[Suprapyloric resection of stomach in patients with ulcer disease]. / Nadprivratnikovaia rezektsiia zheludka u bol'nykh iazvennoi bolezn'iu.

Suprapyloric transversal resection of the stomach is one of relatively sparing methods of surgical treatment for ulcerative disease. In Medical Centre of "VAZ", suprapyloric resection of the stomach was carried out as a method of treatment of gastric ulcer in 181 patients (study group) and 139 patients underwent resection 2/3 of the stomach by Billroth-1 (control group). The ulcer located in cardial and mediogastric regions (1 type by Johnson). Among the patients of study group postoperative lethality made up 1.1%. Follow-up results of operative treatment was quite favourable in 96.3% of cases and unsatisfactory--in 3.7% (persistent pylorospasm). In control group follow-up results of surgical treatment in 86.4% were appraised as excellent and good, in 13.6%--satisfactory due to postoperative development of damping-syndrome. Comparison of results of follow-up examination in two groups of operated patients has evidenced of the best functional results after performance of suprapyloric resection of the stomach.

[Results of organ-preserving operations in gastric ulcer]. / Rezultaty organosokhraniaiushchikh operatsii pri iazvennoi bolezni zheludka.

The authors analysed the immediate and late results of selective proximal or truncal vagotomy with excision of the ulcer from the gastric lumen or wedge resection of the stomach in patients with various localization of the gastric ulcers. The best results were produced (Visick I-II) in patients after selective proximal vagotomy with excision of the ulcer from the gastric lumen (in 93%), the results were poorer in selective proximal vagotomy with wedge resection of the stomach and in truncal vagotomy with excision of the ulcer or wedge resection of the stomach (only in 20%, 38%, and 30% of patients, respectively). The results were unsatisfactory (Visick IV) mainly after vagotomy with wedge resection of the stomach due to recurrences and postvagotomy functional disorders. The authors claim only limited use of organ-preserving operations to be admissible.

[Diagnosis, prevention and treatment of postoperative reflux gastritis]. / Diagnostika, profilaktika i lechenie posleoperatsionnogo refliuks-gastrita.

Postoperative reflux gastritis in persons who were operated on for peptic ulcer occurs much more frequently after resection of the stomach (68.6%) than after organ-preserving operations on the stomach (39.4%). The incidence of reflux gastritis after gastric resection depends on the type of gastroenteroanastomosis. It is encountered much less frequently after Roux' operation (9.2%). The pronounced character and frequency of reflux gastritis after organ-preserving operations on the stomach are determined by the type of stomach-draining operations, the localization of the ulcer before the operation, whether in the stomach or the duodenum, the existence of duodenogastric reflux (DGR) before the operation. Measures for the prevention of postoperative reflux gastritis in the management of peptic ulcer are as follows: (a) wide introduction of organ-preserving operations, preferably SPV by itself or in combination with duodenoplasty; (b) formation of Roux' gastroenteroanastomosis when resection of the stomach is indicated. Reflux gastritis must be treated by nonoperative methods, including medicinal, dietetic, and spa therapy. Surgery is indicated in reflux gastritis combined with other diseases of a stomach which had been operated on, for which an operation is necessary, and in occasional cases of erosive reflux gastritis.

[Clinico-morphologic features of giant stomach ulcers]. / Kliniko-morfologicheskie osobennosti gigantskikh iazv zheludka.

74 patients with GSU are studied. These ulcers occur more frequently than ordinary ulcers in aged persons against the background of various diseases. "True" GSU are localized mainly in the proximal regions. GSU combined with duodenal ulcers have a course with grave complications requiring urgent surgery. GSU located in the central parts are characterized by chronic ulcer symptoms, and those located at the periphery by the symptoms of acute ulcers (centrifugal progression). Confluence of adjacent ulcers occurs at the centripetal progression. Epithelization is lacking at the edges of the majority of GSU this indicating the predominance of the destructive processes.

[Mucous membrane of the gastric antrum in late periods after selective proximal vagotomy with surgical drainage of the stomach and duodenum]. / Slizistaia obolochka antral'nogo otdela zheludka v otdalennye sroki posle selektivnoi proksimal'noi vagotomii s dreniruiushchimi zheludok i dvenadtsatiperstnuiu kishku operatsiiami.

