[Living related liver transplantation in the Republic of Uzbekistan: current status and development prospects]. / Rodstvennaya transplantatsiya pecheni v Respublike Uzbekistan: nyneshnee sostoyanie i perspektivy razvitiya.

OBJECTIVE: To analyze primary results of living related liver transplantation in the Republic of Uzbekistan. MATERIAL AND METHODS: There were 44 living related transplantations of the right liver lobe in patients with decompensated liver failure between February 2018 and February 2023. RESULTS: Uneventful postoperative period was observed in 17 (38.6%) recipients. Other 27 patients (61.4%) developed 47 various postoperative complications (1-3 events per a patient). Of these, 8 (18.2%) patients required early postoperative re-laparotomy. Among 44 patients, 9 (20.5%) ones died in early postoperative period, and one patient died in long-term period (3 years after transplantation) from chronic rejection under refusal to take immunosuppressive drugs. Early satisfactory results were obtained in 79.5% of patients, long-term favorable outcomes - in 77.3% of cases. CONCLUSION: Engraftment rates and survival of recipients to a large extent depend on surgical strategy, baseline disease and clinical severity. The so-called "center effect" is essential at initial stages of implementation of the program.

[Specific development and course of portal hypertension complication in patients with hepatic cirrhosis of HBV and HCV etiology].

During 1976-2007 in the Republican Specialized Center of Surgery named after acad. Vakhidov various types of portosystemic shunting were performed in 669 patients with portal hypertension. The aim was to estimate the influence of HBV- and HCV-cirrhosis on the formation of portal hypertension and the results of portosystenic shunting. An analysis of 115 liver cirrhosis patients with portal hypertension was made to find out which of them had variceal bleeding and high risk of its development. Such operations were performed in all these patients by the period of 2004-2007 years. Various types of portosystemic shunting were performed in all cases. The analysis has shown that unlike HCV-cirrhoses, HBV cirrhoses are characterized by more progressive course with a short period of a compensation pause in relation to progression of hepatocellular insufficiency, but a less pronounced risk of hemorrhagic complications.

[An improved method of bronchial stump plasty after pneumonectomy].

66 patients were pneumonectomized and a new method of bronchial stump plasty was used. The stump was forced with the help of an omental flap in 31 patients, pericardial flap was used in 35 cases. The use of omental flap provides no technical difficulties and helps to avoid negative consequences of pneumonectomy. Bronchial stump failure was twice as lower after omentoplasty, rather then after pericardioplasty (6.5%).

[Diagnostics and surgical treatment of tumors of proximal extrahepatic biliary ducts].

147 patients with tumors of proximal extrahepatic biliary ducts were treated. By 118 patients only palliative surgery was possible. Tumor recanalisation and external biliary drainage was performed on 77 patients; 41 patients received transcutaneous transhepatic cholangiostomy as final treatment; endoprosthesis was inserted in 11 patients. Radical and conditionally radical surgical resections were performed in 29 patients: cholecystectomy, common bile duct resection and hepaticojejunostomy was made in 18 patients. The rest 11 had cholecystectomy, liver resection and bi-hepatic jejuno-anastomosis. Postoperative lethality was 10.2%.

[Treatment of esophageal varices bleeding with the use of transformable probes].

Construction of the original transformable esophageal probe is thoroughly described. The innovated construction suggests lesser traumatisation by insertion and spiral expansion, together with secure compression hemostasis. Unlike the traditionally used obturating Blackmore probe, the spiral transformable original construction leaves the esophageal lumen open for further endoscopic hemostatic procedures. The feature provides exclusive advantages of the original construction.

[Surgical treatment of the combined heart, lung and liver hydatid disease].

Results of surgical treatment of 12 patients with the combined hydatid disease of heart and target organs (liver, lungs) are analyzed. Authors recommend echocardiography for all the patients with echinococcosis of target organs as a means of timely heart involvement diagnostics. Simultaneous surgery for the combined hydatid disease is recommended. The use of artificial circulation is reasonable for cardiac echinococcosis (n=66,7%) treatment, whereas pericardial hydatid cysts (n=33,3%) can be operated without such measures. Cyst perforations to the heart cavity should be considered a fatal complication of the disease. Intraoperative lethality achieved 25%.

[The results of porto-systemic shunting in patients with liver cirrhosis].

