[Diagnostics and treatment of postcholecystectomy biliary complications].

The study concerns early postoperative bile leak and obstructive jaundice syndrome after cholecystectomy. 4865 patients were included in the study. The initial cholecystectomy was performed through the traditional laparotomy (n=2122), minilaparotomic access (n=1024) and laparoscopic access (n=1710). Early biliary complications were registered in 135 (2,8%) patients, of whom 47 had bile leak and 88 develop obstructive jaundice. The external drainage bile leak was registered in 0,68%; bile leak trough the trained common bile duct had 0,17% and bile leak into the abdominal cavity had 0,12% of these patients. In 17 cases the bile leak was caused by the cystic duct stump insufficiency, 12 cases were caused by bile leak from the gall bladder bed. 73,5% of bile leak were caused by misdiagnosed choledocholithiasis and papilla Vateri stenosis. Obstructive jaundice in early postoperative period was determined by underdiagnosed bile ductal pathology in the majority of patients (84 patients of 88). The main diagnostic method of biliary complications was the retrograde cholangiopancreaticography with the efficacy of 99,2%. Endoscopic transpapillary operations were curative in 97% of cases. Complications after endoscopic manipulations developed in 3,3%, all of them were successfully conservatively treated.

[Individual prognosis of severity of postoperative period and outcome of general peritonitis].

Evaluation of severity according to SAPS scale and examination of dynamics of middle molecules in blood plasma (MCMn) were carried out in 167 patients with different surgical diseases complicated with general peritonitis. It is demonstrated that level of MCMn compared with SAPS scale data is objective index of endotoxicosis, severity of general peritonitis, and it can be regarded as criterion of prognosis of disease outcome. Dynamic assessment of MCMn level has the most diagnostic importance in groups of patients with 5 - 12 scores according to SAPS scale. Prognostic value of this index is small when infectious-toxic shock occurs.

[Results of application of synthetic antioxidants in treatment of patients with destructive pancreatitis].

Results of examination and treatment of 103 patients with pancreonecrosis are presented. Influence of antioxidant mexidol on acute pancreatitis (AP) was studied. It is demonstrated that mexidol in AP permits to slow down destructive processes in the pancreas, promotes localization of inflammation and normalization of clinical and laboratory picture of the disease that permits to decrease significantly number of severe complications of AP and reduce lethality.

[Extracorporeal detoxication in patients with destructive pancreatitis].

Criteria of severity of endogenous intoxication in patients with destructive pancreatitis in enzymatic toxemia are discussed. It is demonstrated that the level of middle mass molecules and integral index of affection of the pancreas, abdominal cavity and retroperitoneal space are objective criteria of endogenous intoxication and can be used for determination of indications for extracorporeal detoxication and for assessment of treatment efficacy. Prescription of extracorporeal detoxication according to these criteria in an early period of the disease before multiple organ failure development promotes faster management of endotoxemia, prophylaxis of septic complications, decreases lethality and period of treatment of patients with destructive pancreatitis.

[Treatment of patients with pancreonecrosis]. / Lechenie bol'nykh pankreonekrozom.

Results of treatment of patients with necrotic acute pancreatitis taking into account a risk of an unfavorable course of the disease are analyzed. The risk is determined according to the level of albumin measured with fluorescent test. This approach to choice of policy of treatment which doesn't correspond to clinical picture and treatment may be regarded as preventive permits to improve results of treatment in all variants of the disease. Decreased number of severe complications, lethality and time of hospitalization in necrotic pancreatitis an demonstrated.

[Choice of the policy, terms, and method of surgery in acute cholecystitis]. / Vybor taktiki, srokov i metoda provedeniia operatsii pri ostrom kholetsistite.

Results of treatment of 763 patients with different forms of cholecystitis were analyzed. It was revealed that complex ultrasonic examination with dopplerography identifies the form of acute cholecystitis, allows to, predict technical difficulties in cholecystectomy and define optimum method of surgery. Comparative assessment of time of surgeries, rate of conversion of surgical approach, number of intra- and postoperative complications, lethality demonstrated that early urgent surgeries in acute cholecystitis before formation of inflammatory paravesical infiltrate in patients without high anesthesiological risk were similar to ones in elective surgeries and surpassed results of delayed surgeries. Early urgent surgeries permit to decrease hospital stay of patients with acute cholecystitis and reduce cost of treatment.

[Radiodiagnosis of acute appendicitis]. / Luchevaia diagnostika ostrogo appenditsita.

Sixty acute appendicitis suspects with unclear clinical picture were examined with high-frequency ultrasound and native CT. The results of the examinations were compared with clinical data, surgical findings and histological evidence. Acute appendicitis was in 39 patients, other diseases of abdominal cavity and small pelvis--in 21. Sensitivity of CT was 95%, specificity--91.3%, accuracy--96.6%. Sensitivity of US was 92.3%, specificity--100%, accuracy--95%. The above parameters for non-invasive diagnostic methods were similar to ones for laparoscopy. Native CT and US are highly precise methods for diagnosis of acute appendicitis. They are preferable in unclear clinical situations, atypical location of the appendix, in children, elderly and aged patients, and in patients with mental disorders.

[Correction of enteral insufficiency syndrome in general peritonitis]. / Korrektsiia poiavlenii sindroma énteral'noi nedostatochnosti pri rasprostranennom peritonite.

Efficacy of enteral ozone lavage in combined treatment of patients with general peritonitis is analyzed. It is demonstrated that intestinal lavage with ozone-enriched physiological salt solution through nasointestinal probe in postoperative period eliminates effectively bacterial contamination of the intestine, decreases toxicity of enteral contents and leads to significant improvement of functional characteristics of the small intestine and results of treatment.

[Lesions of retroperitoneal fatty tissue in destructive pancreatitis]. / Porazhenie zabriushinnoi kletchatki pri destruktivnom pankreatite.

Experience of examination and treatment of 102 patients with lesion of retroperitoneal space undergone surgery for pancreonecrosis is analyzed. Based of data of ultrasonic examination, computed tomography, surgery and autopsy laws of morphologic transformation and ways of spread of pathologic process into retroperitoneal space in pancreonecrosis were revealed. Developed scheme is important for substantiation of surgical policy.