[Surgical treatment for gastrointestinal stromal tumors].

The results of treatment of 15 patients with GIST tumors from 2007 to 2010. We describe the clinical manifestations depending on the location and development of complications. Estimated the complexity and accuracy of preoperative diagnosis using different instrumental technigues in accordance with the recommendations of an international agreement in 2005. Accurate diagnosis can be established only by using immunohistochemical study,which is true in all cases the presence of GIST tumors. As an additional method of imaging for suspected tumor site in the small intestine is used angiography of visceral abdominal arteries.

[Efficacy of jejunotransversoanastomosis in treatment of conglomerate forms of adhesive ileus].

The results of the surgical treatment of 175 patients with conglomerate forms of adhesive ileus are analyzed. The bypass jejuno(ileo)transversoanastomosis was necessitated in 79 patients. This allowed decrease the rate of postoperative complications and lethality. 31 patients were subjected to the long-term follow-up. Good and satisfactory results were achieved in 93,5% of operated patients.

[Pathogenesis and prophylaxis of venous thromboembolic complications at large ventral hernias].

Overall 188 patients undergone surgical treatment due to large postoperative ventral hernias are analyzed. It is demonstrated that venous hemodynamics at these patients before surgery is characterized by disorders of "abdominal-caval pump" function due to anterior abdominal wall destruction and low mobility of diaphragm's cupula. The recovery of their functions is the key point in prophylaxis of thromboembolic complications.

[Videothoracoscopic vagotomy in surgical treatment of patients with peptic ulcer of the gastroenteroanastomosis after resection of the stomach].

Treatment of 130 patients with peptic ulcer of the gastroenteroanastomosis after resection of the stomach included operation by the method of videothoracoscopic truncal vagotomy (22 patients), left-side videothoracoscopic truncal vagotomy (19 patients), and operation from the right-side access (3 patients). Cicatrization of the ulcer in the postoperative period was obtained in 16 patients. Recurrent peptic ulcer was revealed in 2 patients. There were no lethal outcomes.

[Methods of surgical and pharmacotherapeutic influence on the celiac plexus in abdominal surgery].

Literature and own experience in surgical, surgical-pharmacological and contact electro-pharmacological influence on the celiac plexus for correction of dysfunctions in the upper abdominal diseases are analyzed. Original surgical procedures on sympathetic nerves in celiac neuro-ischemic syndrome, chronic duodenal obstruction, duodenal ulcer, and also methods of catheterization and electro-pharmacological impact on celiac plexus in celiac ganglioneuritis and surgical trauma of the stomach are described.

[Treatment and prophylaxis of infected forms and complications of pancreatic necrosis with the use of regional intraarterial infusion]. / Lechenie i profilaktika infitsirovannykh form i oslozhnenii pankreonekroza s primeneniem regionarnoi vnutriarterial'noi infuzii.

The aim of the investigation was to study the variants of the course of sterile and infected pancreatonecrosis, the character of the developing complications depending on the state of organic blood circulation in the pancreas and the influence of its correction upon the outcomes of the disease. The material of examination and treatment of 121 patients with pancreatonecrosis was analyzed. Complex treatment of 51 of the patients included the method of regional intraarterial infusion. Celiacography and CT with the intraarterial contrast reinforcement have revealed that in 35 (68.6%) patients there were symptoms of "perfusion block" of the pancreas of different degrees which was due to spasm, thrombosis of the vessels and impairment of the regional microcirculation. Differentiated approach to the composition of the infusate resulted in arrest of phenomena of "perfusion block" of the pancreas in 24 out of 35 patients. As a whole, using this method allowed to reduce the number of purulent complications, primary open operations and reoperations. Lethality in the group with infusion was 9.8%.

[Treatment of complications of pylorus preserving stomach resection]. / Lechenie oslozhnenii rezektsii zheludka s sokhraneniem privratnika.

