[Analysis of the short and long-term results of traditional duodenum-saving resections of the pancreas head and the original resection-draining method of treatment of chronic pancreatitis]. / Analiz blizhaishikh i otdalennykh rezul'tatov traditsionnykh duodenumsokhranyayushchikh rezektsii golovki podzheludochnoi zhelezy i original'noi rezektsionno-dreniruyushchei metodiki pri khronicheskom pankreatite.

AIM: Compare the short and long-term results of traditional duodenum-saving resections of the pancreas head and the original resection-draining method of the surgery of chronic pancreatitis. MATERIALS AND METHODS: There has been the analysis of the immediate and long-term results of various types of duodenum-saving operations in 48 patients with chronic pancreatitis since 2011 to 2020. The patients were divided into two groups: the control group (n=26) where typical duodenum-saving operations were performed, and the study group (n=22) - the original resection-draining method of surgery. RESULTS: The groups had no difference in gender, age, clinical manifestations. After typical duodenum-saving operations, the number of postoperative complications was higher than after original resection-draining method (31 [14; 52]% and 23 [8; 45]% respectively). In the control group the incidence of pancreatic fistula 19% [7; 39], hemorrhagic complications 12% [2; 30] was higher. In both groups, one patient died in the early postoperative period. However, these differences were statistically insignificant. 12 (52% [31; 73]; p<0.001) patients have died in the control group for the 9-year observation period, mainly (7 cases) as a result of the progression of chronic pancreatitis against the background of alcoholism. The groups had no difference in the level of pain reduction, development of dyspeptic syndrome and diabetes mellitus. CONCLUSIONS: The proposed original technique of subtotal resection of the head, ventral part of the body and tail of the pancreas with longitudinal pancreatojejunoanastomosis made it possible to improve the short-term results and reduce the incidence of pancreatic fistula formation. Taking into account the level of compliance the selection of patients permitted to achieve a better quality of life according to the results of the SF - 36 questionnaire and to reduce the lethality to 5 [0; 25]% (p<0.001) in the long-term period. Statistically significant difference was obtained for three of the five criteria, the total value of the physical (PCS, p=0.033) and mental (MCS, p=0.032) health components.

[Morphofunctional Changes of Spleen After Hemostasis by Nonequilibrium Plasma].

BACKGROUND: Heavy bleeding is developed in case of spleen injury. It often leads to death. At present the search and development of new methods for hemostasis of spleen bleeding continues. An innovative method is coagulation of nonequilibrium plasma. OBJECTIVE: Our aim was to study the effect of nonequilibrium plasma on the morphofunctional state of the spleen. METHODS: The non-randomized study by type of "case-control" was conducted. The experiment was carried out on 45 male rabbits weighing 3000-3200 g. 1st group (control; n = 5)--intact animals without surgery; 2nd group (experimental, n = 40)--animals after atypical resection of the spleen and hemostasis by nonequilibrium plasma. The volume of blood loss, FBC, histological data, splenogram analysis data were assessed at defined periods (60 min, 3rd, 5th, 7th, 14th, 30th, 90th, 180th days) after surgery. They were compared with data of the control group. RESULTS: The volume of blood loss during the resection of the spleen with hemostasis by nonequilibrium plasma was 16.6 [15.98; 17.22] ml. Increase of neutrophil to 38 [24; 39] (control group 17[13, 18], p = 0.009), monocytes to 15 [14, 18] (control group 8 [6, 11], p = 0.036) is revealed in the FBC in the early period after hemostasis with nonequilibrium plasma. It is reduced to the norm on 30 day. Histological examination revealed leukocyte infiltration, edema, microvascular stasis, dilatation of vessels in the early period. At long-term period structure of the organ is normalized. Splenogramm analysis revealed a statistically significant (p = 0.023) decrease in the relative number of small lymphocytes by 28% in animals after hemostasis with nonequilibrium plasma as compared to control (23.3 [179; 26.7] versus 30.8 [29.25; 34.3] respectively). CONCLUSION: treatment of bleeding surface by plasma flow for 1.5-2 min is required order to achieve effective hemostasis during surgery of spleen injuries in the experiment. After coagulation there is minimal damage of the spleen parenchyma, which manifests itself as activation reaction. At long-term period parenchyma ofthe spleen completely regenerates with theformation of cicatrical tissue that does not affect thefunctioning of organ.