AUXILIARY ENDOTHELIUM-TROPHIC THERAPY AT HEPATOCELLULAR CARCINOMA
Introduction. Endothelial dysfunction is the universal pathological process which is observed in particular at oncological diseases. Its correction can provide clinical effect. Research objective was determination of results of correction of endothelial dysfunction at patients with hepatocellular carcinoma. Materials and Methods. A prospective experimental clinical study was conducted according to the "experience-control" scheme. 78 patients with hepatocellular cancer carcinoma of II and III clinical stages which were exposed to radical surgical treatment are examined. The status of vascular endothelium and results of treatment depending on the carried-out correction of endothelial dysfunction (NO-group donator L-arginine and ACE inhibitors) was investigated. Comparison of quantitative traits was carried out with the help of the Student's test. If the boundary criteria for the applicability of parametric methods are not met (the criterion for the equality of Fisher variances and the normality of the Kolmogorov-Smirnov distribution), the Mann-Whitney method is used. The frequencies were compared using a two-sided Fisher exact test. The level of statistical significance for the refutation of the null hypothesis was p <0.05. Results. Existence of significant disturbances of indicators of endothelial function in patients hepatocellular carcinoma in the initial period and their aggravation when performing treatment is revealed. In particular, acute increase of the contents of the circulating endotheliocytes and Villebrand's factor, decrease in an endothelium-dependent vazodilyatation was observed. This analysis at hepatocellular carcinoma is carried out for the first time. It is also established for the first time that application of L-arginine and its combination to inhibitors of angiotensin converting enzyme has allowed achieving partial correction of endothelial dysfunction, including decrease in a endothelium damage rate and restoration of his functional activity. Also decrease in frequency of complications in the early and remote postoperative period was observed. So, number of early postoperative complications and a recurrence and metastasises at implementation of correction of endothelial dysfunction on average decreased twice. Conclusion. Correction of endothelial dysfunction can be recommended in oncological practice in the perioperative period for prevention of postoperative complications development.