Causes of unsatisfactory outcomes of pylorus preserving stomach resection are analyzed, method of prophylaxis and surgical correction is proposed. Pylorus preserving stomach resection was performed in 207 patients with chronic gastric ulcer. 2 groups of patients were compared: 166 patients who have undergone pylorus preserving stomach resection by Maky--Gorobashko (group 1); 41 patients operated according to an original method of suprapyloric stomach resection with preserving of distal Latarget nerves on serous-muscular flap formed from lesser curvature of the stomach (group 2). Of 122 examined patients of group 1 excellent and good long-term results according to Visick's criteria were achieved in 101 (82.79%), satisfactory--in 12 (9.84%), unsatisfactory--in 9 (7.37%). Bad stump evacuation due to a stable spasm of the denervated pylorus and hypokinesia of the stump were the main causes of unsatisfactory results. In group 2-39 of 41 patients were examined in long-term period. Excellent and good results were achieved in 38 patients, satisfactory--in 1. There were no unsatisfactory results.

[Acute pancreatitis after resection of stomach for low duodenal ulcer]. / Ostryi pankreatit posle rezektsii zheludka po povody nizkoi duodenal'noi iazvy.

Results of the treatment of 71 patients with postbulbar ulcer of the duodenum are presented. Stomach resection by Bilrot-II was performed in 22 (30.9%) patients, by Bilrot-I--in 2 (2.8%), by Roux with plastic reconstruction of duodenal stump with intestinal tube--in 16 (22.5%) patients. Precardial proximal vagotomy with drainage operation was performed in 31 (43.6%) patients with massive periulcerous infiltration. Acute postoperative pancreatitis (APP) was seen in 29 (40.8%) patients chiefly after resection of stomach, 6 (8.4%) of them had pancreonecrosis. Postoperative lethality in the group of patients with APP was 12.6%. Ultrasonic examination of the pancreas and its vascular structures is the main method for diagnosis of postoperative pancreatitis. The cause of APP is the mechanic deformation and spasm of major duodenal papilla (MDP) that may be associated with cholinergic denervation and edema of MDP after resection and trauma of tissues. The removal of MDP spasm is an effective prophylactic measure for elimination of pancreatic hypertension. One of the methods of removal of MDP spasm is periarterial sympathectomy of gastroduodenal artery and prolonged drug blockade of celiac plexus in addition to stomach resection.

[Selective proximal vagotomy in combination with prolonged drug blockade of the celiac plexus in the treatment of patients with duodenal ulcers]. / Selektivnaia proksimal'naia vagotomiia v sochetanii s dlitel'noi medikamentoznoi blokady chrevnogo spleteniia v lechenii bol'nykh s duodenal'nymi iazvami.

The work deals with the results of SPV in combination with prolonged drug blockade of the celiac plexus in 78 patients with duodenal ulcers. The motor activity of the antral part of the stomach intensified and its blood supply increased after blockade of the celiac plexus. The course of the immediate postoperative period improved after SPV and the number of patients with hypokinesia of the stomach reduced.

[Surgical treatment of chronic duodenal ulcer complicated by extravasal compression of the celiac trunk]. / Khirurgicheskoe lechenie khronicheskoi iazvy dvenadtsatiperstnoi kishki, sochetannoi s ékstravazalnoi kompressiei chrevnogo stvola.

The work analyses the results of examination and operative treatment of 69 patients with chronic duodenal ulcer and concurrent extravasal compression of the celiac trunk. The clinical signs characteristic of this combination are distinguished and it is shown that these patients have low indices of maximal acid production with a high frequency of duodenal reflux. Decrease of the hepatic and gastric blood flow was also found. It is suggested that such patients should be treated by combination of selective proximal vagotomy and decompression of the celiac trunk which is accomplished by exposure of the aorta over the celiac trunk and retrograde division of the median diaphragmatic ligament. The late-term results of the operation were analysed for follow-up periods of up to 10 years. Poor results were recorded in 6.2% of cases.

[The function of the celiac plexus in patients with duodenal ulcers]. / Sostoianie chrevnogo spleteniia u bol'nykh s duodenal'nymi iazvami.

