[Prophylaxis of complications in patients after pancreaticoduodenal resection].

Experience of pancreaticoduodenal resection performance was summarized in 163 patients in 2005-2009 yrs. Duodeno(gastro)enterostomy was formed in anterior position, taking an objective to reduce the risk of postoperative gastrostasis occurrence; and formation of invagination ductojejunal anastomosis--for prophylaxis of pancreatogenic complications. External pancreatic duct drainage and medicinal therapy conduction do not guarantee reduction of the postoperative complications occurrence risk.

[Pancreatic resection using laparoscopic access].

Experience of their own on performance of pancreatic resection interventions, using laparoscopic access, conducted in the clinic in 2009 - 2013 yrs, was presented. In 8 patients laparoscopic distal pancreatic resection was conducted, in 5--laparoscopic enucleation of pancreatic tumor, in 1--laparoscopic pancreaticoduodenal resection. The results were compared with such after open operations, performed in this period of time. There was not a trustworthy difference in the postoperative complications rate, intraoperative blood loss severity and the distal resection duration. The patient stationary treatment duration was trustworthy less after conduction of laparoscopic operations. The intraoperative blood loss severity and duration of laparoscopic enucleation of pancreatic tumor are trustworthy less.

[Ultrastructural peculiarities of mononuclear macrophages of the demarcation zone in an acute necrotic pancreatitis and elaborating of methods for the disease course prognosis and treatment].

Results of the electron microscopic investigation of the pancreatic tissues biopsies, obtained intraoperatively from the demarcation inflammation focus, while operating 42 patients for an acute necrotic pancreatitis (ANP), were summarized. No less than two populations of mononuclear macrophages, the cells, owing raised or lowered functional activity, were revealed in inflammatory focus of demarcation area. Determination of absolute quantity of monocytes in a peripheral blood was used as a prognostic criterion for the disease course. If the absolute quantity of monocytes did not exceed 400 in 1 mcl of the blood, estradiol dipropionate was used in the ANP treatment, permitting to lower a purulent-septic complications rate, to improve immediate and remote results of treatment.

[Principles of direct surgical procedures on the pancreas in surgical treatment of chronic pancreatitis].

An analysis of treatment of 584 patients with complicated forms of chronic pancreatitis operated during 2000-2100 years was carried out. Quality of life of postoperative patients was estimated according to a technique of calculations of modules EORTC QLQ-C30 and EORTC QLQ-PAN26. The indicators of quality of life have improved by 19.7% in performance of saving duodenal outflow of operations of pancreatic juice. Change of the surgical strategy has led to decreased number of postoperative complications by 4.6% and to satisfactory long-term results in 92.6% of the patients.

[Application of thermostream method in the surgical treatment of infectious pancreatic diseases].

Application of thermostream method secures a safe sterilization in infected pancreatic affection. It was confirmed by the results of 9 operations, performed on pigs with follow-up to 270 days. Thermal influence toward infected pancreatic tissue was delivered using hot air stream during 20 sec for 1 cm2 area in temperature 140 degrees C. Interstitial oedema is local after thermostream processing of pancreas, the reversible structural-functional changes were revealed in the organ tissues, localized aside from the influence zone. According to bacteriological investigations data obtained, microflora was absent. Successful clinical trial of thermostream method in patients with infected pancreatic affection in an acute necrotic pancreatitis permits to recommend its wide application in surgical practice.

[Intraoperative possibilities of reduction of postoperative complications frequency in pancreaticoduodenal resection on its reconstructive stage].

Experience of pancreaticoduodenal resection (PDR) performance in 81 patients in 2007-2008 yrs was summarized. There were studied up the risk of postoperative gastrostasis occurrence and factors, promoting such a risk lowering. In 24 patients (the main group) gastro- and duodenoenteroanastomosis were formatted in antecolic position, while in 57 (the control group) the gut continuity was restored according to standard method. Postoperative gastrostasis in a control group had occurred in 10 (17.5%) patients, while in the main group this complication was absent. Formation of gastro- and duodenoenteroanastomoses in antecolic fashion and absence of early postoperative complications are considered the factors, trustworthy influencing the risk of postoperative gastrostasis occurring. Application of a pylorus--preserving procedure of PDR had not promoted the risk of raising of postoperative gastrostasis occurrence.

[Application of preparations--analogues of somatostatin in surgical pancreatology].

The experience of application of shortly acting and durably acting preparations--analogues of somatostatin in complex therapy of various pancreatic diseases was summarized. There was established similar efficacy of the preparations in blockade of the pancreatic external secretion and the various duration of their inhibiting influence on the blood flow. The trustworthy differences in the complications frequency and lethality while application of various preparations--analogues of somatostatin were not revealed.

[Lumbotomic videocontrolled sanation of retroperitoneal space in patients, suffering an acute necrotizing pancreatitis].

During 2007-2008 yrs 55 patients, suffering an acute necrotic pancreatitits, were followed up. In the main group 7 patients were included, in the complex treatment of whom the lumbotomy transcutaneous sanation of necrotic foci, using nephroscope, was done. In patients of a control group the conventional operative interventions were performed. In the main group in one patient relaparotomy was performed, all the patients are alive. In a control group in 7 patients relaparotomy was performed, 5 patients died. The results of investigation performed had permitted to recommend the method of the lumbotomy transcutaneous retroperitoneal necrsequestrectomy, using nephroscope, for practical application in the staged treatment of patients, suffering infected pancreonecrosis.

[Intraductal papillary-mucinous tumors as a variant of cystic pancreatic tumors. The problems of diagnosis and surgical treatment].

