[Prospects of qualitative and quantitative assessment of bowel perfusion by fluorescent angiography with indocyanine green in colorectal surgery. First experience]. / Perspektivy kachestvennoi i kolichestvennoi otsenki perfuzii kishki metodom flyuorestsentnoi angiografii s indotsianinom zelenym v kolorektal'noi khirurgii. Pervyi opyt.

OBJECTIVE: To assess the possibilities of fluorescent detection system in qualitative and quantitative assessment of bowel perfusion in colorectal resections. MATERIAL AND METHODS: From May to August 2023, a single-center pilot cross-sectional unblinded study with inclusion of 18 patients with colon cancer (of left-sided - 12, of right-sided - 6, mean age - 72.9 years, m/w - 61/39%) was conducted. All patients underwent laparoscopic colorectal resections with extracorporeal stage of bowel transection. The evaluation of the bowel's ICG perfusion was conducted to assist in decision making about the level of its resection. Qualitative (visual) assessment was carried out in all 18 patients, in one patient twice, quantitative assessment of perfusion was conducted in 8 patients (left-sided resections - 6, right-sided hemicolectomy - 2). The qualitative evaluation was performed in real time on the analysis of the color gradient. The time parameters and fluorescence intensity at different level proximally and distally from the resection line were quantitatively estimated: Tstart - time of occurrence of minimal fluorescence in the areas of interest after the ICG injection (sec); Tmax - time to achieve maximum fluorescence intensity after the ICG injection (sec); Tmax-start - time interval between Tstart and Tmax, Imax - level of maximum fluorescence intensity (I). RESULTS: Visual qualitative analysis of fluorescence revealed unsatisfactory perfusion characteristics (black, dark-gray color) in the area planned by the surgeon to anastomose the bowel in 3 of 18 patients (16.6%). When analyzing the quantitative data of this group of patients, there was a 2-6-fold decrease in Imax level, and one patient had an increase in Tmax-start at the level of intended resection compared to the bowel's sections in the favorable zone. In all cases, the final bowel transection was conducted in the area of good perfusion. There was no clinical evidence of anastomotic dehiscence in the study group. CONCLUSION: Intraoperative evaluation of bowel perfusion is an important component of safe anastomosis formation in colorectal surgery. The use of ICG-FA allows to conduct qualitative and quantitative assessment of tissue perfusion of the bowel in order to assist in making intraoperative decisions. Quantitative evaluation of fluorescence provides more objective information about perfusion parameters. Imax and Tmax-start are the most promising quantitative indicators of local bowel's perfusion. Nevertheless, the precise interpretation of the quantitative indicators of ICG perfusion needs to be clarified.

[Fluorescence lymphography for sentinal lymph node biopsy in breast cancer]. / Sobstvennyi opyt primeneniya flyuorestsentnoi limfografii dlya biopsii signal'nykh limfouzlov pri rake molochnoi zhelezy.

OBJECTIVE: To study diagnostic value of fluorescence lymphography for sentinel lymph node biopsy in breast cancer. MATERIAL AND METHODS: The study enrolled 25 patients with breast cancer T1-2N0-1M0 between March 2023 and July 2023. Eight ones underwent neoadjuvant chemotherapy. In 3 patients, morphologically verified metastases cN1 in axillary lymph nodes regressed after treatment. After sentinel lymph node biopsy, all patients underwent standard axillary lymphadenectomy. Subareolar injection of indocyanine green 1 ml (5 mg/ml) was performed immediately before surgery. Fluorescence imaging was performed using the MARS system. RESULTS: Detection rate was 100%. Mean number of sentinel lymph nodes was 2. Metastatic lesions of sentinel lymph nodes were observed in 6 patients (24%) with micro-metastases in 2 cases. In 50% of cases, metastatic lesion did not extend beyond sentinel lymph nodes. False negative result was obtained in 1 (4%) patient. Mean number of metastases was 1.8 (max 3 in one patient). CONCLUSION: Sentinel lymph node biopsy with fluorescence lymphography is a sensitive method. The advantages of this technique are visualization of subcutaneous lymphatic vessels and skin incision for access to sentinel lymph nodes, as well as visualization of sentinel lymph nodes after skin incision.

