Britain Ireland 1977.-Vol.57.- P.291
-1898-VoL32.-P.4. 34.Makuuchi M., Kawasaki S., NoguchiT. et.al. Donor
17.Child C D . I l l , McClure R.D..Hays D.M. Stadies hepatectomy for living related partial liver transplantation.
on hepatic circulation in the Macaca mulatta monkey and // Surgery.-1993.-VoI.U3.-N.14.-395-402.
in man. // Philadelphia, Saunders.-1954. 35.McClusky D.A., Lee B.A., J.Skandalakts et al.
18-Couinaud C. Lobes et segments hepatiques: notes Hepatic Surgical Anatomy: Historical Partners in Progress.
sur architecture anatomique et chirurgicale du foie.//Presse // World J.Surg.-1997.-Vol.21.-P.330-342.
Med.-1954.-105-310. 36.0tle J.., Goyel V., Albert! D. Et al. The concept
19. Couinaud C. Controlled hepatectomies and exposure and technique of the split liver in clinical transplantation.
of the int-rahepatic bile ducts. Anatomical and technical // Surgery,-1990.-Vol. 107.-P.605-612.
study.- Paris.- 1981. 37. Ponflick E. Experimentelle Beitrage zur Patologie
20. Demikhov V.P. Some essential points of the der Leber.//Samml.Klin-Vortr.Chir.-1896.-vol. 16.-P.209.
technique of transplantation of the heart.lungs, and other 38. Pichlmayr R., Grosse H., Hauss J., el al. Technique
organs. In experimental Transplantation of Vital Organs. and preliminary results of extracorporeal liver surgery
Moscow, Medgiz. State Press for Medical Literature in / bench procedure/ and Surgery on the in situ perfused
Moscow, 1960, Chap.2.pp.29-48; translated from Russian liver.//Br. J. Surg.- 1990.-Vol.77.-P.21.-26.

10

39. Quattlebaum J.K., Quattlebaum J.K, Jr. Technic of se Applications aux Resections Hepatiques.// Hanoi, Tese-
hepatic lobectomy.// Ann.Surg.-1959-Voi.149.-P.648. 1939.
40. Rex H. Beitrage zur Morphologie der Saugerleber. 45.Tanaka K., Vemolo S., Tokunaga Y. Et al. Surgical
// Morph. Jahrb.-1888- 14-517. techniques and innovations in living related liver
41.Starzl .., Marchioro T.L., K.N.Von Kaaulla, transplantation// Ann.Surg.-1993.-Vol.217.- P.82-91.
G.Hermann, R.S.Brittain and W.R.Waddell 46.Wendel W. Beitrage zur Chiryrgie der Leber.
"Homotransplantation of the Liver in Humans"// Surgery, // Arch.Clin.Chir.-1911.-95-887.
Gynecology, and Obstetrics.-1963.-Vol.117.-P.659-76. 47.Wangensteen O.H. Primary resection of rectal
42. Surgery of (he liver and biliary tract. - London ampulla for malignancy with preseravalion of sphincteric
1994-Vol.I, . Edited by L.N.BIumgart. function together with futher account of primary resection
43. Scheele J. Segment orientated resection of the liver: of colon and recto-sigmoid and note on excision of hepatic
rationa-le and technique. In: Lygidakis N.J., Tytgat G.N.J, metastasis.// Surg.Gynecol.Obstet.-1945.-Vol.81.-P.l.
/eds/ Hepatobiliary and Pancreatic Malignancies. Thieme; 48. Welch C.S."A Note on transplantation of the Whole
New York.- 1989. Liver in Dogs"//Transplantation Bulletin..-1955-Vol.2.-
44. Tung T.T La vascularisation Veirteuse du Foie et P.54.
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19.Hjortsjo C H . The topography of the intrahepatic
. // .-1986.-N7.- .3-9. duct system.//Acta Anat.(Basel).-I951-VoI.ll.- 1951.
7. .., .. 20. Healey J.E., Schroy P.C. Anatomy of the biliary
.- .-.- 1975.- 200 . ducts within the human liver: analysis of the prevailing
8. .. pattern of branchings and the major variations of the biliary
.// .-1963.-JS68.-.46-54 ducts.//Arch. Surg.-1953.-Vol.66.-P.599.
9. .., ,. 21.Iwatsukl S., Sheahan D., Starzl T. The changing
.- .- face of hepatic resection.// Current problems in
- 1984.- 144 . Surgery. - 1989 - Vol. 25- N5,- P.281-379
. .. . 22. Launois ., Jamieson G.G. Modern Operative
// .- 1962.-3.-. 151-153. Techniques in Liver Surgery.- Churchhill Livingstone.-
11. . . . - 1993.- 152 p.
.- .- 1967.- 239 23. Surgery of the liver and biliary tract. - London
12. .. 1994-Vol.1, II. Edited by L.N.Blumgart.
.// - 24. Tung T.T La vascularisation Veineuse du Foie et se
.-1968.-2.-.1-6. Applications aux Resections Hepatiques.// Hanoi, Tese-
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1. .. 13. Kinoshita H., K.Sakai, K.Hirohashi, S.Igawa,


