[Choice of the method of isoperistaltic tubular esophagogastroplasty completion based on intraoperative assessment of vascularization of gastric transplant].

Intraoperative assessment of vascularization of isoperistaltic tubular gastric transplant using angiotensiometry and Doppler flowmetry was performed at 136 patients undergone extirpation of esophagus with esophagogastroplasty. The main criteria of gastric transplant convenience for anastomosis with esophagus were: clear intramural pulse on all circle of gastric transplant by flowmetry data; intramural arterial pressure according to angiotensiometry data have to be not less 80 mm Hg, and the ratio of venous to arterial pressure has not to be more 50%. At inadequate criteria the surgery must be finished with cervical esophago- and gastrostoma.

[Choice of the method of forming an isoperistaltic graft from the stomach for total esophagoplasty]. / Vybor sposoba vykraivaniia iz zheludka izoperistal'ticheskogo transplantata dlia total'noi ézofagoplastiki.

An anatomical experiment was conducted on 50 cadavers of human adults and an acute experiment on 50 unbred dogs to choose the most rational method for forming an isoperistaltic graft from the stomach for total esophagoplasty. The anatomo-experimental study was concerned with the peculiarities of angioarchitectonics and the merits and shortcomings of some methods for lengthening gastric grafts. The macro- and microcirculation in the modelled isoperistaltic gastric grafts of various width and configuration was studied in the animal experiments. It was shown that the best gastric graft was an isoperistaltic tube measuring 2.5 cm at the base, formed by the authors' suggested method of angular division of the gastric walls above the pylorus, and with a dilatation in the proximal part (beginning 4 cm below the level of division of the main vascular arcade) up to 3.5 cm in size. When the length of the greater curvature of the stomach from the lower pole of the spleen to the pylorus, measured in mild stretching of the tissues (before mobilization of the stomach) is less than 20 cm it is advisable that the vascular connections in the hilus of the spleen are included in the nutrient-supplying pedicle of the graft to improve the supply of blood to its proximal segment. The method for formation of the gastric graft along a broken line was used in the clinic in 300 operations for extirpation of the esophagus with one-stage esophagoplasty. Necrosis of the graft was not encountered. Total postoperative mortality was 3%. It is concluded that wider introduction of this operation into clinical practice is expedient.

[Pancreatoduodenal resection and total duodenopancreatectomy in surgery for stomach cancer]. / Pankreatoduodenal'naia rezektsiia i total'naia duodenopankreatéktomiia v khirurgii raka zheludka.

Experience with combined operations for stomach cancer in combination with pancreatoduodenal resection or total duodenopancreatectomy is presented. Immediate and long-term results of 10 pancreatoduodenal resections and 5 total duodenopancreatectomies are analyzed. There were 2 lethal outcomes. Complicated postoperative period was seen in 7 patients. During the first year of follow-up 6 of 13 operated patients died due to dissemination. After total pancreatectomy severe homeostatic disorders were seen. Prognosis after pancreatoduodenal resection is better when the tumor involves the duodenum than when it invades the pancreas. Subtotal resection of the stomach and gastrectomy in combination with duodenopancreatosplenectomy lead to unfavorable functional results and have bad long-term prognosis.

[Surgical treatment of cancer of the esophagus and esophagogastric junction]. / Khirurgicheskoe lechenie raka pishchevoda i pishchevodno-zheludochnogo perekhoda.

Immediate and long-term results of surgical treatment of cancer of the esophagus and esophageal-gastric passage in 103 patients were analyzed. Ninety-nine extirpations of the esophagus with simultaneous isoperistaltic tubic esophagogastroplasty (95) and coloplasty (4), 4 Luis surgeries were performed. Hospital lethality was 4.9%, rate of postoperative complications - 47.6%. 5-year survival after surgery was 32.4+/-5,8%: in cancer of cervical or upper-thoracic part of the esophagus - 0, middle-thoracic part - 24.6+/-7.2%, lower-thoracic part - 56.5+/-11.9%, esophageal-gastric passage - 35.6+/-16.1%. Problems of surgical techniques, indications for transhiatal and transthoracic approaches to the esophagus, schemes of combined treatment are discussed.

[Esophageal extirpation with one-stage esophagoplasty]. / Ekstripatsiia pishchevoda s odnomomentnoi ézofagoplastikoi.