The research is based on the analysis of 500 patients with liver cirrhosis and complicated portal hypertension, treated during 1976--2005. Survival analysis was performed using the Kaplan-Mayer method. Immediate and long-term results of various modifications of porto-systemic shunting procedure are analyzed for stratificated groups. Thus, the highest mortality (12.5-19.5%) is noted during the first 3 years after operation in all groups. The best survival results showed patients with functional class Ch "A" and no varices bleeding anamnestically, with no regard of method of the shunting procedure, ages of patients and cirrhosis morphological type. The 5-year survival-rate after distal spleno-renal anastomosis and central variants of porto-systemic shunting are 89 and 85%, respectively.

[Operations in injuries and strictures of bile ducts].

Analysis of surgical treatment of 336 patients with cicatricial strictures and iatrogenic external fistulas of extrahepatic bile ducts is presented. The causes of these complications were intrasurgical injuries during cholecystectomy (n=302), resection of the stomach (n=21) and echinococcectomy (n=13). In all the cases correction of water-electrolytic balance, treatment and prophylaxis of hepatic and renal insufficiency, control of anaerobic infection were carried out before and after surgery. Restorative operations were performed in 31 (9.2%) patients, reconstructive surgeries -- in 305 (90.7%). Recurrence of the stricture required surgical intervention in 38 (11,3%) patients. Various postoperative complications were diagnosed in 119 (35.4%) patients, 26 (7.7%) patients died. The main causes of death were insufficiency of anastomotic sutures, intoxication, hepatic and renal insufficiency due to purulent cholangitis and cholangiolytic abscesses of the liver.

[X-ray diagnostic parallels in estimation of the degree of portohepatic circulation reduction in patients with liver cirrhosis].

The data obtained in a retrospective analysis, angiographic and hepatoscintigraphic examinations of 86 patients (aged from 12 to 64 years) with liver cirrhosis (LC) treated during the period from 1998 through 2003 were analyzed. Among them there were 64 men and 22 women. The investigations performed have shown that the angiographic data obtained in LC patients determine not only the topographic interaction of the major and collateral vessels of the porto-lienal pool that is of principal significance in the decision for the method of surgical correction in portal hypertension but also allow an estimation of the picture of the hepatopetal blood flow inversion. The data obtained allowed the authors to define three degrees of reduction of the hepatopetal blood flow. A conclusion was made that the degree of reduction of the hepatopetal blood flow when compared was the findings of angiographic and radionuclide examinations were of great prognostic significance for an estimation of the necessary decompression and possible maximal preservation of the hepatopetal blood flow with respect to the preoperative level.

[On the improvement of surgical treatment of destructive pancreatitis]. / Puti uluchsheniia khirurgicheskogo lecheniia destruktivnogo pankreatita.

Results of treatment of destructive pancreatitis during the recent 20 years have been analyzed. Among 189 patients with this disease there were 54.5% of women and 45.5% of men aged from 20 to 80 years. The main principle of the surgical treatment was active ablation of all foci of destruction in the pancreas, abdominal cavity and retroperitoneal fat. "Closed", "open" and "combined" operations were used according to individual indications established by highly informative methods of diagnostics such as ultrasound, CT, retrograde pancreatocholangiography, laparoscopy. Combined use of the operations, flow lavage of bursa omentalis and retroperitoneum, complex therapy using intraarterial laserotherapy have allowed to reduce postoperative complications from 41 to 17% and mortality from 31 to 11.5%.

[Results of drainage operations for the destructive pancreatitis]. / Rezul'taty dreniruiushchikh operatsii po povodu destruktivnogo pankreatita.

Results of treatment of 189 patients with destructive pancreatitis were analyzed. The surgical tactics improvement in 1999-2002 yrs in wide-spreading forms pancreonecrosis had constituted the substantiated active excision of all the pancreatic destruction foci present as well as in retroperitoneal fat and peritoneal cavity, individual performance of "closed", "open" and "combined" operative intervention. Application of the staged programmed sanation interventions have permitted to achieve the postoperative complications frequency occurrence from 41 to 17.9% and mortality from 31 to 11.5%.

[Some pathogenetic aspects of developing liver failure and preventing it in patients with liver cirrhosis after portosystemic shunting]. / Nekotorye patogeneticheskie aspekty razvitiia pechenochnoi nedostatochnosti i ee profilaktika u bol'nykh s tsirrozom pecheni posle portosistemnogo shuntirovaniia.