O.Yamasaki, Sh.Kubo: Preoperative portal vein
embolization for hepatocellular carcinoma. Worid.J.Surg.
. - ..-.-1997.- 30 . 1986. 10, 803-808.
2. .. 14.Lin T.Y., C.S.Lee, K.M.Chen, C.C.Chen: Role
, of surgery in the treatment of primary carcinoma of the
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. 18.0zawa K. Liver Surgery Approached Through the
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. // 8. . .
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3. .. , 9. Ryan J.A. et al. Liver resection without blood
.// , 1981. transfusion. // Am-J-Surg-1989.-V. 157 (5).-P. 472-475.
4. .., .., .. lO.Sejourne P. et al. Effect of haemodilution on
. //. 2- transfusion requirement in liver resection.//Lancet. 1989.-
. - , 1981, 2, . 194196. Dec.9, 2 <8676).-P.380-382.
5. .., .., .. 11.Stephenson K.R. et al. Perioperative blood
. transfusions, associated with decreased time to reccurrence
and decreased survival after resection of colorectal liver
. // . 3- . -. metastases. // Ann-Surg. -1988.- V.208 (6). -P.679-687.
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. . 8. Ishak K.G., Rabin L. Benign tumors of the liver.//
.--. - 2001 . - 144 . Med. Clin.North Am.-1975.- Vol.59.-P.995.
2. .., .. 9. Ishak K.G.,Sesterhenn I.A.,Goodman Z.D. et al.
- Epitelioid hemangioendothelioma of the liver: A
.//.-1984.-7.-.61-64. clinicopathologic and followup study of 32 cases.// Hum
3. .., .. PathoI.-1984.-Vol. 15.-P.839-852.
. ---1999-176. lO.Kerlin P.,Davis G.L., McGill D.B. et al. Hepatic
4. .., .. adenoma and focal nodular hyperplasia : clinical,
.-.-1999.- 152. pathologic, and radiologic features.// Gastroenterology .-
5. Adam Y.G.,Huvos A.G.,Fortner J.G. Giant 1983.- Vol.84.-P.994.
hemangiomas of the liver.// Ann.Surg.- 1970.- Vol. 11. Knowles D.M., Casarella W.J., Johnson P.M., Wolff
172.-P. 239. M. The clinical, radiologic and pathologic characterization
6. Farges O., Daradkeh S., Bismuth H. Cavernous of benign hepatic neoplasms .//Medicine.(Baltimore)-
Hemangiomas of the Liver: Are There Any Indications 1978.-Vol.57.-P.223.
for Resection? // World J.Surg.- 1995.-Vol.19,- N.I.- 12. Nagao T.,Inoue S.,Mizuta et al. One hundred hepatic
P. 19-24. resections: indications and operative resultas.//Ann.Surg.-
7. Friedman L.S.,Gang D.L., Hedberg S.E., 1985.-Vol.202.-P.439.
Isselbacher K.J. Simultaneous occurence of hepatic 13.Nagorney D.M. Benign Hepatic Tumors: Focal
adenoma and focal nodular hyperplasia: report of case Nodular Hyperplasia and Hepatocellular Adenoma.//
and reiew of literature. // Hepatology . - 1984. - World J.Surg. - 1995.-V61.19.- N.l- P. 13-18.