A clinicomorphological analysis was performed of the gastric antrum mucous membrane of 60 patients after selective proximal vagotomy because of stenosing duodenal ulcer. The patients were subdivided into two randomized groups depending on the type of the draining operation. The first group had a gastroduodenoanastomosis for the gastric drainage and the second group underwent duodenum plasty (drainage of the duodenum). Discontinuation of the pylorus function in the gastric drainage operation resulted in higher incidence and intensity of duodenum-gastric reflux and made more severe antrum gastritis; reflux-gastritis developed frequently. Morphological signs of reflux-gastritis in 95% of cases coincided with the results of the radionuclide method. Duodeno-gastric reflux decreased as a rule Helicobacter pylori (HP) contamination of the mucous membrane but did not eliminate it completely in all cases. The combination of these two factors resulted in more severe gastritis than that provoked by each of them separately. The etiology of gastritis and its intensity may be determined only by morphological examination of gastric mucous membrane. The results of endoscopic and histologic methods coincided in 70% of cases. Duodenal-gastric reflux, HP and high acid production play a certain role in ulcer recurrence.

[First experience in treatment of hepatic echinococcal cyst by percutaneous puncture drainage]. / Pervyi opyt lecheniia ékhinokokkovykh kist pecheni punktsionnym chreskozhnym drenirovaniem]

The article deals with the new possibilities of bloodless management of parasitic cysts of the liver by means of ultrasonic examination and computed tomography. The authors suggest a puncture-aspiration method of goal-oriented percutaneous drainage of a hydatid cyst which prevents possible complications. The method was applied in four patients with hydatid cysts of the right hepatic lobe. The outcomes in two cases were successful, the death of one patients was associated with the use of the method.

[Complications after removal of hepatic echinococcal cysts and possibilities of their prevention]. / Oslozhneniia posle ékhinokokkéktomii pecheni i vozmozhnosti ikh profilaktiki.

Operative treatment of hydatid disease is the only radical method at present. According to the data in the literature, the incidence of postoperative complications in patients with hydatid disease of the liver ranges from 14.32 to 64%. The work generalizes the results of operations in 278 patients with hepatic hydatid disease. Closed echinococcectomy was conducted in 168 (65.87%) patients, partly closed--in 34 (12.23%), open echinococcectomy--in 14 (5.04%), pericystectomy--in 21 (7.55%), ideal echinococcectomy--in 17 (6.12%), resection of the liver with removal of the hydatic cyst--in 15 (5.4%), and percutaneous transhepatic drainage of the cyst--in 9 (3.2%) patients. Postoperative complications occurred in 32 (11.51%) cases. Among them were suppuration of the residual cavity in 19, external biliary fistula in 11, and subdiaphragmatic abscess in 2 patients. The least number of complications was encountered after closed echinococcectomy--in 5 (2.97%) patients. One patient died after partly closed echinococcectomy as the result of development of multiple cholangiogenous hepatic abscesses. The results of the authors' observations provide evidence that the character and frequency of postoperative complications are determined by timely diagnosis of echinococcosis of the liver before the development of complicated forms, correct choice of the type of the operation, and the techniques of the operation and the operative approach.

[Diagnosis and treatment of hepatic echinoccosis complicated by rupture into the biliary tract]. / Diagnostika i lechenie ékhinokokkoza pecheni, oslozhnennogo proryvom v zhelchnye puti.

In the period from 1980 to 1990 operations were carried out on 412 patients with echinococcosis of the liver. Complicated forms were encountered in 108 patients. Rupture of the hydatid cyst into the biliary tract occurred in 72 patients. Among the patients with this complication 14 had changes of the bile ducts with the development of obstructive jaundice, 14 had a history of short-term jaundice, in 35 patients the cystobiliary fistula was discovered only during the operation. Percutaneous transhepatic and retrograde cholangiography proved to be the most informative diagnostic methods in rupture of the hydatid cyst into the biliary tract with the development of obstructive jaundice. Echinococcectomy with one-stage operative intervention on the biliary tract was conducted in 14 patients. Along with echinococcectomy, 7 underwent cholecystectomy and drainage of the common bile duct, 2 were subjected to choledochoduodenostomy, 1 to papillosphincterotomy, in 4 patients echinococcectomy was preceded by percutaneous transhepatic cholangiostomy.

