Gas jet transection of liver parenchima. Experimental research.

BACKGROUND: There is a great variety of liver parenchyma transection techniques. The objective of this research lies in developing a new method of liver transection and comparing it to the existing ones. METHODS: The original gas jet transection method of biological tissues and the apparatus for its realization "Pneumojet" were developed in our institute. Efficiency comparison of gas jet,water jet, ultrasonic methods of liver transection and clamp crushing technique were carried out on 24 mini-pigs. We did not use Pringle manoeuver. RESULTS: The mean blood loss was the smallest in the group of animals that had a gas jet transection (3.5+-0.15 ml/cm²) and the highest in the clamp crushing technique group (5.5+-0.46ml/cm²). Indicators present statistically authentic differences(p 0.001). The transection speed was the highest in the Clamp crushing technique group (2.9+-0.25 cm²/min) and was credibly higher than in the gas jet (2.4+-0.16 cm²/min), ultrasonic(2.4+-0.13 cm²/min) and water jet (2.5+-0.14 cm²/min) transection groups. Compared to the water jet and ultrasonic methods of liver transection the original method does not have statistically reliable distinctions on the basic indexes of work. CONCLUSIONS: The research conducted proves high efficiency and safety of the gas jet transection method. Gas jet transection,therefore, can be recommended for further improvement and clinical application.

[Surgical treatment of a solitary hepatic abscess].

Retrospective analysis of the treatment results of 120 patients, suffering solitary hepatic abscess (SHA), was conducted. The sanation methods, in accordance to technology, the treatment impact intensity and aggressiveness, may be divided on three lines: aspirational, draining and resectional. The method of sanation is selected on the background of morphological peculiarities of abscess--its sizes, by presence of sequesters, divisioning septs, dense rigid capsule, grade of periprocess. Surgical access is determined by the abscess localization, the patient's state severity, instrumental equipment of the clinic. Differentiated approach, taking into account genesis, sizes, localization and stage of its formation, constitutes a background of successful treatment of SHA. In totally formatted acute SHA, as a rule, the methods of choice are aspirational and aspiration-draining methods of sanation under ultrasonographic control or laparoscopy. In the presence of chronic SHA or suppurated parasitic hepatic cyst it is mandatory to select the resectional methods.

[The role of ischemical preconditioning in the development of ischemia-reperfusion hepatic injury in experiment].

The optimal regimen of preliminary ischemic preparation, in which the vessels occlusion causes minimal pathohistological hepatic changes without inhibition of its regeneration capacities, was studied in experiment. The ischemic-reperfusional damage of liver, using hepatoduodenal ligament crossclamping in various regimens, was modeled on 40 rabbits in a randomized experimental investigation. Morphological investigations of the animals liver fragments, taken immediately after ligament crossclamping and on the third postoperative day, were performed. There was established, that severity and reversibility of the hepatic tissue affection have differed, depending on the ischemia duration and reperfusion period. The vessels occlusion regimen with preliminary ischemic preparation was the most safe for hepatic tissue, without rude structural injuries and functional disorders, permitting to recommend it for clinical application as the optimal one while performance of hepatic resection in combination with afferent vascular exclusion.

[Functional state of liver before and after its resection using various dissection methods].

Today a few randomized investigations have been accomplished, in which advantages and disadvantages of various methods of hepatic resection are compared. The investigation objective was to estimate the hepatic functional state before and after its resection, using various methods of parenchymal dissection. Randomized investigation was conducted in 90 patients, to whom hepatic resection, using scalpel, with its preliminary suturing by the block-like sutures with the Vycril thread, applying radiofrequency coagulator, "clamp crushing" procedure, ultrasonic (Sonoca 300) and a water-jet (Hydrojet) dissectors. The dissection was not combined with the hepatic vessels exclusion. Coefficient of elimination of indocyangreen and a speciphic coefficient of its elimination were estimated. There was established, that putting the block-like sutures and radiofrequency coagulation, concerning the hermetization peculiarities, causes the resection area ischemia, what is accompanied by persisting degradation of hepatocytes and hepatic functional reserve reduction as a result of its resection performance. While the extended hepatic resection conduction it is expedient to apply the methods of ultrasonographic, the jet-like dissection or a "clamp crushing", which guarantee minimization of risk of postoperative hepatic insufficiency occurrence.

[The gas-squirt dissection of hepatic parenchyma. Estimation of efficacy and safety of the method in experiment].

The method of dividing of the parenchymatous organs tissues was elaborated, consisting of a working milieu (carbon acid) delivery under the pressure on the operated organ surface, exceeding its durability, permitting to isolate the vessels from parenchyma before their division and than to clip and ligate them precisely with subsequent their transection, and using, if necessary, various methods of the definitive hemostasis achievement. The method was applied in 32 rabbits and 5 pigs while hepatic resection performance. The main indices of its functioning does not differ from such of ultrasonic dissection, the method is secure, permitting to recommend it for clinical application.

[The caudate hepatic lobe syndrome. Peculiarities of clinical course, surgical tactics].

Clinical and diagnostic peculiarities of the tumor affection of caudate hepatic lobe, which, by the sum of criteria, are divided on four stages of the caudate lobe syndrome, were discussed. The authors had proposed an optimal preoperative preparation and adequate surgical tactics, depending on the present stage.

[Application of mini-invasive technologies in the treatment of gastrointestinal bezoars].

The data on etiology, clinical signs, diagnosis and variety of approaches to the treatment of gastrointestinal bezoars were presented, basing on the worldwide literature analysis. The results of surgical treatment of patients for bezoars, using miniinvasive methods, are presented.