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.96 . 44 HP

1. .. ( Hepatic undifferentiated /embrional/ sarcoma and


). - .,- . -1992. 290 . rhabdomyosarcoma in chiidren.//Cancer.- 1987.- Vol.59.-
2. .. P. 396-402./
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,
() .
50
25% ,
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),
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- ,
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.


56,9%,
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1957 . (8) 1965 . (Kiatskin) ,
(, -
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( Klatskin)

<40 41 - 60 61 - 75 >75

129 13 58 49 9 76 {58,9%) 53 (41%)

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(, 58%), , 13 (8,2%) -
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. 24.

( TNM), (100%), (88%),
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.
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20,8% - IV (. 71). 10,4% , 33,5%
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1954 ( 200 /).
(12). ,
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, ,
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, .

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63
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Pinson . 1988 25 4 84 44 35

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15- 96,5 0 - 27,3 41,3- 56,3 17- 35

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64

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Cubertafond P. el al.(14) II - . 6
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).
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5 - 2908 65
V.

1. .., .., .. 13.Carr D.H., Hadjis N.S.,Bankss A.P. et al.


Computed Tomography of hilar cholangiocarcinoma: A
--.-1982.-270. new sign. //A.J.R.-1985.-VoU45.- P.53-56.
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.., .. . treatment of 724 Carcinomas of the Gallbladder. Results
.//- of the French Surgical Association Survey.// Annals of
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, tree and gallbladder. // Surgery. International edition.-
.-.- 1992.- 206 . 1992.-Vol.17.- P.84-88.
4. .., .., 16. Freeny P.C.,Lawson T.L.: Radiology of the
.., .. pancreas.// SpringeI-Verlag,New-York.-l982
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.//.-1999.-11.-5-1. duct obstruction: Radiologic evaluation of level, cause and
5. B.C., .., . tumor resectability.// Radiology.- 1986.- Vol.160.- P.43-
47.
.//.~1991.-.68-72 18. KJatskin G. Adenocarcinoma of the hepatic ductal
6. .., .., .., its bifurcation within the porta hapalis: an unusual tumor
.. with distinctive clinical and pathological features. //
.-- Am.J.Med.-1965.-Vol.38.-P.241.
,- 1980.-304. 19. Meyer D.G., Weinstein B.J. Klatskin tumors of
7. .., .., .. - the bile ducts: Sonographic appearance. // Radiology.-
, .., .., ... 1983.- Vol.148.- P.803-804.
\\ 20.Ogura Y., MizumotoR., Tabata M., etal. Surgical
. 2, treatment of carcinoma of the hepatic confluence: Analysis
2000. of 55 resected carcinomas.// World J. Surg.- 1993.-
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approach for resection of tumor.// Aust.N.ZJ.Surg.- biliary carcinoma: CT evaluation.// Radiology.- 1984.-
1954.-Vol.23.-P.308. Vol.l52.-P.479-483.

.

Pettavel (31), Taylor (38)
German (16, 18). I
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69
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-- , ,
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.
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72
V.

1. . . Surgery. - 1994.-Vol. 116.-N4.-P.703-711.


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1. .., .. biliaries intra-hepatiques.// 1 vol. Masson Edit., Paris


().//.-1982.-I.- 1964- 59-123.
108-114. 6. Dayton M.T., W.P.Longmire, R.K. Tompkins .
2. .., .., .., Caroli's disease: a premalignant condition ? // Am.J. Surg.-
.., .. 1983.-Vol.l45.-P.41-48.
: 7. Parc R., Chavallier J.M.. Surgical approach to
.// congenital biliary duct abnormalities.// In book Bile and
.-2000.-.5.-2.-.43-47. Bile duct Abnormalities. Edited by G.N.J. Tytgat and K.
3. .., .., Huibregtse. Stuttgart, New York: Thieme-1989.- 126 p.
.., .., .. 8. Todani ., Watanabe Y., Narusue M. et al.
.// Congenital bile ducts cysts. Classification, operative
.-1998.-.-1.- procedures and review of thirty seven cases including
. 73-79. cancer arising from choledochal cysts.//AmJ.Surg.-1977.-
4. .., .., Vol.134.-P.263.
.., .. 9. Watts D.R.,G.A.Lorenzo, J.M.Beal . Congenital
.-.-1993.-512. dilatation of the intrahepatic biliary ducts. //Arch. Surg.
5. rli J., V.Corcos. Dilatation congenitale des voies 1974.- P. 592-598-