[New possibilities of the antibiotic use in the treatment of patients with acute cholecystitis]. / Novye vozmozhnosti ispol'zovaniia antibiotikov v lechenii bol'nykh ostrym kholetsistitom.

The authors studied the efficacy of directed transport of antibiotics in autologous blood shadows in the complex treatment of 73 patients with acute cholecystitis (the main group) in comparison with the traditional nonoperative treatment of 67 patients with the same disease (the control group). The directed transport of antibiotics in autologous blood shadows makes it possible to arrest adequately the clinico-laboratory manifestations of acute cholecystitis, thus preventing the development of infectious complications of the disease, shorten by 4.5 times the terms for arresting the clinico-laboratory manifestations of acute cholecystitis, and to optimize planned operative treatment. The suggested method increases the quality and the economy of management of surgical patients.

[Surgical tactics in associated echinococcosis of the liver and lung]. / Khirurgicheskaia taktika pri sochetannom ékhinokokkoze pecheni i legkih.

Over 10 years operations were conducted in 28 patients with hydatid disease with concurrent involvement of the liver and lungs, which accounted for 5.76% of all patients with hydatid disease of the thoracic and abdominal organs. The following variants were encountered: uncomplicated echinococcosis of the right lung and right hepatic lobe (13 patients); uncomplicated echinococcosis of the left lung and liver (3); suppurative hydatid cyst of the liver with rupture into the pleural cavity and the development of pyothorax (9); rupture of a hepatic hydatid cyst into the bronchial tree of the right lung with the development of a cysto-bronchial fistula (3 patients). In the group of 28 patients with concurrent involvement of the liver and lung 18 were operated on through a thoraco-phreno-laparotomic approach, 9 through a transpleural approach, and one patient underwent a two-stage operation. The success of the treatment is determined by early recognition of the concurrent echinococcosis and the choice of the optimal surgical tactics. One-stage echinococcotomy from the liver and lung is the operation of choice in concurrent affection of the liver and right lung.

[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.

[Selective proximal vagotomy and duodenoplasty in surgical treatment of stenotic duodenal ulcer]. / Selektivnaia proksimal'naia vagotomiia i duodenoplastika v khirurgii stenoziruiushchei duodenal'noi iazvy.

Experience in the treatment of 70 patients with stenotic duodenal ulcer by surgery is generalized. In addition to SPV the patients underwent duodenoplasty as a draining operation. There were 61 (87.1%) males and 9 (12.9%) females. Their ages ranged from 18 to 70 years. The stenosis was compensated in 21 (30%), ++non-compensated in 32 (45.7%), and decompensated in 17 (24.3%) patients. To determine the possibility of performing SPV, the maintenance of the gastric contractile activity was studied by noninvasive methods: computed peripheral electrogastrography and computed gastro-scintigraphy. Involvement of the pylorus into the cicatricial-ulcerous inflammatory infiltration is the main contraindication for duodenoplasty. In view of that, intensive 2-3 week preoperative antiulcer therapy acquires particular significance; it removes or reduces significantly the inflammatory infiltration in most cases and raises the possibility of conducting duodenoplasty. Only intraoperative inspection of the pyloroduodenal segment allows the possibility and type of pylorus -preserving duodenum draining operation to be determined. This operation can be undertaken if the proximal boundary of the stenotic cicatricial-ulcerous deformity is at a distance of at least 1 cm from the pyloric sphincter, whatever the degree and length of the narrowing. A total of 43 operations form the Heineke-Mikulicz Mikulicz duodenoplasty, 17 for Finney's pyloroplasty, and 10 for bulbo-duodenostomy were carried out. The authors consider excision of the duodenal ulcer to be expedient and safe only when it is located on the anterior wall; it was carried out in 9 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical treatment of giant cavernous hemangioma liver.

