[Experience of ASVS-test application in diagnosis of insulin-producing pancreatic tumor].

In 2009-2013 yrs in 7 patients, suffering insulin-producing pancreatic tumors, the ASVS-test was conducted, the result of which was compared with data of standard methods of investigation, including abdominal ultrasound, computer tomography and magnetic resonance imaging. The insuloma enucleation was performed in 3 patients, distal subtotal pancreatectomy with splenectomy--in 1 and the completed total pancreatectomy--in 1. The ASVS-test conduction is indicated in patients with diagnosed hyperinsulinism while impossibility to perform a topic diagnosis of insulinoma, in accordance to data of other noninvasive methods of diagnosis.

[Possibilities of preoperative studying of vascular anatomy in surgery of a periampullar zone tumors].

In 115 patients, suffering malignant pancreatic tumors as well as those, localized in periampullar zone, a CT angiography was performed preoperatively to study up the variants of vascular anatomy. The data obtained were depicted by a surgeon, anatomic variants of truncus coeliacus and mesenterical vessels were recorded in accordance with classification of Michels, Hiatt. Individualized approach for surgical treatment, using CT angiography data, was applied. In 30 patients the operative intervention with the vessels resection was performed and in 6--a no-touch method. Distal pancreatic resection, using the RAMPS technology. was performed in 7 patients for malignant tumors. Complications have had occurred in 12 (10%) patients, 2 (1.7%) of them died. Lethality after operations with vessels resection have constituted 6.6%. The data on variants of vascular anatomy, obtained preoperatively, have permitted to escape massive intraoperative blood loss with subsequent irreversible necrotic changes in the abdominal cavity organs.

[Pancreaticoduodenal resection in the treatment of malignant periampullar tumors].

The experience of performance of pancreaticoduodenal resection (PDR) in 412 patients in 1998-2009 yrs for malignant periampullar tumors was analyzed. In 296 patients a standard PDR was done and in 116, with tumoral affection of distal part of common biliary duct and duodenal large papilla - pylorus-preserving PDR Individualized approach was used, exploiting modern technologies of pylorus-preserving PDR: saving gastroduodenal artery, selective ligation of right branch of dorsal pancreatic and lower pancreatoduodenal artery, dorsal and translateral surgical approaches usage. In 26 patients PDR was accomplished with resection of vessels. In 12 patients a no-touch procedure of PDR was applied. There were analyzed the results of application of modified extended lymphadenectomy while PDR performance. Complications had occurred in 29.5% patients, lethality was 2.7%. The survival indices had constituted at average 24 mo--in pancreatic tumors, 48 mo--in tumors of a distal part of common biliary duct and 72 mo--for localized in duodenal large papilla. Introduction of a new methods of PDR would permit to improve an early and late results of treatment.