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.- 6. Pitt H.A. Surgical management of hepatic abscesses.
. - .-1999.-48. // World J Surg 1990.- Vol.14.- P.498- 504.
3. .., .. 7. Pitt H.A. Liver abscesses . // In. Zuidema G.D. ed.
Surgery of the alimentary tract, 3rd ed.Vol.3. Philadelphia:
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, ..
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.

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.

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.)

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,
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.

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24
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- ...
, I , 3-

(. 129 130). (1 , 2
II III - ).

IVb. (V + V, TV+V + VI, 5
. (2 - , 2 - , I - ).
V I .

1. .. 2001.-1.-.86-90.
.-1997.-.-1997.-605 . 13. . . -
2. .., .. : .- .- 1967.- 239
.- : 14. .., ..
, 1995.-108 . .//
3. .. - .-1990.-].-.-10.
.- .- 1983,- 185 15. B.C. .- .-
. .- 1967.-298 .
4. .. 16. .., ..,
. .., .. -
. - .- 1990 .-359. .-1993.-.-1993.-512.
5. .., .., .., 17. Bismuth . Surgical anatomy and anatomical surgery
.. . of the liver.// World J. Surg.-1982.-Vol.6.-3-9.
.// 18. Bismuth H., Castaing D., Dagarden O.G. Major
.-1996.-.1.-.15-23. hepatic resection under total vascular exclusion.//
6. .., .. - Ann.Surg.-1989.-Vol.210.-P.13-19.
- 19. Blumgart L.H., Baer H.U. Czezniak R. et al. Extended
left hepatectomy: technical aspects of an evolving
. // .-1986.-17.- .3-9. procedure.// Br.J.Surg.-1993.-Vol.80.-P.903-906.
7. .., .., .. 20. Iwatsuki S., Sheahan D., Starzl T. The changing
- face of hepatic resection.// Current problems in
.//.-1987.-7.-.-9. Surgery. - 1989.- Vol. 25- N5.- P.281-379
8. .., .., .., 21.Launois ., Jamieson G.G. Modern Operative
.., .. Techniques in Liver Surgery.- Churchhill Livingstone.-
.// 1993.- 152 p.
.-1997.- 22. Mazziotti A., Cavallari A. Techniques in liver surgery.
.8-13. GMM.-1997.- 370 p.
9. .., .. 23. Surgery of the liver and biliary tract. - London
.- .- .- 1975.- 200 . 1994-Vol.I, II. Edited by L.N.Blumgart.
. .. 24. Scheele J. Segment orientated resection of the liver:
. -.- 1986.-214 . rationale and technique. In: Lygidakis N.J., Tytgat G.NJ./
. .., ,. eds/ Hepatobiliary and Pancreatic Malignancies. Thieme;
.- .- New York.- 1989.
- 1984.- 144 . 25. Tung T.T La vascularisation Veineuse du Foie et se
12. .., .., .., Applications aux Resections Hepatiques.// Hanoi, Tese-
.., .. 1939.
26.Kokevling F., Schwartz S.I. Liver surgery.-2001.-
.//.- GmbH.-232 p.
VII
( PICHLMAYR)

.
1988 . (1, 2). Biopump (. 131).

, (. 131).

, ,
- ex situ
in situ.
. .
,
, .
, ,
-
. , .
- - -
.
.
, in situ
- -

. 131. Biopump

1 1 9
VII.

. 13 ,
(. 132) situ (1), 9. 8 ,
, in situ, .
,
. , ,

,
(. 133). .