[Integration of ICG-fluorescence cholangiography into the safety system of laparoscopic cholecystectomy]. / Integratsiya ICG-fluorestsentnoi kholangiografii v sistemu bezopasnosti laparoskopicheskoi kholetsistektomii.

THE AIM OF THE STUDY: Is evaluating the possibility of integrating ICG-fluorescent cholangiography into the general safety system for laparoscopic cholecystectomy to prevent damage to the extrahepatic bile ducts by working out the methodological aspects of navigation technologies. MATERIALS AND METHODS: The analysis of literature data on various approaches to improve the perioperative identification of anatomical structures during laparoscopic cholecystectomy, including the ICG-fluorescent cholangiography, was carried out. This program was implemented during the provision of elective surgical care to 24 patients with cholelithiasis who underwent laparoscopic cholecystectomy with ICG-fluorescent navigation. RESULTS AND DISCUSSION: The developed program included: preoperative assessment of the anatomy of the biliary tree using MRCP; intraoperative technique of safe laparoscopic cholecystectomy with mandatory application of the concept of «critical view of safety¼ (CVS), which allows the most effective identification of the necessary anatomical structures; the use of ICG-fluorescent cholangiography, which allows to improve the control of anatomical structures at all stages of the operations. CONCLUSIONS: The first experience of using ICG-fluorescent cholangiography testifies to the high informative value of the method, the possibility and prospects of integrating the technology into a comprehensive safety system during laparoscopic cholecystectomy.

[Possibilities of tissue perfusion assessment in abdominal surgery: integration into the intraoperative system of safety control points]. / Vozmozhnosti otsenki perfuzii tkanei v abdominal'noi khirurgii: integratsiya v sistemu intraoperatsionnykh kontrol'nykh tochek bezopasnosti.

OBJECTIVE: To evaluate the possibility of integrating tissue perfusion assessment techniques (ICG perfusion and imaging photoplethysmography - iPPG) into the system of intraoperative control points of laparoscopic interventions with a reconstructive component. MATERIALS AND METHODS: Quantitative assessment of ICG fluorescence and iPPG were used during 8 laparoscopically assisted interventions: gastrectomy for gastric cancer (total - 2 and distal - 1) and colorectal resections (left-sided colorectal resections - 4 and right hemicolectomy - 1). RESULTS: Four stages are presented for the assessment of tissue perfusion: initial assessment, before intestine transection, before anastomosis formation, and evaluation of anastomosis. From the point of view of the significance of clinical decision-making, the «before intestine transection¼ stage is of great importance, due to the ease of transferring the resection level to the optimal tissue perfusion zone. CONCLUSION: Integration of tissue perfusion assessment techniques into the system of intraoperative checkpoints is possible and promising.

DIAGNOSIS AND TREATMENT OF SOLID-PSEUDOPAPILLARY NEOPLASM OF PANCREAS IN A YOUNG WOMAN.

In the article we present clinical case of rare tumors of the pancreas - solid-pseudopapillary tumor. The stages of diagnostics and clinical-instrumental and morphological features. We performed spleen preserving distal pancreatectomy as a definitive treatment. The article provides a review of literature on this issue as well.

[OPTIMIZATION OF THE METHOD OF SUPRAPANCREATIC LYMPH NODE DISSECTION IN LAPAROSCOPY-ASSISTED GASTRECTOMY (IN THE FINAL ANALYSIS OF INTERNATIONAL CONFERENCES <>)].

The article analyzed the methods of suprapancretic lymph node dissection in laparoscopic gastrectomy which were devel- oped and applied in Japan. The authors described the details of operation technique. There were noted the advantages of medial approach for suprapancreatic lymph node dissection.

[Predominantly intraductal low-grade differentiated adenocarcinoma in young man with long time mask clinic of chronic pancreatitis].

