[Sucking effect of diaphragm and its significance in drainage of abdominal cavity during hepatic surgery]. / Prisasyvaiushchii éffekt diafragmy i ego znachenie pri drenirovanii briushnoi polosti pri operatsiiakh na pecheni.

Investigation of the value of the sucking effect of the diaphragm in 44 patients was carried out. The first group consisted of 28 patients who have not undergone hepatic resection. The second group included patients after hepatic resections of various volume in local pathology. The balloon method in modification of this clinic was used for measurement of the value of the sucking effect. In patients of the first group the value of sucking effect was almost two times more under the right cupula of the diaphragm (130.33 + 4.78 mm of water column) in comparison with the left infradiaphragmatic space. It is responsible for presence of the slot between the right half of the liver and the diaphragm, which aggravates the sucking effect. In the second group of patients the value of the sucking effect under the right diaphragmatic cupula was practically the same as in patients of the first group. After right-sided hemihepatectomy the value of the sucking effect under right cupula of the diaphragm has significantly diminished. After resection of the right lobe of the liver as well as after left-sided hemihepatectomy, or without them, the value of sucking effect under left cupula of the diaphragm did not significantly differ. The investigations showed that vacuum-aspiration with vacuum of not less than 150 mm water column should be used for effective drainage of infradiaphragmatic space.

[The effect of immune system disorders on the incidence of inflammatory complications in surgeries on the liver]. / Vliianie narushenii immuniteta na chastotu gnoinykh oslozhnenii u bol'nykh pri operatsiiakh na pecheni.

Inflammatory complications in the abdominal cavity are the most frequent complications after operations on the liver. Immunological studies were conducted in 71 patients with local lesions of the liver who had undergone various surgical interventions. Cellular and humoral immunity factors were studied. The absolute and percentage content of T- and B-lymphocytes and the level of the main three classes of immunoglobulins-A, M and G were determined. The authors noted a definite correlation between the degree of disturbance of the immune system and preoperative complications, preoperative complications of the principal disease (purulent complications--suppuration of the cavity of disintegration of the alveococcus, abscesses of the liver), functional condition of the liver, and postoperative purulent complications. The treatment of inflammatory complications in the postoperative period (suppuration of residual cavities after resection of the liver and echinococcotomy, subdiaphragmatic and subhepatic abscesses) was more effective in patients with mild changes in immunological parameters.

[Drainage of the abdominal cavity after resection of the liver because of tumors]. / Drenirovanie briushnoi polosti posle rezektsii pecheni po povodu opukholi.

After resection of the liver for benign and malignant tumours, 20 (44.4%) of the 45 patients developed purulent complications in the abdominal cavity. In most of them, ineffective drainage of the abdominal cavity was the main cause of such complications. For effective drainage of the abdominal cavity with active aspiration, a plait-like drain consisting of 4-5 tubes was suggested. The drain was used in 5 patients, no purulent complications occurred.

[Treatment of abscesses of the upper abdominal cavity after surgery on the liver]. / Lechenie abstsessov verkhnego étazha briushnoi polosti posle operatsii na pecheni.

Complications after 454 various operations on the liver are analysed. Abscesses of the upper part of the abdominal cavity (subdiaphragmatic and subhepatic abscesses, suppuration of residual cavities after resection of the liver and echinococcotomy) developed in 18.5% of patients in the postoperative period. Inadequate drainage of the abdominal cavity was among the main causes of such complications. The authors suggest an original method for drainage of the abdominal cavity after operations on the liver. With its use the number of these complications was three times less. It was found that in 40.5% of cases abscesses of the upper abdominal cavity may be cured by nonoperative measures, by puncture of the purulent cavity under control of ultrasonic examination and introduction of drains for subsequent aspiration. A surgical intervention is still the main method for the treatment of abscesses of the upper abdominal cavity. The success of the operation is determined to a great measure by effective drainage. A drainage method is suggested which allowed the time needed for the treatment in cases with such complications to be reduced almost by half.

[Bacteriological study of the wounds during drainage of the abdominal cavity after operations on the liver and pancreas]. / Bakteriologicheskoe issledovanie ran pri drenirovanii briushnoi polosti posle operatsii na pecheni i podzheludochnoi zheleze.

Results of bacteriological studies have shown that the secondary infection of wounds and the abdominal cavity in patients comes through the glove-gauze tampon in 76.9% of cases. The pathogenic microflora comes into the wound and the abdominal cavity by the tampon from the skin under the aseptic adhesive. It occurs much more rarely (7.15% of cases--p < 0.001) if tube drains and active aspiration are used for drainage at the postoperative period. This method of drainage of the abdominal cavity is followed by 3 times less amount of complications than when using the glove-gauze tampons. Tampons should be used for drainage of the abdominal cavity but when hemostasis is not thorough for certain and when it is necessary to delimit the pyo-inflammatory process from the free abdominal cavity.

[Device for abdominal drainage]. / Ustroistvo dlia drenirovaniia briushnoi polosti.

A device for draining the abdominal cavity is suggested consisting of a system of 4-5 tubes with openings in the sides. The tubes of the system are joined to form a loosely coiled braid with a large coil pitch, while the axes of the side openings in the tubes are arranged on the helicoidal line with a pitch differing from that of the braid. This design of the device makes it possible to avoid obstruction of the side openings of the drain by the mobile organs and tissues of the abdominal cavity, which considerably raises the efficacy of draining in vacuum aspiration. The device is simple in design and may be easily constructed using 4-5 ordinary drainage tubes. The device was used successfully in 6 patients for abdominal drainage after resection of the liver for focal lesions.

[The role of determining the level of middle molecules in patients in the diagnosis and treatment of suppurative-inflammatory complications after operations on the liver and pancreas]. / Rol' opredeleniia urovnia molekul srednei massy u bol'nykh v diagnostike i lechenii gnoino-vospalitel'nykh oslozhnenii posle operatsii na pecheni i podzheludochnoi zheleze.

Investigations of the level of medium-mass molecules were performed in blood plasma of 52 patients in dynamics after different operations on the liver and pancreas. Significant elevation of the level of medium-mass molecules was noted in patients with pyo-inflammatory complications. The inverse relationship between the level of medium-mass molecules and the prognostic coefficient value (the ratio of the general plasma protein to the general protein of wound discharge) was revealed. The indicators of the prognostic coefficient value decreased when the level of the medium-size molecules elevated against the background of purulent complications. These data allowed to estimate the severity of purulent complications and degree of intoxication which helped to determine the correct method of treatment of patients and to timely detect pyo-inflammatory complications.

[Effectiveness of drainage of the abdominal cavity after surgery of the liver and pancreas]. / Kontrol' éffektivnosti drenirovaniia briushnoi polosti posle operatsii pecheni i podzheludochnoi zheleze.

With the aim to control the effectiveness of drainage of the abdominal cavity after operations on the liver and pancreas in 28 patients, a value of the prognostic coefficient (PC) of the course of wound process (ratio of total protein level in the blood plasma of the patients to its content in wound discharge), content of middle molecular mass peptides in the blood, pH were measured in dynamics, qualitative reaction to gamma-globulins of the wound discharge was performed. The study of these indices in combination with clinical data permits to judge more fully about the effectiveness of the abdominal cavity drainage, to prognosticate purulent complications and to take in time measures for their prevention.