Jild 5 Nomeri 2 (2026): Mart-Aprel
14-32
2025-04-30
Ochiq kirish

Bolalarda gepatobiliar xirurgiya va jigar transplantatsiyasi: Milliy bolalar tibbiyot markazi kam invaziv xirurgiya va transplantatsiya bo‘limi tuzilmasi, logistikasi va klinik natijalari

Konstantin O.Semash
Timur A.Djanbekov
Mansur M.Nasirov
Qosimjon M.Umarov
DOI: https://doi.org/10.56121/MSU-2026-2-00008

Qabul qilingan: 2026-05-19 08:07:44

Nashr etilgan: 2025-04-30

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Annotatsiya










Maqsad. Oʻzbekiston Respublikasi ixtisoslashtirilgan pediatriya markazi hisoblangan Milliy bolalar tibbiyot markazi kam invaziv xirurgiya va transplantatsiya boʻlimining tashkiliy tuzilmasi, logistika tizimi, jarrohlik aralashuvlari spektri va klinik natijalarini baholash.


Materiallar va usullar. Tadqiqotga 2020–2026-yillar davomida boʻlimda ketma-ket davolangan 259 nafar pediatrik bemor kiritildi. Biliar atreziya, xoledox kistalari, exinokokkoz, jigar tashqarisidagi portal gipertenziya, tugʻma porto-sistem shuntlar, jigarning xavfli oʻsmalari, shuningdek jigar transplantatsiyasi va pankreatoduodenal rezektsiyadan oʻtgan bemorlarning maʼlumotlari tahlil qilindi. Klinik tavsiflar, intraoperatsion koʻrsatkichlar, asoratlar va kuzatuv natijalari baholandi.


Natijalar. Eng koʻp uchragan kasalliklar exinokokkoz (n = 91), biliar atreziya (n = 56), xoledox kistalari (n = 54) va jigar tashqarisidagi portal gipertenziya (n = 17) boʻldi. Exinokokkozli bemorlarning aksariyatida jigar zararlanishi (n = 67) kuzatildi, kamroq hollarda oʻpka (n = 13), kombinatsiyalashgan shakllar (n = 6), shuningdek taloq, diafragma va kichik chanoq zararlanishi qayd etildi. Ochiq operatsiyalar 68,1% bemorlarda, laparoskopik operatsiyalar 28,6%, videotorakoskopik operatsiyalar esa 3,3% bemorlarda bajarildi. Exinokokkozning qaytalanishi 7,7% bemorlarda kuzatildi va aksariyat hollarda operatsiyadan keyingi albendazol terapiyasiga rioya qilinmaganligi bilan bogʻliq edi. 5 oylikdan 16 yoshgacha boʻlgan bolalarda tirik qarindosh donordan 12 ta jigar transplantatsiyasi bajarildi. Transplantatsiyaning asosiy koʻrsatmalari biliar atreziya, autoimmun gepatit, Vilson–Konovalov kasalligi va Karoli kasalligi boʻldi. Operatsiyaning oʻrtacha davomiyligi 523,8 ± 117,0 daqiqani, qon yoʻqotish medianasi esa 200 mlni tashkil etdi. Qon tomir asoratlari retsipientlarning 25%ida kuzatildi, biliar asoratlar esa qayd etilmadi. Kuzatuvning barcha muddatlarida retsipientlar va transplantatlarning yashovchanligi 100%ni tashkil etdi. Barcha donorlar birinchi yoki ikkinchi darajali qarindoshlar boʻlib, Clavien–Dindo tasnifi boʻyicha II darajali asoratlar donorlarning 16,7%ida kuzatildi, oʻlim holati qayd etilmadi.


Kohortaga jigarning birlamchi xavfli oʻsmalari (gepatoblastoma va gepatotsellyulyar karsinoma) boʻlgan 20 nafar bemor ham kiritildi. Ularni davolash bolalar onkologiya xizmati bilan hamkorlikdagi multidisiplinar yondashuv asosida amalga oshirildi. Rezektsiya hajmi PRETEXT tasnifi boʻyicha bosqichga qarab belgilandi. 5–11 oylik chaqaloqlarda kengaytirilgan oʻng gemigepatektomiya tajribasi barcha holatlarda R0-rezektsiyaga erishilganini, oʻrtacha intraoperatsion qon yoʻqotish 120 mlni tashkil etganini va perioperatsion oʻlim kuzatilmaganini koʻrsatdi. Rezektsiya qilib boʻlmaydigan oʻsmalarda onkologik tanlash mezonlariga muvofiq jigar transplantatsiyasi koʻrib chiqildi.


Jigar tashqarisidagi portal gipertenziyaga ega 17 nafar bemorning barchasida operatsiyadan oldin wedged-angiografiya bajarildi. 1 bemorda Rex-shunt, 5 bemorda Uorren shunti va 2 bemorda devaskulyarizatsiya qiluvchi operatsiyalar bajarildi. Ikki bemorda shunt trombozi va stenozi sababli qayta operatsiya talab qilindi. 2023–2026-yillarda 5 ta pankreatoduodenal rezektsiya bajarildi: ulardan 4 tasi oshqozon osti bezining solid-psevdopapillyar oʻsmasi, bittasi esa insulinoma sababli amalga oshirildi. Bir bemorda gastroenteroanastomoz oqmasi rivojlandi, boshqa bemorda insulinoma qaytalanib, oshqozon osti bezining subtotal rezektsiyasi bajarildi. Barcha bemorlar shifoxonadan chiqarildi va ambulator kuzatuv ostida qolmoqda. Shuningdek, tugʻma porto-sistem shuntlari boʻlgan 4 nafar bemor davolandi.


Xulosa. Milliy bolalar tibbiyot markazi tajribasi oʻrta daromadli mamlakatda bolalar gepatobiliar xirurgiyasi va jigar transplantatsiyasining toʻlaqonli dasturini yaratish mumkinligini koʻrsatadi. Bemorlarni yoʻnaltirishning integratsiyalashgan modeli, multidisiplinar yondashuv va xalqaro hamkorlik yuqori yashovchanlik koʻrsatkichlarini taʼminlash hamda Markaziy Osiyoda bolalar HPB-xirurgiyasi boʻyicha milliy referens-markazni shakllantirish imkonini berdi.






 

 






 

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Mualliflar haqida

Konstantin O.Semash
doctorsemash@gmail.com
Milliy bolalar tibbiyot markazi
Timur A.Djanbekov
house-md@mail.ru
Milliy bolalar tibbiyot markazi
Mansur M.Nasirov
mansoornasyrov@gmail.com
Milliy bolalar tibbiyot markazi
Qosimjon M.Umarov
Qosimjon81@mail.ru
Milliy bolalar tibbiyot markazi

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Bolalarda gepatobiliar xirurgiya va jigar transplantatsiyasi: Milliy bolalar tibbiyot markazi kam invaziv xirurgiya va transplantatsiya bo‘limi tuzilmasi, logistikasi va klinik natijalari. MSU [Internet]. 2025 Apr. 30 [cited 2026 Jun. 30];5(2):14-32. Available from: https://fdoctors.uz/index.php/journal/article/view/263
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