The authors present the case of diagnosis of low-grade adenocarcinoma of the pancreas, a man 34 years old, a long time to mask clinic chronic pancreatitis. Laboratory and instrumental investigations, including tumor markers CD 19-9, CEA, ultrasound, CT, MRI showed no reliable data for the presence of tumor. On the other hand, a young man of 34 years present credible evidence of chronic pancreatitis, in the form of a typical pain, a significant increase in serum am- ylase and lipase, and the presence of parenchymal and ductal signs of pancreatitis in visual research methods. Diagnosis of tumors, including obtaining morphological material, pre-operative pain relief were obtain by endoscopic methods. Histological examination of surgical specimens was detected a rare type of poorly differentiated adenocarcinoma of the pancreas tubulo-papillary structures, with predominant intraductal growth and a minimum depth of invasion due to pronounced fibrotic outcome variables, which leads to a complex disease diagnostics. After 1.5 years, after adequately performed surgery the patient was revealed metastases to the liver.

[Treatment of giant diaphragmatic hernia].

The authors demonstrate the results of treatment (16 patients) with giant paraesophageal and posttraumatic diaphragmatic hernia. The article represents the main principles of operation management, key moments of the choice of access, operative techniques and also the features of the usage of modern reticular implants.

[Ways of optimization of standards of treatment of acute cholecystitis].

The article presents an analysis of tactical approaches in patients with acute cholecystitis on the basis of an experience with treatment of acute cholecystitis under conditions of multiprophile hospital in Saint Petersburg and modern ideas of the problem in the world.

[Improvement of outcomes and quality of life of patients with portal esophagogastric bleedings due to using endoscopic haemostatic methods].

Effectiveness of endoscopic haemostatic methods for acute esophagogastric bleedings of portal genesis was analyzed. Under study there were indices of survival and mean life span of 157 patients divided into two groups: main and of comparison. Considerable improvement was established in indices of survival and mean life span in patients of the main group, where haemostatic methods were used for hemostasis. The patients of the main group had higher level of quality of life in long-term periods of follow-up, longer kept ability to work, physical activity and self-service.

[Use of the multislice spiral computed tomography in planning the treatment of patients with tumors of the biliopancreatoduodenal zone].

The authors elucidate an experience with using multislice spiral computed tomography with the method of multiphase scanning (CT-angiography) in patients with suspected tumors of organs of the biliopancreatoduodenal zone. The proposed method allows getting information on the character of the pathological process, dissemination of the tumor lesion. It helps to decide on the strategy of treatment of the patient, to plan the operative intervention and assess the results of operative treatment.

[Video capsule endoscopy in the diagnostics of small intestine diseases].

Video capsule endoscopy is a safe and noninvasive, well-endurable method of the direct visual inspection of the whole of the small intestine. The most frequent indications for video capsule endoscopy are the diagnostics of latent gastro-intestinal bleedings, angiodysplasias, Crohn disease, celiac disease, syndromes of hereditary polyposis and tumors of the small intestine. The authors describe the first experience of using this new method in the domestic clinical practice. Data concerning the diagnostics of lesions of the small intestine by the method of video capsule endoscopy as well as the wide range of lesions of the mucous membrane in different diseases of the small intestine are presented.

[The endoscopic ligation and sclerotherapy in a complex prevention program of variceal bleedings in extrahepatic portal hypertension]. / Endoskopicheskoe ligirovanie i skleroterapiia v kompleksnoi programme profilaktiki varikoznykh krovotechenii pri vnepechenochnoi portal'noi gipertenzii.

The results of prophylactic endoscopic treatment of 22 patients with extrahepatic portal hypertension (main group--EPH) and 76 patients with cirrhosis of the liver (a comparison group--CL) who had had variceal bleedings were analyzed. In the EPH group permanent eradication was obtained in 14 patients (63.6%), in the CL group--in 46 patients (50.5%). With the average duration of achieving the eradication the number of sessions before achieving it proved to be greater than that for CL. Recurrent bleeding during the first month of observations was noted in 7 out of 22 patients. In most cases the sources of bleedings were postligational and postinjectional ulcers of the cardial part of the stomach. Long-term results (1-5 years) were followed-up in 14 patients. In 9 patients there was no recurrent bleeding during 2-5 years of observation. Thus, it is expedient to use endoscopic interventions as the methods of the "first line" in the complex program of secondary prophylactics of variceal bleedings in extrahepatic portal hypertension.

