[Rate of biliary ducts' decompression by the tumorous obstructive jaundice].

Results of biliary decompression were analyzed in 185 patients with malignant obstructive jaundice. Among them 85 patients underwent nasobiliary drainage, 37 - percutaneous transhepatic bile drainage and 63 - cholecystectomy. Dynamics in biochemical indices of blood serum, cholangiomanometry and jaundice response to decompression according to T. Shimizu et K.Yoshida's formula in our modification were evaluated for estimation of bile flow rate. It is ascertained that application of nasobiliary drainage leads to low-rate decompression, percutaneous transhepatic bile drainage and cholecystectomy - to high-rate decompression. Low-rate decompression enables to decrease significantly the frequency of "fast decompression syndrome" and complications, particularly augmenting of liver dysfunction, multiple organ failure and lethality in post-decompression period related to them.

[Postoperative biliary complications after liver resections].

Postoperative biliary complications (BC) after liver resections carried out from 1990 to 2009 were analyzed in 216 patients. Among them - 139 women and 77 men aged 15-79 years (mean age 49,8±0,9 years). Complications in early postoperative period were observed in 110 patients (50,9%); among them BC - in 27 patients (12,2%), bilomas - in 6, external biliation - in 14, abscesses - in 7. Lethal outcomes were not observed. Average duration of hospital stay amounted 41,3±12 days. Relationship between frequency of BC and age, malignancy of neoplasm and extent of liver resection was estimated. All patients were cured using low invasive techniques. Recurrent operations were not carried out.

[The role of biliary decompression and correction of dysbiosis in the treatment of obstructive jaundice].

The article providing in-depth analysis of pathogenesis of obstructive jaundice shows that this disease is manifest not only as changes at the hepatic level (cholestasis, cholehemia, cholangitis, cholangio- and lymphovenous shunts, hepatic encephalopathy) but also as marked dysbiotic disturbances due to anacholia and toxic metabolites that cause bacterial translocation and endotoxemia complicating liver insufficiency. Based on the literary data and original observations, a new scheme for the treatment of obstructive jaundice is proposed including simultaneous correction of both components of hepatoenteric turnover, also, it permits to improve the outcome of the postoperative period.

[Endoscopic peroral pancreatico-cholangioscopy in the diagnosis of diseases of bile ducts and the pancreas]. / Endoskopicheskaia peroral'naia pankreatikokholangioskopiia v diagnostike zabolevanii zhelchnykh protokov i podzheludochnoi zhelezy.

Till nowadays the diagnosis of biliary and pancreatic ducts disorders remains to be rather difficult. Cholangioscopy is the only method, that gives an opportunity of visual evaluation of the ducts. The results of 234 retrograde peroral pancreatico-cholangioscopies (RPCS) in 149 patients are analysed. 2 systems of the "Olympus" endoscopes, including both "mother" and "daughter" apparatus with uncontrolled (model PF-24, external diameter 2.4 mm) and controlled distal tip (model CHF B 20, external diameter 4.5 mm) were used for the tests. Endoscopic papillosphincterotomy has been performed in 87 of the patients, who were later on tested with RPCS (147 tests). 38 RPCS have been performed in 29 patients after transduodenal papillosphincterotomy. 47 cholangioscopic procedures have been undertaken in 31 patients after various types of biliodigestive anastomoses. In 2 cases RPCS has been performed after the balloon dilatation of the major duodenal papilla. The signs of catarrhal cholangitis have been observed in 27% of the cases. Purulent cholangitis was present in 13.4% of the patients. Cholangitis was detected in 19.5% of the cases in long-term follow up after endoscopic papillosphincterotomy; in 88.2% of such cases catarrhal inflammation of duct's mucosa was observed. It is stated that after endoscopic surgery cholangitis is observed 2.5 times less frequently, than after relevant transduodenal procedure.

[Results of various treatment modalities in the calculous cholecystitis]. / Rezultaty primeneniia razlichnykh metodov lecheniia kalkulëznogo kholetsistita.