In the period from 1980 to June, 1989 the authors conducted operations on 128 patients for extirpation of the esophagus with one-stage esophagoplasty by means of an isoperistaltic tube formed from the greater curvature of the stomach. Fifty-four of these patients had benign esophageal strictures, 74 had malignant lesions of the esophagus. The authors claim this operation to be the operation of choice in carcinoma of the lower third of the esophagus and in carcinoma of the cardia extending to the thoracic esophagus. It may be carried out in carcinoma of the thoracic esophagus at any level, in benign strictures of the thoracic esophagus, and in stage IV cardiospasm in patients in whom operations had been performed earlier on the cardia. The abdominocervical approach can be supplemented by right thoracotomy in carcinoma of the midthoracic part of the esophagus. Four patients (3%) died after the operation. The authors recommend wider use of the operation.

[Diagnosis and surgical treatment of obstructive jaundice in benign diseases]. / Diagnostika i khirurgicheskoe lechenie obturatsionnoi zheltukhi pri dobrokachestvennykh zabolevaniiakh.

The article analyses the results of the diagnosis and surgical treatment of obstructive jaundice caused by benign diseases in 279 patients. Cholelithiasis was the cause of obstructive jaundice in 82.4% of patients; in 30.3% of cases the clinical symptomatology of the disease was atypical due to which the patients were at first placed erroneously in hospitals for infectious diseases. Endoscopic methods of examination proved to be most informative: the informativeness of ERP was 91%, that of combined laparoscopy--98.5%. Choledochoduodenostomy is the operation of choice in choledocholithiasis, and double drainage after O.B. Milonov--in combination of obstructive choledocholithiasis with papillostenosis.

[Functional obstruction of the cardia and cancer localized in the cardia and esophagus]. / [Funktsional'naia neprokhodimost' kardii i rak kardial'no--pishchevodnoi lokalizatsii.

The work is based on the experience with the exploration and treatment of 310 patients with the functional obstruction of the cardia which are found to have two pathogenetic forms-cardiospasm and cardiac achalasia. Errors in the diagnosis in the outpatient department were 38%. Causes of the diagnostic errors and the differential-diagnostic tables are given. Against the background of the continuous course of cardiospasm and cardiac achalasia there appeared carcinoma of the cardiac-esophageal localization in 2,5% of cases. All the patients subjected to operations or instrumental cardiodilatation who have gastro-esophagal reflux should be taken under special control with periodic endoscopic examinations.

[Surgical procedure in joint cardiospasm and cardial hiatal hernia]. / Taktika khirurga pri sochetanii kardiospazma s kardial'noi gryzhe pishchevodnogo otverstiia diafragmy.

In 39 patients cardiospasm was associated with a hiatal hernia or the latter was formed in the process of treatment by cardiodilatation. An analysis of results of the treatment has shown that pneumocardiodilatation under control of esophagomanometry should be considered the method of choice in the treatment of such patients. The decreased gradient of the gastroesophageal pressure up to 12-14 mm of mercury is responsible for prevention of reflux-esophagitis. Operative treatment is indicated when cardiodilatation is ineffective or the manometric control is impossible. Cardiomyotomy in combination with an "incomplete" fundoplication is preferable. There are no good reasons for performing fundoplication after Nissen in patients with cardiospasm.

[Duodenoplasty as a draining operation in postbulbar stenosing duodenal ulcers]. / Duodenoplastika kak dreniruiushchaia operatsiia v khirurgii postbul'barnykh stenoziruiushchikh duodenal'nykh iazv.

Different variants of duodenoplasty were fulfilled in 12 patients with subcompensated postbulbar ulcerous stenosis as draining operations in selective proximal vagotomy. Good immediate and remote (up to 2 years) results were obtained. No relapses of ulcer, dumping syndrome, duodenogastral reflux were observed in the operated patients.

[The characteristics of the electromagnetic situation close to overhead electric power transmission lines in St. Petersburg]. / Kharakteristika élektromagnitnoi obstanovki vblizi vozdushnykh linii élektroperedachi na territorii Sankt-Peterburga.

According to task by Environmental Protection Department of St. Petersburg Municipal Administration, levels of electromagnetic fields induced by high-voltage electric power lines were measured in development lands of St. Petersburg. The authors present hygienic evaluation of electromagnetic fields intensity, match calculated and actual values of magnetic induction of occupational magnetic fields.