[A comparative analysis of results of treatment of patients with acute varicose esophago-gastric bleeding: the role of endoscopic technologies]. / Sravnitel'nyi analiz rezul'tatov lecheniia bol'nykh s ostrym varikoznym pishchevodno-zheludochnym krovotechenirm: rol' endosckopicheskikh tekhnologii.

The aim of the work was to make a comparative analysis of results of treatment of patients with varicose esophago-gastric bleeding depending on using the endoscopic technologies--ligation and sclerotherapy. The investigation included 161 patients. The main group consisted of 65 patients treated with using the endoscopic technologies--ligation and sclerotherapy due to emergency indications. The comparison group included 96 patients given conservative treatment with the application of Blackmoor probe. The endoscopic methods of surgery allowed to get arrest of bleeding reliably more often (92.3 vs 67.7%, p < 0.05). The number of patients having recurrent bleedings in the main group was 2.7 times less, the intrahospital lethality--3.4 times less than in the group of comparison (p < 0.05).

[Endoscopic sclerotherapy and ligation of varicose veins of the esophagus and cardia]. / Endoskopicheskaia skleroterapiia i ligirovanie varikozno-rasshirennykh ven iz pishchevoda i kardii.

Results of endoscopic treatment of 39 patients with acute bleeding from varicose veins of the esophagus and cardia and of 46 patients as prophylaxis of bleeding recurrence are presented. Rate of primary hemostasis in acute bleeding was 92.3%. In 3 patients with bleeding from varicose veins of cardia endoscopic treatment was not effective. In prophylactic treatment rate of bleeding recurrence during 1 year was 15.2%. A 6 month--survival was 93.3%, it depended on functional group by Child. Endoscopic methods (sclerotherapy, ligation) are effective for arrest and prophylaxis of portal bleedings.

[Evaluation of the effectiveness of Dopplerography in patients with diffuse liver disease with portal hypertension syndrome]. / Otsenka éffektivnosti dopplerografii u bol'nykh diffuznymi zabolevaniiami pecheni s sindromom portal'noi gipertenzii.

Under analysis were the results of Dopplerography of the abdominal cavity vessels in 66 patients with liver cirrhosis and 14 patients with the extrahepatic portal block. The sensitivity of the method in diagnostics of the intrahepatic block was 96.9%. The linear rate of the blood flow along the upper mesenterial vein was the most sensitive dopplerographic criterion of liver cirrhosis with the portal hypertension syndrome, the most specific test was the determination of the hepatic artery pulsativity index. A considerable decrease of the index of linear and volume rates of blood flow along the splenic vein and higher index of the splenic artery pulsativity were observed when the functional reserves of the liver decreased. A higher resistance index and the presence of the III degree gastroesophageal anastomoses are characteristic of the patients with bleedings from the veins of the esophagus and stomach.

[Endovascular intrahepatic portacaval shunting]. / Endovaskuliarnoe vnutripechenochnoe portokaval'noe shuntirovanie.

Pilot experience in Russia of transjugular intrahepatic portosystemic shunting is presented. Results of endovascular shunting in 14 patients with cirrhosis of the liver were analyzed. Four patients underwent emergency endovascular shunting when conservative treatment was not effective. Ten patients underwent elective surgery. Repeated esophagealgastric bleedings were indications for shunting. Relapse of bleeding was seen in 1 patient 5 days after surgery. Regular dopplerography permitted to reveal timely stenotic process. When stenosis of portosystemic shunt was diagnosed, ambulatory balloon dilatation of anastomosis through transjugular approach was performed. It was enough for opening of anastomosis lumen and decrease of pressure gradient.

[Endoscopic methods of prevention and treatment of hemorrhage of portal genesis]. / Endoskopicheskie metodi profilaktiki i lecheniia krovotechenii portal'nogo geneza.

Results of endoscopic interventions on 72 patients with portal hypertension of different etiology are presented. In patients with acute bleedings the frequency of primary hemostasis was 94%. In 2 patients with hemorrhages from the cardial veins of the stomach the endoscopic interventions proved to be ineffective. Prophylactic treatment gave 20% recurrent bleedings during a year. Survival of the patients during 6 months was 88.5% and considerably depended on the functional group according to Child. The endoscopic interventions (sclerotherapy, ligation) should be considered effective methods to arrest bleeding and to prevent bleedings of portal genesis.