In the past five years, 16 adults (10 females, age 25-61 years, mean 48) with giant cavernous hemangioma of the liver measuring 15-31 cm (mean-19) underwent surgery in a single Institution. Diagnosis was made with the help of multimodal investigations- ultrasound (US), computed tomography (CT), hepatic angiography, hepatic scintigraphy and fine needle biopsy. Ultrasound and CT had sensitivities of 69% and 82% respectively. Fourteen had preoperative selective hepatic artery embolization to study its effect on operative blood loss. Indication for surgery in all cases was a large abdominal mass with varying severity of pain. In addition, 5 had hemetological and/or coagulation abnormalities, hemobilia in 1 and pyrexia in 1. Seven left lobectomies, 3 left lateral segmentectomies, 2 right lobectomies, 2 right trisegmentectomies and 4 non-anatomical resections of 1 to 3 segments were performed. Postoperative complications developed in 25% with no operative mortality. Preoperative selective hepatic artery embolization helped to decrease the operative hemorrhage in 13 (mean blood loss- 1146 ml). In two cases severe bleeding required use of Cell-saver and massive donor blood transfusion. Our results suggest use of preoperative selective hepatic artery embolization and Cell-saver as an adjunct to the liver resection for these vascular tumors.

[Diagnosis and surgical treatment of cancer of the gallbladder]. / Diagnostika i khirurgicheskoe lechenie raka zhelchnogo puzyria.

Operations were carried out on 41 patients with carcinoma of the gallbladder. Coexistent cholelithiasis was encountered in all cases. Ultrasonic examination (USE) and computed tomography (CT) are the most informative methods of preoperative diagnosis. With the use of both methods the correct diagnosis was made in 100% of cases. The true diagnosis was made before the operation in 73% of cases. In 9 patients the correct diagnosis was established only during the operation. Two patients underwent operation for calculous cholecystitis, stage I gallbladder carcinoma was identified during planned histological study. Among 32 patients 2 were found to have stage I, one--stage II, 17--stage III, and 12 patients--stage IV of the disease. Radical operations were carried out on patients with stages I and II and on 7 patients with stage III of the disease. Nine patients (28%) died in the immediate postoperative period. Cholecystectomy with careful removal of the elements of the gallbladder bed should be considered the radical operation for stage I of the disease; in stage II the operation should be supplemented by lymphadenectomy along the course of the hepatoduodenal ligament. Hemihepatectomy or atypical resection of the liver is indicated in stage III of the disease.

[Glutathione levels and the activity of the enzymes of glutathione metabolism in erythrocytes of patients with acute cholecystitis]. / Dinamika urovnia glutationa i aktivnosti fermentov obmena glutationa v éritrotsitakh bol'nykh ostrym kholetsistitom.

It is shown that in acute cholecystitis patients versus chronic cholecystitis ones and donors, the total glutathione in blood is lower while the activity of glutathione metabolism enzymes in red blood cells inhibited. Enzymological findings correlate with clinical symptoms of intoxication. Surgery aggravates disturbed activity of the enzymes. Conventional conservative therapy is not effective in normalizing the enzymes activity either. A good therapeutic response can be achieved by a directed transport of antibiotics in autologous blood ghosts which promotes recovery of normal activity of glutathione metabolism enzymes, routine glutathione level, early stabilization of hepatocytic membranes beneficial for surgical patients.

[A method of pancreato-duodenal resection and total duodeno- pancreatectomy]. / Metodika pankreatoduodenal'noi rezektsii i total'noi duodeno- pankreatéktomii.

During 1975-88 the staff of the Vishnevskii+ Institute of Surgery performed 95 pancreatoduodenal resections (PDR) and 23 total duodenopancreatectomies (TDPE) in malignant tumors of the head of the pancreas (49), major duodenal papilla (30), terminal choledochus (12), duodenum (12), and in 15 patients with chronic pancreatitis. In 13 cases PDR and TDPE were undertaken as a second operation after creation of biliodigestive anastomoses: after laparoscopic cholecystostomy in 24 and after various abdominal operations in 20 cases. In 30 cases PDR was carried out with the formation of a pancreaticojejunal+ anastomosis, by the longitudinal techniques in 7 of them, in 47 cases with occlusion of the pancreatic duct, and in 6 with the formation of a "occlusive" pancreaticojejunal anastomosis++ suggested by the authors. PDR was performed in 3 cases with maintenance of the stomach and in 4 in combination with vagotomy. The mortality rate was 20% after PDR and 39.1% after TDPE.