[PROGNOSTICATION OF AN ACUTE POSTRESECTIONAL HEPATIC INSUFFICIENCY].

An acute postresection hepatic insufficiency (PHI) constitutes a necessary moment before the hepatic resection planning, permits in some situations to conduct prophylactic measures and to avoid this severe complication. Possibility of PHI occurrence was prognosticated for results of surgical treatment improvement in patients, suffering focal hepatic affection, using introduction of certain preoperative preparation and surgical tactics. The main task of the investigation was to determine the diagnostic and prognostic value of the investigation methods and elaboration of prognostic algorithm of an acute PHI occurrence.

[DIAGNOSIS OF VASCULAR INVASION BY PANCREATIC TUMORS].

Basing on analysis of own material (84 patients) and data of literature there was established, that vascular invasion by pancreatic tumors constitutes the main obstacle for conduction of the patients' radical treatment. Early diagnosis permits radical resectability of the patients, what constitutes the only one effective method of treatment. In vascular invasion by tumor a surgeon experience and professional preparation determines possibility of the extended operation performance with intervention on affected main vessel, enhancing the treatment radicalism.

[SURGICAL TREATMENT OF FOCAL HEPATIC AFFECTION: ANALYSIS OF THE RESULTS AND PERSPECTIVES].

Basing on own material analysis (386 observations) and the literature date there was established, that hepatic resection occupies the first place in treatment of the organ focal affection, together--nontumoral and a tumoral one. The treatment of all kinds of focal hepatic affection must be expanded in a specialized clinic in the Ukraine. The main task of the investigation was to determine a permissible volume of hepatic resection, depending on functional state of the organ parenchyma, improvement of existing and elaboration of a new methods of operative intervention, directed on the complications prophylaxis and the hepatic function preservation.

[REMOTE RESULTS OF SURGICAL TREATMENT IN PATIENTS, SUFFERING LOCALLY SPREAD FORMS OF MALIGNANT PANCREATIC TUMORS].

Remote results of surgical treatment of patients, suffering locally spread forms of pancreatic malignancies (PM), using different approaches, were analyzed. In retrospective investigation were included 84 patients with PM and invasion of the main vessels. In the group І patients palliative operations were performed, including in a subgroup Іа­ cryoablation of PM, in a subgroup Іb ­ palliative pancreatic resection with leaving the tumor on the main vessels intact; and in patients of group ІІ the tumor was resected radically, including in a sub* group ІІа­pancreatic resection or total pancreatectomy with resection of the main vessels, and in subgroup ІІb ­ pancreatic resection or total pancreatectomy with cryoablation of tumor, which was left on the main vessel. The one­year, three­years and five­years survival indices have constituted in a subgroup Іа, accordingly 74, 17 and 0% (survival median 16 mo); in a subgroup Іb ­ 70, 20 and 0% (survival median 20 mo); in a subgroup ІІа ­ 83, 49 and 21% (survival median 29 mo); in a subgroup ІІb ­ 73, 41 and 18% (survival median 26 mo). Difference between the general survival indices in subgroups Іа and ІІа, Іb and ІІа is statistically significant. Application of aggressive surgical tactics have permitted to improve the general survival indices of the patients.

[POSSIBILITY OF ENHANCING OF THE TRANSPAPILLARY INTERVENTIONS EFFICACY, APPLYING OPTIMIZATION OF THEIR ANESTHESIOLOGICAL SUPPORT].

In 2015 yr еndoscopic transpapillary interventions (ЕТI), performed for diseases of the hepatopancreatoduodenal zone organs, were done in 697 patients. In 315 (45.2%) of them ЕТI were diagnostic, in 382 (54.8%) ­ performed with treatment objective. Меdicinal support for the ЕТI conduction in 631 (90.5%) patients have included conduction of superficial sedation and local anesthesia of pharynx. Аnesthesiological support was applied in 66 (9.5%) patients, including total intravenous anesthesia ­ in 11 (16.6%), еndotracheal narcosis ­ in 55 (83.4%). Using of general anesthesia in comparison to superficial sedation creates more favorable conditions for the ЕТI performance, what have permitted to reduce their duration and complications rate twice.

[COMBINED LAPAROSCOPICALLY AND RETROPERITONEOSCOPICALLY ASSISTED PANCREATONECRSEQUESTRECTOMY].

Combined method of laparoscopically and retroperitoneoscopically assisted necrsequestrectomy, consisting of staged application of miniinvasive methods with simultaneous laparoscopic and retroperitoneoscopic control of necrsequestrectomy, was elaborated with the objective to improve surgical treatment of an acute pancreatitits. The procedure has significant advantages over open operative intervention in purulent complications of necrotic purulent pancreatitis: reduction of the local and systemic operative treatment severity, minimization of microbial metabolites coming into the blood, total visual control of intervention, reduction of the vascular injuries risk, аdequate surgical sanation with saving of viable pancreatic parenchyma, absence of conditions for the purulent complications occurrence while the operative wound healing is going on, preservation of possibility for an adequate draining, using drains of a large diameter.

[Effect of apparatus plasmapheresis on the bowel barrier and motility function in patients with acute necrotizing pancreatitis].

Influence of therapeutic plasmapheresis on bowel barrier function and evacuation was investigated in 83 patients with severe acute necrotizing pancreatitis. Except standard therapy patient obtained therapeutic plasmapheresis using "Haemonetics" PCS 2 system. Complex treatment of patients with acute necrotizing pancreatitis and dynamic ileus using plasmapheresis increases contractive and propulsive function of stomach and duodenum and prolongs period of activity of these organs on 32%. Intestinal barrier function associates with restoration of bowel evacuation. Addition of plasmapheresis to standard therapy of necrotizing pancreatitis can be effective prevention of dynamic ileus.

