[Endovascular technologies in the treatment of patients with blunt abdominal trauma]. / Endovaskulyarnye tekhnologii v lechenii patsientov s zakrytoi travmoi organov bryushnoi polosti.

Trauma is one of the leading causes of disability and mortality in working-age population. Abdominal injuries comprise 20-30% of traumas. Uncontrolled bleeding is the main cause of death in 30-40% of patients. Among abdominal organs, spleen is most often damaged due to fragile structure and subcostal localization. In the last two decades, therapeutic management has become preferable in patients with abdominal trauma and stable hemodynamic parameters. In addition to clinical examination, standard laboratory tests and ultrasound, as well as contrast-enhanced CT of the abdomen should be included in diagnostic algorithm to identify all traumatic injuries and assess severity of abdominal damage. Development of interventional radiological technologies improved preservation of damaged organs. Endovascular embolization can be performed selectively according to indications (leakage, false aneurysm, arteriovenous anastomosis) and considered for severe damage to the liver and spleen, hemoperitoneum or severe polytrauma. Embolization is essential in complex treatment of traumatic vascular injuries of parenchymal abdominal organs. We reviewed modern principles and methods of intra-arterial embolization for the treatment of patients with traumatic injuries of the liver and spleen.

[Vacuum-assisted laparostomy for advanced peritonitisis]. / Rol' vakuum-assistirovannoi laparostomy v lechenii rasprostranennogo peritonita.

OBJECTIVE: To evaluate the efficacy of negative pressure therapy in patients with peritonitis. MATERIAL AND METHODS: The study included 127 patients with advanced secondary peritonitis between 2019 and 2022. All patients were divided into 2 groups. All ones underwent staged sanitation of the abdominal cavity. In the first group (n=76), re-laparotomies were accompanied by skin suture only and passive abdominal drainage. The second group included patients (n=51) with open abdominal cavity strategy and negative pressure therapy (vacuum-assisted laparostomy). We analyzed the number of surgeries, postoperative complications, duration of hospital-stay and mortality. RESULTS: In the second group, there were significantly lower morbidity, mean number of surgeries and hospital-stay. In addition, incidence of fascial closure of abdominal cavity was higher and mortality rate was lower in the same group. CONCLUSION: Vacuum-assisted laparostomy in patients with advanced peritonitis can reduce the number of secondary purulent complications and mortality, as well as increase the incidence of fascial closure of abdominal cavity. This approach reduces the number of surgical interventions and duration of in-hospital treatment.

[Stomach and spleen preserving total pancreatectomy]. / Total'naya duodenopankreatektomiya s sokhraneniem zheludka, selezenki, zheludochnykh i selezenochnykh sosudov.

INTRODUCTION: Pancreatic surgery expands the indications and the use of total pancreatectomy. Considering a rather high rate of postoperative complications, the search for the ways to improve its outcomes is extremely relevant. The purpose of this study is justification and implementation of organ-preserving variants of total pancreatectomy. MATERIAL AND METHODS: Retrospective analysis of treatment results after classic and modified total pancreatectomy in the surgical clinic of Botkin Hospital was performed from September 2010 to March 2021. During the development and implementation of pylorus-preserving total pancreatectomy with preservation of the stomach, spleen, gastric and splenic vessels, we thoroughly analyzed aspects of exocrine/endocrine disorders and changes of the immune status after performing the modified technique. RESULTS: We performed 37 total pancreatectomies, including 12 pylorus-preserving total pancreatectomies with preservation of the stomach, spleen, gastric, and splenic vessels. General and specific postoperative complication rate in patients after the modified operation was significantly lower compared to the results of classic total pancreatectomy with gastric resection and splenectomy. CONCLUSION: Modified total pancreatectomy is a method of choice for pancreatic tumors of low malignant potential.

[Spleen-preserving total pancreatectomy for low-grade tumors]. / Pilorosokhranyayushchaya pankreatektomiya s sokhraneniem selezenki pri opukholyakh s nizkim potentsialom zlokachestvennosti.

OBJECTIVE: To justify organ-preserving variants of total pancreatectomy. MATERIAL AND METHODS: We retrospectively analyzed the results of classic and modified total pancreatectomy between September 2010 and March 2021. Implementing pylorus-sparing total pancreatectomy with preservation of stomach, spleen, gastric and splenic vessels, we thoroughly analyzed exocrine/endocrine disorders after total pancreatectomy and changes in immune status after splenectomy. Serum C-reactive protein and ferritin were assessed in 1, 3, 5, 7, 14 and 30 days after surgery in both groups. We also estimated daily glycemic profile after total pancreatectomy in classical and organ-preserving modifications. RESULTS: We performed 37 total pancreatectomies including 12 pylorus-preserving total pancreatectomies with preservation of stomach, spleen, gastric and splenic vessels. General and specific postoperative complication rate was significantly lower after modified surgery compared to classic total pancreatectomy with gastric resection and splenectomy. CONCLUSION: Modified total pancreatectomy is preferable for low-grade pancreatic tumors.