. 132. in vivo - . 133. in vivo -




1. Pichlmayr R., Bretschneider HJ., Kirchner et coll. Ex Lamesch P., Bretschneider H.J. Technique and preliminary
situ operation and der leber. Eine neue Moglichkeit in der results of extracorporeal liver surgery (bench procedure)
Lberehinin5e//UngenrjecksArch.Chir.-1988.-P.373-122--126. and of surgery on the in situ prfused liver// BrJ.Sura -
2. Pichlmayr R., Grosse H., Hauss J., Gubernatis G., 1990-Vol.77.-P.21-26.
VIII I


. Starzl 1967 .
.
, ,
1 1963. .
Tomas Starzl. 3- 1966 . 1968 .
, -
, . (5). 1970 .
,
.
. 1987 .
1963 ., 3 (9). (-

. 134. .. Starzl.
1. , 2. , 3. , 4.
2,0 , 5.

1 2 2

. 135. .
1. , 2. , 3.
, 4. , 5.


.. -
236 17.02.1987). (1),
1990.
.. -
.
() 1992 ., 4 ,
. ,
. 200 ,
2001 . . ,
5000 .
. , :

, , 12 .
, ,
.

,
. . 1
, 85% ,
, , , 5 - 70%, 20 40%.

:
,
1) -;

2)
.
;

123
VIII.

. 136. Piggyback 1.
. 2.
. 3. . 4. . 5.
. 6. - - . 7. - . 8.

3) ; ,
4) ;
5) ; ( , subfulminant
6) . hepatic failure).

, , 2
, , , 8
, (subacute hepatic failure).
, , 50-90%.
, 30~8%
. , ,
, 30-50% , 5%
, 5% , 5-10% -
. .
UNOS (
(). , ,
),

, 5,4%, - 10,5% .
.
,
. .
,
8 21,6%
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. - 6,1%, 12%,
8 24 - 5%.

124

- , .
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.
, -
, :
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). , 1 2000
10,9% , ,
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3. ,
. .
- 1 - , , - 4. .
, , , II 5. , .
I , [I . 6. .
7. ,
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.
. 4,6% .

, - 1,5%. 50-
, Welch Starzl (1,9,10).
, -
, ( ), - -

. 137. Split : 2
(- , - ) . 1. . 2.
5. . 6. . . 1.
. 2. . 3. . 4.

125
VIII.

. 138. Auxiliary .
1. . 2. . 3.
4. - 5.
. 6-

. .

. .
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,

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.
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. 134 .
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,
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. (. 134).
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126

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,
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,
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). .
-
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. ,

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23F 28F,

.
Biopump 2000 . prolen 7-0 -
4000 . .

, - ,
. .
.
, -
-
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(prolen 5-0). .

. 139. ( ).
. . 1.- . 2-
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3- 4,- -
5. ( ) .-

127
VIII.

. 135.

. 1981 . (3).

Piggyback Split

Piggyback
.
.
- , in vivo ex vivo back table.
,
.
.
,
,
. Piggybacko (.137). split
. 1988 . (7).

(.136). Piggyback
Auxiliary
.
I ,
,
;
. (auxiliary ).


Reduced size (. 138).

,
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. .
, . .
back table*. - -

38

( 3 )

, %

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30-60

30-60

20-50

20-40

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10-20

10-20

10-20

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1-10

128

, . -
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.

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. 38.

. 1989 . Raia ,
(8). ,
. ,
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+ , ), -
(. 139). , .

.
. .

.
,
.

Otte J.B. Broelsch .. (4,6).

,

.
. ,
2000 11
1 86,6% , 3
228
77,5%, 5 - 71,4%.
105 , 123 .
90,8, 84,9
90% (111 123)
81,2%, - 90,9, 85,1
. 1
82,9%,
(0,4%),
79,9, 71,5 68,9%,
17,8 % .
- 90%, 82,4% 79,5%.
86%, - 83%.
,
2000 . 30 , 5-
. 38,9%.
0,3%.
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, 3% , .
. , 40%.

(2). ,

.
,
,
(
) . , -

1992 . . (). .

, .

9 - 2908 120
VIII.