The authors suggest a method of transgastric electrostimulation of the celiac plexus which allows its functional condition to be appraised. The method consists in electrostimulation of the celiac plexus through a gastroscope and registration of the effect by dynamic rheohepatography. It was approbated in 23 patients with duodenal ulcers, postvagotomy syndromes, and gastroduodenitis. Analysis of the curves reveals two types of pathological responses characterizing increased and diminished reactivity of the celiac plexus. Diminished reactivity of the celiac plexus is characteristic of celiac ganglioneuritis with fibrosis and dystrophy of the celiac ganglia. Increased or diminished reactivity of the celiac plexus is registered in patients with duodenal ulcers, depending on the presence of complications.

[Status of the celiac plexus in patients with extravasal compression of the celiac trunk and its role in the etiology of pain syndrome]. / Sostoianie chrevnogo spleteniia u bol'nykh s ékstravazal'noi kompressiei chrevnogo stvola i ego rol' v geneze bolevogo sindroma.

The technique and results of surgical treatment of 109 patients with extravasal compression of the celiac trunk (ECCT), which in 77 patients was combined with a duodenal ulcer, are described. In the celiac plexus of the patients with ECCT, the inflammatory-sclerotic changes of a different degree of pronouncement were revealed. It was established that periarterial sympathectomy of the celiac artery and its branches had an essential effect on the state of gastric functions. In patients after isolated transection of a median phrenic ligament, the changes in gastric functions were not sharply pronounced.

[Blood flow in the gastric mucosa and components of the kallikrein- kinin system in patients with duodenal ulcer]. / Krovotok v slizistoi obolochke zheludka i sostoianie osnovnykh komponentov kallikrein-kininovoi sistemy u bol'nykh s iazvoi dvenadtsatiperstnoi kishki.

The results of study of the blood flow rate in the gastric mucosa by means of intraoperative rheography and content of the main components of kallikrein-kinin system in the systemic and regional blood flow were compared. It was established that increase in the volumetric blood flow rate in patients with a complicated duodenal ulcer disease was caused by activation of the kallikrein-kinin system in the regional blood flow. Blockade of the celiac plexus has a pronounced effect on the state of a kallikrein-kinin system.

[Causes of unsatisfactory results of selective proximal vagotomy and the choice of corrective operation]. / Prichiny neudovletvoritel'nykh rezul'tatov selektivnoi proksimal'noi vagotomii i vybor korrigiruiushchei operatsii.

Analysis of the causes of the unsatisfactory results of SPV in 39 patients has shown that the leading ones among them were the preservation of a high level of acid formation, antral stasis, chronic duodenal obstruction resulting from the extravasal compression of the celiac trunk and celiac ganglioneuritis. When choosing the corrective operation, it is necessary to consider the main factors causing the occurrence of an unsatisfactory result.

[Effect of periarterial sympathectomy and decompensation of the celiac trunk on gastric secretion in the abdominal pain syndrome]. / Vliianie periarterial'noi simpatektomii i dekompensatsii chrevnogo stvola na zheludochnuiu sekretsiiu pri abdominal'nom bolevom sindrome.

The gastric secretion was investigated after periarterial sympathectomy and decompression of the celiac trunk in 50 patients. It was shown that basal and stimulated secretion was persistently increased in cases with intact structure of the celiac plexus, while in cases with degenerative changes with fibrosis of the ganglia and conductors the gastric secretion was not found to significantly change. The data obtained should be taken into consideration when operating upon the celiac artery and celiac plexus.

[Sympathectomy and decompression of the celiac trunk in combination with proximal selective vagotomy in surgical treatment of duodenal ulcer complications]. / Desimpatizatsiia i dekompressiia chrevnogo stvola v sochetanii s proksimal' noi selektivnoi vagotomiei pri khirurgicheskom lechenii oslozhnennoi duodenal' noi iazvy.

The article describes 20 patients with complicated duodenal ulcers and 50 patients with chronic abdominal pain syndrome who had inflammatory-sclerotic alterations of elements of the celiac plexus and the arcuate ligament of the diaphragm accompanied in certain cases by compression stenosis of the celiac trunk. Patients with duodenal ulcers were subjected to desympathization and decompression of the celiac trunk in combination with proximal selective vagotomy and drainage of the stomach in cases of stenosis. The postoperative period was found to be favourable, without disturbed gastric evacuation. Good remote results were observed in 8 patients within one year and in 4 patients within 2 years after the operation.