[Preoperative radiation navigation in determining surgical strategy for liver echinococcosis]. / Predoperatsionnaya luchevaya navigatsiya v opredelenii khirurgicheskoi taktiki pri ekhinokokkoze pecheni.

OBJECTIVE: To analyze the technology for diagnostic modeling of liver echinococcosis. MATERIAL AND METHODS: In the Botkin Clinical Hospital, we developed a theory of diagnostic modeling of liver echinococcosis. Treatment outcomes were analyzed in 264 patients who underwent various surgical interventions. RESULTS: A retrospective group enrolled 147 patients. When comparing the results of diagnostic and surgical stages, we identified 4 models of liver echinococcosis. The choice of surgical intervention in the prospective group was based on previous models. Diagnostic modeling reduced the number of general surgical and specific complications, as well as mortality in the prospective study group. CONCLUSION: The technology for diagnostic modeling of liver echinococcosis made it possible not only to identify 4 models of liver echinococcosis, but also determine the most optimal surgical intervention for each of model.

[Selecting the most appropriate surgical treatment of true splenic artery aneurysm]. / Vybor sposoba khirurgicheskogo lecheniya istinnykh anevrizm selezenochnoi arterii.

OBJECTIVE: To analyze the results of diagnosis and treatment of true splenic artery aneurysms. MATERIAL AND METHODS: We analyzed the results of diagnosis and treatment of 27 patients with true splenic artery aneurysm. All ones underwent surgical treatment at the Botkin Municipal Clinical Hospital between 2017 and 2021. Splenic artery aneurysm >1 cm was an indication for surgical treatment. Surgical option depended on aneurysm location. Laparoscopic splenectomy and aneurysmectomy were performed in 4 cases (14.8%), 5 (18.5%) patients underwent endovascular intervention, laparoscopic clipping was performed in 18 (66.7%) cases. Methods of surgical treatment, general and specific postoperative complications according to the Clavien-Dindo and ISGPS classifications were analyzed. RESULTS: Laparoscopic clipping was accompanied by fewer general and specific postoperative complications. Specific complications after laparoscopic splenectomy occurred in 2 patients (BL according to the ISGPS 2016 classification). There was one case of acute pancreatitis after endovascular interventions. In long-term postoperative period, aneurysm recanalization after endovascular intervention was observed in 1 case. CONCLUSION: Surgical treatment of splenic artery aneurysms requires a differentiated approach based on topographic and anatomical assessment of aneurysm relative to the arterial vessel.

[Specific complications of liver resection and their prevention]. / Rezektsiia pecheni. Spetsificheskie oslozhneniia i ikh profilaktika.

AIM: To improve the results of treatment of patients with focal liver formations by preventing the development of postoperative complications after liver resections. METHODS: The study included 304 patients with benign and malignant liver lesions. In 196 (64.4%) patients, resections were performed for malignant liver damage, in 108 (35.6%) - for a benign process. To assess the impact of ongoing measures to prevent the development of postoperative complications, patients were divided into two time periods: from 2007 to 2012 and from 2013 to 2018. RESULTS: The introduction of a protocol of preoperative examination of patients for whom resection of 3 or more liver segments is planned, with the inclusion of SPECT/CT, which allows determining the volume of the remaining functioning liver parenchyma, allowed to reduce the percentage of development of acute post-resection liver failure from 11.6% to 3.6% during the second time period (p=0.0064). The use of modern suture material, surgical binocular loops, as well as the use of the concept of predominantly performing parenchyma-saving resections, reduced the number of biliary complications from 8.1% to 5.7% (p=0.1). The use of a proprietary dissection algorithm for the liver parenchyma significantly reduced hemorrhagic complications from 5.3% to 1.04% (p=0.0074). CONCLUSION: The use of modern pre- and intraoperative technologies has reduced the number of postoperative complications after liver resections from 38.3% to 20.9% (p=0.018) and mortality from 2.6% to 0.5% (p=0.004), thereby improving the results of liver resections.

[Comparative analysis of side-by-side antegrade stenting and Y-biliary stenting for malignant biliary stricture]. / Sravnitel'nyi analiz antegradnogo stentirovaniia side-by-side i Y-stentirovaniia pri zlokachestvennoi zhelchnoi strikture vorot pecheni.