1. .. of the donor liver is a safe way to alleviate the shortage of


.-.1960-259. size-matched organs in pediatric liver transplantation. //
2. .. Ann.Surg-1990-Vol.211- P.146-157.
.// 7. Pichlmayr R.,Ringe B.,Gubernatis G. et al.
-2000, 9.- .2-5. Transplantation einer SpenderLeber auf zwei Empfanger
3. Bismuth H.,Houssin D. Reduced-sized orthotopic (Splitting-transplantation). Eine neue Methode in det
liver grafting in children.// Surgery. ~1984.-Vol.95.-P. 367 Weiterentwicklung der Lebersegment-transplantation.//
370 Langenbecks Arch. Chir-1988 -P.212.367-377.
4. Broelsch C.E., Whitington P.F., Emond J.C. et al. 8. RaiaS.,Nery J.R.,Mies S. Liver transplantation from
Liver transplantation in children from living related live donors.//Lancet-1989.-Vol.2.-P.497.
donors:surgical techniques and results. //Ann Surg-1991.- 9. Starzl .., Marchioro T.L., Kaaulla K.N.Von,
VoI.214.-P.428-439. Hermann G., Brittain R.S. and Waddell W.R.
5. Conference of Medical Royal College and their eHomotransplantation of the Liver in Humans*// Surgery,
Faculties in the UK. Diagnosis of brain death. // Br.Med.J Gynecology, and Obstetrics.-1963.-Vol.ll7.-P.659-76.
1967-P.1187-8. 10. Welch C.S. A note on transplantation of the whole
6. Otte J.B., De Goyet J, Sokal E. et al. Sized reduction liver in dogs.// Transpl. Bull.-1955.-Vol.2.-P.54-55.

, .
, ,
. 39 (I, 2). .
, 5 (
, , ,
) . 42.
,
() .
(20,8%).
30,5%
(. 40). .
, , ,
29 (9,3%) 311 . -
.

9,3% 7,1% (. 41). Jackson-Pratt,

- ,
, (3).
, ,
2 , -

39

Yanagaet l. 1986 > 60

>210

>4500

et al. > 13

Andersson et al. > 400

>7600

> 7

..1998 > 46

= >3

> 240

> 2000

9* 131
IX.

40

oe

145 54 (37,2%) 18(12,4%)

166 41 (24,7%) 7 (4,2%)

311 95 (30,5%) 25 (8%)

. (),
5-7- ,
50 . .
-
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.
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,
.
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.
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.
(4,8%),
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97,4 98,8%. (0,3%), . 43.
--


,
. 314
25 (7,96%) , 18 (72%)
, , , 7 (28%)
- .
-
, 4,2% - 12 (48%) ,
, - 7 (28%),
- - - 2 (8%), -
(0,9%). 2 (8%) 2 (8%) .

. (1 (1,9%)
53 )
,
, , -

41

311 3 (0,96%) 19/1 (6,1%) 5/1 (1,6%) 3/1 (0,96%) 9 (2,9%) 5(1,6%) 29 (9,3%) 22 (7,1 %) 95/3 (30,5%)

132

42

-
-
-

- - - - - - - 2 (100) 2

20 1 (5%) 1 (5%) /1 <10%) - - 1 (5%)


- 6 (30%) 11 (55%)

- - - - - - - -
7
-
5
- - - - - - - - -
3
- - - - - - - - -
HP 16 3(18,8%) 3

53 1 (1.9%) 1 (1.9%) 2 (3,8%) 1 (1,9) 11 (20,8%) 16 (30.2%)

' , .

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;
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.
. . 44 ,

(< 5%) .
: ,
1) -
. -
, , ,
;
2) , ,
, ,
(> 2000 ); ,
3) 30%.

43

(4,8%)

- (4,2%)

- (1,3%)

(0,9%)

(0,6%)

(0,3%)

133
IX

44

-O - / , %
- - -
,% ,% % 1 5 10 20

Yang M.D. 1992 62.1

Chou F. 1994 84 3,6 74 56 49

Iwatsuki S. 1989 123 9,8 77 50 26

Kawasaki S. 1995 122 0,9 92,4 78,9

Bismuth H. 1995 68 2,9 19 74 52 40 26

Takenaka K. 1996 280 2 29

Launois B. 1996 207 65,7 8,4 34,7 28,6

1999 46 31,6 21,2 33,3 95,4 88,3 68,6

Foster J. 1977 30

August D. 1985 25

Iwatsuki S. 1989 153 0 84 51 31

Schelle J. 1995 469 27,3 4,4 16 39,3 23,6 17,7

Machado M. 1996 166 86,5 6,2 28 75 32,3 24,6

1999 97 73,9 8,2 34 79,5 53,0 41,7


1. .. biliary tract. - London 1994-Vol. I Edited by L.N.BIumgart,


// P. 147-160.
. .- .-1998 . 3. Donovan A, Beme T.// Surgery of the liver and
2. Andersson R., Bengmark S. Infections in hepato- biliary tract. - London 1994-VoI.I Edited by L.N.Blumgart,
pancreatico-biiiary surgery.// Surgery of the iiver and P. 1234.


