[REOPERATIONS IN PATIENTS, SUFFERING CYSTIC TRANSFORMATION OF COMMON BILIARY DUCT].

Own experience of treatment of the common biliary duct cysts was analyzed in the patients, to whom earlier noneffective operative procedures for this purpose were performed. The main causes of the operations faults were unmasked, the proposed treatment-diagnostic algorithm was proposed, immediate and remote results of operative treatment were analyzed.

[Simultaneous operations during laparoscopic cholecystectomy]. / Simultannye operatsii pri vypolnenii laparoskopicheskoi kholetsistektomii.

Simultant laparoscopic operations were performed in 1993-2003 yrs period in 321 patients, including 287--using laparoscopic and 34--the combined (laparoscopic and open) access. Concurrent diseases were diagnosed preoperatively in 219 (68.2%) of patients and were disclosed while doing intraoperative revision--in 102 (31.8%). The simultant operations performance, as a rule, enhanced mildly the total duration of a basic stage, did not influence the duration of postoperative period and the patients rehabilitation essentially, as well as for frequency of the intra--and postoperative complications occurrence. The authors consider that it is expedient to perform laparoscopic intervention simultaneously for concurrent surgical diseases of abdominal cavity.

[Dynamics in the local and systemic immune factors in patients with cystic transformation of the bile duct]. / Dinamika mestnykh i sistemnykh faktorov zashchity u bol'nykh s kistoznoi transformatsiei zhelchnykh protokov.

Cystic transformation of biliary ducts (CTBD) is a rare inborn anomaly of the biliary system development. For the patients with CTBD quite high metabolic activity of neutrophils according to data of spontaneous test with nitroblue tetrazolium (NBT-test), reduction of IgA content in the initial period, significant raising of interleukin-6 (IL-6) level on the first postoperative day are characteristic. Quantity of active neutrophils of type II in the blood of patients with CTBD depends on antigenic load. Neutrophils in the bile restore the NBT according to type I. Local concentration of IL-6 and IL-8, and also the functional activity of neutrophils in ductal bile in patients with CTBD are the sensitive indexes of clinical state and immunological reactivity.

[Injury of biliary ducts in laparoscopic cholecystectomy]. / Povrezhdenie zhelchnykh protokov pri laparoskopicheskoi kholetsistéktomii.

Peculiarities of the biliary ducts (BD) damage while performance of laparoscopic cholecystectomy (LCHE) and their significance in the choice of the operative correction method were studied up. In 35 patients the kinds and mechanisms of BD damage were analyzed. Taking into account large and small injuries, the general frequency of BD trauma while performance of LCHE had constituted 0.11%, what is comparable with indexes, characteristic for open cholecystectomy. Electric burn of BD wall, isolated one or in conjunction with other kinds of trauma, were observed in 15 (42.8%) of patients. Miniinvasive interventions, including those using laparoscopic access, are effective in treatment of small and some kinds of partial injuries. The operation of choice in correction of BD damage is formation of high hepaticojejunoanastomosis, when diagnosis is established intraoperatively or was postponed.

[Diagnosis and treatment of cystic transformation of biliary ducts]. / Diagnostika i khirurgicheskoe lechenie kistoznoi transformatsii zhelchnykh protokov.

Experience of surgical treatment of 58 patients with cystic transformation of biliary ducts of various type was presented. There were adduced tactics of examination of the patients, kinds of operative treatment, postoperative complications were analyzed. In 33 patients there was performed resection of cystically-changed common biliary duct and subsequent formation of hepaticojejunoanastomosis with the jejunal loop, excluded according to Roux method. Late results of treatment of patients were studied. Malignization in cystic wall was revealed in 2 (3.4%) of patients. One patient died.