[Bile composition in patients with chronic pancreatitis].

There was investigated a hepatic bile in 50 persons, aged 35-58 years old, including 20--practically healthy persons (I group), 20 patients, suffering chronic fibrose-degenerative pancreatitis (CHFDP) without jaundice syndrome (II group) and 10 patients, suffering CHFDP with jaundice syndrome (III group). There were determined the contents of the bile acids, the lipids and electrolytic contents of bile. A trustworthy difference in the bile contents was registered in patients, suffering CHFDP with the jaundice syndrome and without it, comparing with such in healthy persons. This have had permitted to add the complex of medicinal preoperative preparation of these patients substantially, and to apply the electrolytes content of a bile to apply as an additional diagnostic marker.

[The method of calculation of maximally admissable mass of adipose-cutaneous flap, excised during abdominoplasty].

The dependence of a hypercoagulation state occurrence from value of the adipose-cutaneous flap mass, excised while performing abdominoplasty, was established, using the logistic regression method, in patients, suffering the anterior abdominal wall cosmetic defects and obesity. The possibility the hypercoagulation state occurrence raises nonlinearly together with such of the excised flap mass (% EFM), it exceeds 50% (high risk of hypercoagulation occurrence), when the EFM value constitutes 5.1% of the body mass.

[Diagnosis and prognosis of hepatic insufficiency in focal hepatic lesions].

The priority of surgical approach for focal hepatic affection is doubtless. Hepatic resection (HR) is the main method, securing notable lengthening of life and sometimes--radical reconvalescence of patients, suffering hepatic tumors. At the same time HR is a very high risk operation in sense of danger of the complications occurrence. The hepatic insufficiency occurrence or exacerbation constitutes one of the dangerous and frequent complications. The problem of an acute hepatic insufficiency is actual, because the necessity exists to perform HR in patients with insufficient postresectional residual parenchyma volume, the lowered regeneration capacity in presence of cirrhosis, chronic hepatitis, dystrophic changes, etc. That's why the only method for prophylaxis of this complication occurrence is its prognosis estimation. The hepatic functional reserve and residual parenchyma volume determination constitute the base of postoperative hepatic insufficiency prognosis.

[Prognosis of the disease severity in patients with acute pancreatitis].

Estimation of the severity state in patient, suffering an acute pancreatitis, while admitting him into a hospital, constitutes a significant part of diagnosis and complex treatment. Application of a highly accurate scales and markers, which are used to prognosticate the disease course severity and to determine the inflammation grade, may influence the results of complex treatment of the patients. In the investigation a high diagnostic accuracy in prognosis of an acute pancreatitis course severity was noted for APACHE II scale (24 hours) and Ranson scale (48 hours). There was established, that determination of a C-reactive protein content has less diagnostic accuracy, but it may be applied as a less complex and more rapid test for prognostication of an acute pancreatitis course severity after admitting the patient to hospital.

[Antiatherogenic effect of abdominoplasty in patients with anterior abdominal wall deformity and obesity].

The impact on a lipids metabolism of a certain volume of fat tissue extraction from organism was investigated. With that objective there was determined the lipids content in a blood serum before and on a 14th day after abdominoplasty. In 73 patients (the main group) surgical interventions were performed on the organs of abdominal cavity, small pelvis and anterior abdominal wall with a simultant abdominoplasty, in 59 patients (a comparison group) abdominoplasty was not performed. The lipids metabolism desorders was observed in both groups of patients. The results of operations, conducted with a simultant extraction of a fat tissue were characteristic for positive dynamics of the lipids spectre in the blood. A normalizing impact on the blood serum lipids was caused by a triglyceride depot volume reduction, which promotes a catabolism processes strengthening in atherogenic lipoproteins and stabilizes a nonesterified fat acids concentration on optimal level. The data obtained witness, that abdominoplasty conduction secures antiatherogenic affect in patients, suffering obesity.

[Impact of abdominoplasty on quality of life in patients, suffering anterior abdominal wall deformity and obesity].

The modern tendencies of surgery development include not only the operative procedures improvement but guaranteeing also a maximally high level achievement in the patients quality of life in the early, as well as during remote, postoperative period. The quality of life analysis was done in 132 patients, operated on for the anterior abdominal wall defects, obesity and other surgical diseases, using special questionnaire SF-36. The patients have aged 23-65 years old, in all of them the excessive body mass or obesity of abdominal type was noted.

[Changes of micellarity and lithogenicity of bile under conditions of transcutaneous electrostimulation and enterosorption in patients with obturation jaundice of nontumoral genesis].

The conduction of pathogenetically substantiated treatment--enterosorption together with procedures of electrostimulation--in patients, suffering obturation jaundice of nontumoral genesis, secures favorable course of postoperative period, the hepatorenal insufficiency prophylaxis, and postcholecystectomy syndrome occurrence as well.

[Hemocoagulation disorders in patients with acute pancreatitis].

62 patients with acute pancreatitis (AP) were examined in order to determine hemocoagulation disorders. The obtained results showed that the patients developed the consumptive coagulopathy with high levels of D-dimer, activation and exhaustion of antithrombin III (AT III). The development of hemocoagulation disturbances in patients with severe AP was confirmed through decrease of activity of AT III up to 68% and high level of D-dimer>693 ng/ml.