Patients with cirrhosis of the liver were found to have a considerable suppression of the system of biotransformation of the liver before operation which correlated with the data of the direct indices of monooxigenase system of hepatocytes--cytochrome P-450 and activity of N-demethylase of amidopyrine. Operative interventions on such patients independent of the type of portosystemic shunting result in considerably decreased content of metabolites of amidopyrine--4AAP and N-ac-4-APP in urine as compared with the preoperative level (p < 0.05). Hyperbaric oxygenation is the optimal stimulator of activity of the liver biotransformation system. Better indicators characterizing the increased metabolic activity of the liver were noted in patients with selective portosystemic anastomoses and hyperbaric oxygenation in the postoperative period.

[Diagnosis and surgical treatment of bilateral pulmonary echinococcosis]. / Diagnostika i khirurgicheskoe lechenie dvustoronnego ékhinokokkoza legkikh.

Results of diagnosis and treatment of 205 patients with bilateral pulmonary echinococcosis were analyzed. 141 patients underwent two-sided surgeries: 77--staged operations with interval from 2 weeks to 3 months, 64--one-stage operations on both lungs. One-stage operations through thoracotomies were performed in 49 patients, through medial sternotomy--in 15. Mean hospital stay was 20 bed-days. Long-term results from 6 weeks to 15 years were studied in 60 patients. Stable curative effect was achieved in all the patients.

[Treatment strategy in bleeding from gastroesophageal varicose veins in patients with liver cirrhosis complicated by portal hypertension]. / Taktika lechenii krovotecheniia iz varikoznykh ven gastroézofageal'nogo kollektora u bol'nykh s tsirrozom pecheni, oslozhnennym portal'noi gipertenziei.

The article presents an analysis of results of different operations disuniting the gastroesophageal collector in patients with portal hypertension. Unsatisfactory long-term results of the Pazior operation widely used in CIS are known although this operation meets the requirements of emergency surgery aimed at saving the patient's life. The authors have developed an original method of disuniting the gastroesophageal collector. The method was tested in planned and emergency operations. An analysis of the preliminary results shows good perspectives of this direction.

[The surgical treatment of echinococcosis of the diaphragmatic surface of the liver]. / Khirurgicheskoe lechenie ékhinokokkoza diafragmal'noi poverkhnosti pecheni.

The results of surgical treatment of 628 patients aged 15-76 years operated on for echinococcosis of diaphragmatic surface of the liver have been analysed for period from 1976 to 1996. 333 patients had complicated echinococcosis, 124 combined pathology of other organs. Methods which have been applied for diagnosis of echinococcosis of the liver and its complications are described. Details of surgical treatment of the echinococcosis of the diaphragmatic surface of the liver are elucidated in time course aspects, as a staged treatment, during which various factors were used for antiparasitic treatment of cystic cavity as well as various methods of elimination of the residual cavity. Problems concerning application of laser and plasmatic scalpel during various stages of the operation, as well as low-intensity lasers and low-frequency ultrasound during the operation and in postoperative period are considered. Postoperative complications were detected in 99 (15.8%) patients, lethal outcomes were in 5 (0.8%) cases.

[The combined treatment of cholangitis in patients with intraoperative damage and posttraumatic cicatricial stricture of the extrahepatic bile ducts]. / Kompleksnoe lechenie kholangita u bol'nykh s intraoperatsionnym povrezhdeniem i posttravmaticheskoi rubtsevoi strikturoi vnepechenochnykh zhelchnykh protokov.

The result of treatment of 196 patients with cholangitis, occurred due to intraoperative trauma and posttraumatic cicatricial stricture of extrahepatic biliary ducts (EBD) was analysed. Methods of extracorporeal detoxication-hemosorption (in 53 observations), plasmapheresis (in 32), biohemosorption (in 21) were applied in the complex of treatment. The EBD decompression was conducted using endoscopic diathermocoagulation and bougienage of cicatricial stricture (in 56 patients) with introduction of a hidden drain (in 9) or nasobiliary catheter (in 47). In all the patients reconstructive and restorative operations were conducted. Postoperative complications occurred in 43 (22%) patients, 31 (15.8%) patients died. Stricture recurrence, necessitated reoperation conduction, was noted in 15 (7.6%) patients.