In the time period from 2009 to 2017 in Botkin Hospital (Moscow) bilateral biliary stenting was performed in 43 patients with malignant common hepatic duct stricture. Patients were divided into 2 statistically homogeneous groups: 'side-by-side' stenting in 28 patients and percutaneous 'Y'-biliary stent placement in 15 patients. The causes of malignant obstruction were as follows: in the 1st group 13 (46.4%) patients with extrahepatic cholangiocarcinoma (46.4%), 8 (28.6%) patients with intrahepatic cholangiocarcinoma, 4 (14.3%) patients with gallbladder cancer, 3 (10.7%) patients with metastatic cancer. In the 2nd group 6 (40%) patients with extrahepatic cholangiocarcinoma, 4 (26.6%) patients with intrahepatic cholangiocarcinoma, 2 (13.3%) patients with gallbladder cancer, 3 (20%) patients with metastatic cancer. Characteristics of patients: age - 1st group 71.2±5.1 years, 2nd group 74.3±5.5 years; sex - (m/f) 1st group 18/10, 2nd group 9/6; location of stricture - 1st group Bismuth IIIa/IIIb 17/11, 2nd group Bismuth IIIa/IIIb 11/4; mean level of bilirubin - 1st group 284±8.2 µmol/l; 2nd group 311±7.4 µmol/l. Technically all procedures were successful (100%). No complications and mortality associated with the procedure was recorded. Clinically significant results were achieved in 26 (92.8%) patients in Group 1 and in 13 (86.7%) patients in Group 2 (p=0.043). Following stenting procedures, 23 (82.1%) patients in Group 1 and 11 (68.8%) patients in the Group 2 had chemotherapy (p=0.047). 19 patients from the 1st group and 10 patients from the 2nd group died due to tumor progression of the underlying disease, other patients are under care of a physician. Median survival rate: 1st group (12 patients - 50 days, 7 patients - 100 days, 9 patients are alive at the time of writing); 2nd group (7 patients - 50 days, 4 patients - 100 days, 4 patients are alive at the time of writing). The results of this study showed that 6 (21.4%) patients from the 1st group and 4 (26.7%) patients from the 2nd group had biliary stent occlusion (p=0.041). The average period of stent function in the 1st group was 78±4.5 days, and 63±4.8 days in the 2nd group (p=0.036). Based on the obtained results, it is recommended to use the 'side-by-side' method of bilobar biliary stenting in patients with malignant common hepatic duct strictures.

[Rare forms of the ductal carcinoma of the pancreas].

Clinical cases of patients with rare forms of ductal pancreatic carcinoma are described. Difficulties of preoperative radiologic verification of ostheoclast-like giantcell tumor and cricoids-cell carcinoma of the pancreas are described. Morphologigic and immunohistochemical features of these tumors are highlighted. One of the clinical cases demonstrate the aggressive tumor behavior, led to liver metastases 4 months after the radical operation. Literature review highlights historical aspects and the state-of-art of diagnostics and treatment of rare forms of the ductal carcinoma of the pancreas.

[The role of matrix metalloproteinases in pancreatic ductal adenocarcinoma].

Matrix metalloproteinases-7, -9 (MMP) are crucial factors for prognosis of pancreatic ductal adenocarcinoma (PDA). The expressions of MMP-2, 7, 9 increased in 60 patients with PDA and depended from stage of disease. Metastasis and invasive growth of tumor correlated with increase of MMP production and decrease of MMP inhibitors' expression, stimulated invasive growth of tumor.

[Puncture-drainage treatment of pancreatic postnecrotic pseudocysts]. / Punktsionno-dreniruiushchii sposob lecheniia nesformirovannykh postnekroticheskikh kist podzheludochnoi zhelezy.

From 1989 to 1998 we treated 94 patients with pancreatic pseudocysts. 55 patients underwent laparotomy (external drainage of the cyst, sequestrectomy). 14.5% patients of this group presented with postoperative complications, mean hospital stay was 36 days. During 1997-1998 we performed US-controlled punctures and drainage in 37 patients with pancreatic pseudocysts. This method was efficient in 83.7% of the cases without sequesters in the cystic cavity. Use of this method allowed to decrease the percentage of complications and lethality rate, and reduce the mean hospital stay by 47.2%.

[A comparative analysis of the laparotomy and puncture-drainage methods of treatment in unformed postnecrotic cysts of the pancreas]. / Sravnitel'nyi analiz laparotomnogo i punktsionno-dreniruiushchego sposobov lecheniia pri nesformirovannykh postnekroticheskikh kistakh podzheludochnoi zhelezy.

The authors share their experiences with treatment of 94 patients with unformed pancreatic cysts. In 55 of them the laparotomy method of treatment (external drainage, sequestrectomy) was used after which in 14.5% of the cases postoperative complications developed, and the average time of staying at the hospital was 36 bed-days. In 1997-1998 the puncture-drainage method under USI control was used in 37 patients with the disease in question. It proved to be effective in 83.7% of the patients with the absence of large sequesters in the cyst cavities. This method allowed the number of complications and lethality to be decreased, the period of staying at the hospital being 47.2% shorter.