,
,
, IV
. 1 70 86%, 2
- 30 58% .
21
,
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, (
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. 8, 4, -
. 45
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,
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53 79,5 53,0 41,7

13 89,5 53,4
55 97,6 55,6 15

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.
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.
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, 3 12 .
, 1 -
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,
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.

, , 5,0 1,71 /,

12
. ,
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(, - .
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.

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), . , ,
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.
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.
,

, VIA
VIA , , ,
IVB , - .

1. Bozzetti F., Bignami P., Morabito A. et. al. Patterns colorectal metasteses to the liver.// BritJ.Surg.-I994.-Vol.
of failure following surgical resection of colorectal cancer 8 1 . - P . 2 5 5 - 2 5 8 . - (Department of Surgery of
liver metastases.// Annals of Surgery.- 1987.-Vol.205.- Gastroenterologic and General Surgery, Meyo Clinic and
N3.-P. 246269. Meyo Foundation, 200 First Street South West, Rochester,
2. Que F.G., Nagomey D.M. Resection of "recurrent" Minnesota 55905, USA).


.
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90
3
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- 90
- 50
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57
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14
95-97
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- 41 . 58
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- 26, 27, 42, 43
- 42, 43 31
56 .
25 - mTNM 67
-
- 43 - 21-25, 69
- 44 - 69-70
- 44 - 71
- 44 - 70
- 71
- 50 - 72
- 50 95
- 51, 52
- 50 56
- 51-53, 21-25
- 53 - 76
- 26-29 - 76
- - 76
- 53 - - 76
- 136, 54 - 76, 115
- 54 - 76, 115
- 55 - 77, 78
- 55
- 55 21
- 56, 136
- 61, 25 - 122
- 3- 62, . - 123-125
- 61 - 123
- 61 - 126
- 61 - 126
- 63 - Piggyback 128
- 62, 64 - Reduced size 128
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63, 115 - auxiliary 128
- 64 - 129
- 63, 64 - 129
- 64 -
128
- 131 - 129
- -
132 129

- 26 - . -
- 27

58 21
137
26
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26, 53, X
61, 68, 69 61
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45
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25
57 25
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23
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- - 119
26, 55 - ex situ 119
- in situ 119

1. . . 17.
2. .
. 20.
3. . . 20.
4. .
. 20.
5. ( G. Klose W. Schmiegei, 1989). . 22.
6.
( Gozzetti.G ). . 22.
7. . . 25.
8.
. . 25.
9. Child. . 34.
10. . . 37.
. , . . 39.
12. . . 40.
13. . . 42.
14. . . 48.
15. ( Baer . ).
.51.
16. . . 51.
17. . . 52.
18. . . 52.
19. . . 53.
20. . . 55.
21. . . 56.
22. . . 57.
23. . . 58.
24. ( -
). . 62.
25. . . 63.
26. . . 64.
27. . . 64.
28. mTNM .. 67.
29. . . 69.
30. . . 70.
31. ( < 0,01). . 70.
32. ( < 0,05). . 71.
33. ( < 0,01). . 71.
34. ( Gennary) ( < 0,01).
. 72.
35. ( < 0,05). . 72.
36.
( < 0,05). . 73.
37. . . 86.
38. ( 3 ). . 128.
39- .
. 131.
40. . . 132,
41. . . 132.
42. . . 133.
43. . . 133.
44. . . 134.
45.
. . 136.

143
1

144
10 - 2908 145
3

146
4

ASA
(AMERICAN SOCIETY OF ANAESTESIOLOGIS)

ASA 1.
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.

