inovmedИнновационная медицина КубаниInnovative Medicine of Kuban2541-9897Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 110.35401/2541-9897-2024-9-1-144-151inovmed-824Research ArticleОБЗОРЫREVIEWSПатобиохимические особенности развития пострезекционной печеночной недостаточности и перспективы ее метаболической коррекцииPathobiochemical Features of Posthepatectomy Liver Failure and Prospects for Its Metabolic Correctionhttps://orcid.org/0000-0002-1787-0040БыковИ. М.BykovI. M.

Быков Илья Михайлович, д. м. н., профессор, заведующий кафедрой фундаментальной и клинической биохимии

350063, Краснодар, ул. М. Седина, 4

Iliya M. Bykov, Dr. Sci. (Med.), Professor, Head of the Department of Fundamental and Clinical Biochemistry

Kuban State Medical University, ulitsa M. Sedina 4, Krasnodar, 350063

ilya.bh@mail.ruhttps://orcid.org/0000-0002-2218-4205ШевченкоА. С.ShevchenkoA. S.

Шевченко Алексей Станиславович, аспирант кафедры фундаментальной и клинической биохимии

Краснодар

Aleksey S. Shevchenko, Postgraduate Student, Department of Fundamental and Clinical Biochemistry

Krasnodar

https://orcid.org/0000-0002-5711-6659ЦымбалюкИ. Ю.TsymbalyukI. Yu.

Цымбалюк Игорь Юрьевич, к. м. н., ассистент кафедры фундаментальной и клинической биохимии

Краснодар

Igor Yu. Tsymbalyuk, Cand. Sci. (Med.), Assistant Professor at the Department of Fundamental and Clinical Biochemistry

Krasnodar

https://orcid.org/0000-0002-3649-1361ПоповК. А.PopovK. A.

Попов Константин Андреевич, к. м. н., доцент, доцент кафедры фундаментальной и клинической биохимии

Краснодар

Konstantin A. Popov, Cand. Sci. (Med.), Associate Professor at the Department of Fundamental and Clinical Biochemistry

Krasnodar

https://orcid.org/0000-0003-0366-2301ТутаришеваС. М.TutarishevaS. M.

Тутаришева Саида Муратовна, аспирант кафедры фундаментальной и клинической биохимии

Краснодар

Saida M. Tutarisheva, Postgraduate Student, Department of Fundamental and Clinical Biochemistry

Krasnodar

https://orcid.org/0000-0003-1916-2897УстиноваЕ. С.UstinovaE. S.

Устинова Екатерина Сергеевна, аспирант кафедры фундаментальной и клинической биохимии

Краснодар

Ekaterina S. Ustinova, Postgraduate Student, Department of Fundamental and Clinical Biochemistry

Krasnodar

https://orcid.org/0000-0002-4936-0141СторожукА. П.StorozhukA. P.

Сторожук Александр Петрович, д. м. н., профессор кафедры фундаментальной и клинической биохимии

Краснодар

Alexander P. Storozhuk, Dr. Sci. (Med.), Professor at the Department of Fundamental and Clinical Biochemistry

Krasnodar

https://orcid.org/0000-0002-9386-8049ЕсауленкоЕ. Е.EsaulenkoE. E.

Есауленко Елена Евгеньевна, д. б. н., профессор кафедры фундаментальной и клинической биохимии

Краснодар

Elena E. Esaulenko, Dr. Sci. (Bio.), Professor of the Department of Fundamental and Clinical Biochemistry

Krasnodar

 

Кубанский государственный медицинский университетРоссияKuban State Medical UniversityRussian Federation20243003202401144151Copyright © Быков И.М., Шевченко А.С., Цымбалюк И.Ю., Попов К.А., Тутаришева С.М., Устинова Е.С., Сторожук А.П., Есауленко Е.Е., 20242024Быков И.М., Шевченко А.С., Цымбалюк И.Ю., Попов К.А., Тутаришева С.М., Устинова Е.С., Сторожук А.П., Есауленко Е.Е.Bykov I.M., Shevchenko A.S., Tsymbalyuk I.Y., Popov K.A., Tutarisheva S.M., Ustinova E.S., Storozhuk A.P., Esaulenko E.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.innovmedkub.ru/jour/article/view/824

В обзоре представлен анализ современных представлений о патофизиологии и патобиохимии состояний после обширных резекций печеночной паренхимы с обозначением возможных путей хирургической и метаболической коррекции, в том числе молекулярных мишеней для перспективного терапевтического воздействия. В качестве ключевых патогенетических факторов развития печеночной недостаточности после обширных резекций печеночной паренхимы рассматриваются снижение остаточного объема ткани или синдром «малой доли», отек паренхимы вследствие гиперперфузии и нарушения оттока венозной крови, септические осложнения, ишемия-реперфузия органа, митохондриальная дисфункция и окислительный стресс. С учетом вышеперечисленного перспективными направлениями коррекции состояний после гепатэктомии является использование средств, снижающих давление в портальной системе (аналог соматостатина октреотид и вазопрессина терлипрессин, пропранолол), энерготропных метаболических препаратов (комбинированные препараты сукцината и антиоксидантов, донаторы газотрансмиттеров), антибиотикотерпии и синбиотиков для профилактики инфекционных осложнений. Используемые в настоящее время в клинической практике подходы не всегда способны эффективно справляться с осложнениями после обширных резекций печени, поэтому фундаментальные исследования должны быть направлены на поиск и создание эффективных стратегий профилактики и терапии пострезекционной печеночной недостаточности.

We review the current understanding of pathophysiology and pathobiochemistry of conditions following extensive resections of the liver parenchyma and describe potential ways of surgical and metabolic correction, including promising molecular targets for therapy. Reduced residual tissue volume (small-for-size syndrome), parenchymal edema due to hyperperfusion and impaired venous blood outflow, septic complications, organ ischemia-reperfusion, mitochondrial dysfunction, and oxidative stress are considered key pathogenetic factors in liver failure development following extensive resections of the liver parenchyma. Given the above, promising ways of managing posthepatectomy conditions are the use of agents reducing portal pressure (octreotide [somatostatin analogue], terlipressin [vasopressin analogue], and propranolol), energotropic metabolic drugs (combined preparations of succinate and antioxidants, gasotransmitter donors), and antibiotics and synbiotics for prevention of infectious complications. The approaches currently used in clinical practice cannot always effectively manage complications following extensive hepatectomy, so fundamental research should focus on searching and creating effective strategies for prevention and therapy of posthepatectomy liver failure.

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The authors declare that there are no conflicts of interest present.