Retro- and prospective investigation of the diagnosis and treatment results of 6 patients, suffering intraductal papillary-mucinous neoplasms (IPMN), was conducted. In 2 patients the central type malignant IPMN were diagnosed, in 1 - the central type of IPMN without malignization signs, in 2 - the IPMN of lateral type without malignization signs, in 1 - the multiple malignized IPMN of lateral type. The magnet resonance cholangiopancreatography, permitted to determine the pancreatic ductal system tumoral involvement, had constituted the main method of instrumental diagnosis. Radical operation was performed in 4 patients (in 3 - pancreatoduodenal resection, in 1 - subtotal distal pancreatic resection), in 2 - palliative operations. Follow-up in radically operated patients in terms from 6 to 21 months showed no recurrence of the disease.

[Application of ozone therapy in complex treatment of patients with acute necrotizing pancreatitis].

Examination and treatment of 32 patients was done, in whom an acute necrotic pancreatitis was diagnosed. In 16 patients (the main group) ozonotherapy, according to scheme, elaborated in the clinic, was added to conventional treatment. The ozonotherapy application had permitted to reduce the rate of performance of "open" operative interventions. The cellular, humoral and local immunity improvement and biochemical indices normalization were noted. The stationary treatment duration was 21.4 days at average in the main group and 34.5 -- in a control one. The relaparotomy performance rate in the main group was lesser than in a control one.

[Preoperative biliary decompression in patients with malignant tumor of duodenal major papilla].

Experience of surgical treatment of 241 patients with malignant tumor of duodenal major papilla in 1992-2005 yrs was analyzed. In 95 patients the treatment was conducted in two stages, the first of which have had included biliary decompression. There were analyzed 18 potential risk factors for postoperative complications occurrence. Preoperative biliary decompression conduction have had constituted one of the risk factors for postoperative complications occurrence. There were proposed strict recommendations concerning preoperative biliary decompression conduction in patients with malignant tumor of duodenal major papilla.

[Effect of cerulloplasmin on natural factors of defense in patients with an acute necrotic pancreatitis].

In 81.25% patients with an acute necrotic pancreatitis and in 50% of healthy persons the blood neutrophils are sensitive to cerulloplasmin in metabolic activity. In 62.5% of patients the phagocytic index have had reduced in addition of cerulloplasmin. Phagocytic number in addition of cerulloplasmin have constituted over 1,5 conditional units, in 75% of patients, without such addition - in 84%. The conclusion was made about necessity of individual selection of immunomodulators in patients with an acute necrotic pancreatitis.

[Main principles of antibiotic prophylaxis and antibacterial therapy in abdominal surgery].

The principles of antibioticoprophylaxis and antibacterial therapy in abdominal surgery were expounded. There are adduced the most frequently revealed pathogenic microorganisms, inducing intraabdominal infection, the ways of lowering of the antibacterial therapy expenses, new approaches to application of immunocorrection and directed transport of antibiotics in surgery as well as empirical and etiotropic treatment, basing on the taking account of the spread and antibioticosensitivity of pathogenic microorganisms of nosocomial infections. There was shown, that concentration of interleucin-1beta and tumor necrosis factor-alpha in the blood serum is connected with the severity of patient state. Significant rising of this cytokines concentration constitutes the trustworthy criterion of the ineffective therapy and mortality risk. The influence of microorganisms and some antibiotics on induction of interferons was studied. Amoxicyllin, polymixin, vancomycin, cephalosporins and fluconazol are the most active inductors of gamma-interferon. Maximal efficacy of antibacterial therapy is possible only if an adequate surgical intervention was performed.

[An acute necrotic pancreatitis as a complication of cystic pancreatic tumor].

The peculiarities of the cystic pancreatic tumor morphogenesis were studied up. Possibility and probability of the anastomosis existence between mucinous cystic tumor and pancreatic duct with its secondary mucinous dilatation were confirmed, causing the complications occurrence, an acute pancreatitis in particular. Selecting the surgical tactic in mucinous cystic tumor it is necessary to take into account the probability of the intraductal malignization foci formation, what precludes application of extended pancreatic resection using adjuvant chemotherapy and the postoperative serological control conduction.

[The application efficacy of immunomodulators in complex of treatment of an acute necrotic pancreatitis]. / Efektyvnist' zastosuvannia imunomoduliatoriv v kompleksi likuvannia hostroho nekrotychnoho pankreatytu.

Analysis of efficacy of the immunomodulators application, thymalin in particular, in complex treatment algorhythm in 18 patients with an acute necrotic pancreatitis was conducted. Efficacy of immunocorrecting therapy in the immune state improvement, purulent-septic complications prophylaxis, the abortive course of the disease promotion was established In 12 (66.7) patients the disease regression was noted, in 2 (11.1%)--the inflammatory process delineation with pancreatic pseudocyst formation was observed, 4 (22.2%) patients were operated on. All the patients survived.

[Modern strategies in surgical treatment of acute necrotic pancreatitis]. / Suchasna taktyka khirurhichnoho likuvannia hostroho nekrotychnoho pankreatytu.

The experience of surgical treatment of acute necrotic pancreatitis (ANP) in 172 patients in 1997-2002 were summarized. We started therapy from conservative treatment. In 43 (25%) patients with ANP video laparoscopic intervention in enzyme-toxic period were performed. In 32 of them we avoided laparotomy. Percutaneous intervention under the control of ultrasound imaging was conducted in 130 (75.6%) patients. This procedure was final in 81 patients, 58 (33.7%)--underwent laparotomy, in 42 of them concerning ANP. Postoperative mortality was 11.1%. Individual approach, strict following the tactics chosen, wide use of miniinvasive techniques in deferred period when necessary, laparotomy ensures significant progress in the treatment of ANP.