Two alternative methods for the treatment of calculous cholecystitis are evaluated: extracorporeal lithotripsy was performed in 284 patients, laparoscopic cholecystectomy--in 130 patients. Even in strict selection of patients, lithotripsy was ineffective in 32 of them and they were subjected to an operation; in another group of patients elimination of the fragments from the gallbladder was incomplete. Therefore, extracorporeal lithotripsy may be used in no more than 10% of patients with cholelithiasis. Laparoscopic cholecystectomy was conducted in 130 patients. In 6 (4.5%) of them the operation had to be completed by laparotomy because complications occurred during the laparoscopic intervention. Laparoscopic cholecystectomy has some obvious advantages over open cholecystectomy: easier postoperative period, early activation of the patients, a good cosmetic effect. However, to determine the boundaries and possibilities of this method accumulation of experience is needed.

[Extracorporeal ultrasonic lithotripsy of biliary calculi]. / Ekstrakorporal'naia ul'trazvukovaia litotripsiia zhelchnykh kamnei.

The article analyses the efficacy of extracorporeal lithotripsy by a LT-01 piezoelectric lithotriptor (EDAP, France). A total of 72 lithotripsy sessions were performed on 37 patients, in 2 of them who suffered from chronic calculous cholecystitis the procedure was conducted on the day before the operation. As a method for treatment, extracorporeal lithotripsy was applied in 35 patients for the following indications: solitary and multiple stones measuring in sum no more than 3 cm in the satisfactory functioning of the gallbladder and patency of the bile ducts. In 35 patients the stones were crushed to fragments of various size. In 29 patients extracorporeal lithotripsy produced a marked effect and was the final method of treatment. Six patients were operated on (cholecystectomy) due to exacerbation of chronic cholecystitis in 4 patients, pancreatitis in one patient; total destruction of calcinated large stone fragments could not be achieved after 6 sessions in one patient.

[Ultrasonic endoscopic examination in pancreatic diseases]. / Ul'trazvukovoe éndoskopicheskoe issledovanie pri zabolevaniiakh podzheludochnoi zhelezy.

Under analysis were 76 patients with diseases of the pancreas. The data of the ultrasonic endoscopic method were compared with operative findings in 49 patients and with the final clinical diagnosis in 27 non-operated patients. The correctness of the method in the group of operated patients was 80%, in non-operated patients 96.3%.

[Surgical treatment procedures in patients with external and internal hepatobiliary fistulae]. / Taktika khirurgicheskogo lecheniia bol'nykh s naruzhnymi i vnutrennimi pechenochno-zhelchnymi svishchami.

Within a period of from 1967 to 1987, the authors treated 389 patients with injuries and diseases of the liver, bile ducts, adjacent organs, which were complicated by long-existing external and internal fistulas of the bile ducts, or intrahepatic cavities.

[Fiber duodenoscopy and endoscopic retrograde pancreaticocholangiography in assessing the results of pancreatic resection and pancreatojejunostomy in chronic pancreatitis]. / Fibroduodenoskopiia i éndoskopicheskaia retrogradnaia pankreatikokholangiografiia v otsenke rezul'tatov rezektsii podzheludochnoi zhelezy i pankreatoeiunostomii pri khronicheskom pankreatite.

The endoscopic methods including retrograde pancreaticocholangiography were used for examining 78 patients, 14 of them were subjected to resection of the pancreas and 14 to pancreatojejunostomy. Gastroduodenitis was diagnosed in all the patients after resection of the pancreas, in 3 patients repeated surgical interventions (pancreatojejunostomy) were necessary. The examination of patients with pancreatojejunal anastomos has shown that scarring is more frequently found in terminolateral anastomoses while longitudinal pancreatojejunostomy is followed by good patency of the anastomosis.

[Endoscopic papillosphincterotomy in the treatment of choledocholithiasis]. / Endoskopicheskaia papillosfinkterotomiia pri lechenii kholedokholitiaza.

The article analyzes an experience with endoscopic papillosphincterotomy in 45 patients with recurrent or residual choledocholithiasis with/without stenosis of the major duodenal papilla. In 38 pathients stones were removed after endoscopic papillosphincterotomy or were eliminated spontaneously. In later terms none of the patients showed restenosis of the major duodenal papilla. Thus, endoscopic papillosphincterotomy is considered to be an effective method of treatment of choledocholithiasis.