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5

APACHE II



+4 +3 +2 +1 0 +1 +2 +3 +4

>=41 39-40,9 38,5-38,4 36-38,4 34-35,9 32-33,9 30-31,9 <= 29,9

>=160 130-159 110-129 70-109 50-69 40-54 <=49

>=180 140-179 110-139 70-109 55-69 40-54 <=39

>=50 35-49 25-34 12-24 10-11 6-9 <=5

-2* >=500 350-499 200-349 <200


02" >70 61-70 55-60 <55

. >=7,7 7,6-7,69 7,5-7,59 7,33-7,49 7,25-7,32 7,15-7,24 <7,15

, "* >=52 41-51,9 32-40,9 23-31,9 18-21,9 15-17,9 <15

Na >=180 160-179 155-159 150-154 130-149 120-129 111-119 <=0

>=7 6-6,9 5,5-5,9 3,5-5,4 3-3,4 2,5-2,9 <2,5

>=3,5 2-3,4 1,5-1,9 0,6-1,4 <0,6

Ht >=60 50-59,9 46-49,9 30-45,9 20-29,9 <20

WBC >=40 20-39,9 15-19,9 3-14,9 1-2,9

Dm3ro(GCS)"*"

APS

* FiO2>50%
2<50%
*"* ,
**** 15- GCS

APACHE (acute physiology and chronic health evaluation)


, ,
.

APACHE 3- :

1. APS- acute physiology score- 12 , ,


24 ,
12 , .
GCS.
2. ( 0 6).
3. ( 5 ).

148
< 44
45-54 2
55-64 3
65-74 5
>75
:
, :
1. .
2. IV NY Heart Association.
3. ( , 03 , -
).
4. .
5. .

APACHE II
APS

.
APACHE
6

I.

II

II.

- 15
- 3

150
7

TNM.

. (
(AJCC) 1992 .
- ( )-
. ).

.
1. (155,0),

2. (155.1).


( ).
- .
- .
1 <= 2. .
2 < 2.
<=2,
> 2 . .
- >2.
<=2 .
>2. .
4
.
Nx - .
No - .
N1 - .
.
.
Ml .

1. m TNM
mTl <= 2
m2 > 2 sm, <= 2cm
m - > 2 ,
m4 , ,
N 1 -
Ml

151

2. Gennary
HI - =< 25%
2 - 25-50%
- >50%
s ,
m - ,
b - ,
i - ,
F .
Gennary

( ).
:
1. ,
2. () - ,
3. ( 10%- ).
( Bismuth-Corlette)
I - ,
II .
,
- ,
IV - .
TNM
, , , -
( ), , , .
-
-
Tis
1
1
Tib
2
/ , , ,
, .
Nx -
No -
N1
N l a - , / /
/
N i b - / /, , ,
/ .
-
Ml -

1 5 2

, ,
, ( ), , ,
.
TNM


Tis
TI
1
Tib
2 ,
.
/ =< 2 /
4 2 / 2 /
, 12 . , , , , ,
/.

NX
No
N1 .
N l a , . / ( -
).
N i b ( ), , , /
.

153
154
9

\. :
- 0;
- 3 ;
-8 ).
2. :
2,5 - 0;
2,5-4 - 3 ;
> 4 - 12 .
3. :
< 300 - 0;
- 300-500 - 2 ;
500-1000 - 4 ;
1000 - 10 .
4. :
- - 0;
- 10 .
5. :
- 0;
- 9 .
6. :
< 2 - 0;
3 - 4 ;
- 13 .
7. :
- 0;
+ - 5 ;
- - 15 ;
1-2 - 5 ;
3 , , - 15 .


1.
2. > 60
3.
4.
5. > 38
6. L> 1000 /.
7. >50 /
8. > 100 /
9.
10. <30%
11. < 30 /
12. > 10%

155

1. .
2. .
3. .
4. .
5. .
6. .
7. .
8. .
9. t > 38,5.
10. .
11. .


1. .
2. .
3. > 70.
4. .
5. .
6. .
7. .
8. .
.
.. , .. , .., ..


125363, . , ., . 6, . 7, . 702.
/.: (095) 497-5760, 497-6755, info@miklosh.ru, www.miklosh.ru

..
.
..
..

Na 02780 07.09.2000 .
29.05.2003 . 60 x90'/,.
1. . . . 20. 3000 .
2908.



. .. .
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