[Problems of hemostasis and hermetic properties in liver resections with application of fibrin-collagen substance]. / Problemy gemostaza i germetizma pri rezektsiiakh pecheni s ispol'zovaniem fibrin-kollagenovoi substantsii.

Forty-seven patients with various diseases of the liver were treated from 1992 to 2002. Patients had undergone liver resections of different scope. In 20 patients (study group) wound covering "Tachokomb" was used for final hemostasis and high hermetic properties of wound surface. Conventional suturing of the vessels and bile ducts was performed in 27 patients of the control group. Reliable hemostasis of the hepatic stump after anatomic resection was achieved in all the patients of the study group. Application of wound covering decreased time of final hemostasis, severity of hemorrhage and blood transfusion during surgery. Biliary complications after surgery were seen more often. Application of combined glue composition failed to reduce significantly rate of biliary complications after surgery, their rate increased proportionally to extension of liver resection.

[The use of contact impulse-periodic YAG-ND laser in surgery of major duodenal papilla]. / Primenenie kontaktnogo impul'sno-periodicheskogo AIG-Neodimovogo lazera pri operatsiiakh na bol'shom duodenal'nom sosochke.

YAG-Nd impulse-periodic laser scalpel in elimination of major duodenal papilla stenosis was tested experimentally. The direct damaging influence of the laser was tested in acute experiments and the optimal power of irradiation (5 W) was chosen. The processes of regeneration of the wound inflicted by laser irradiation were tested in chronic experiments. It is shown, that regeneration was accompanied with minimal leucocyte infiltration and complete healing of the wound is achieved in 28 days.

[Diagnosis and treatment of neoplastic diseases of extrahepatic bile ducts and major duodenal papilla]. / Diagnostika i lechenie opukholevykh porazhenii vnepechenochnykh zhelchnykh protokov i bolshogo sosochka dvenadtsatiperstnoi kishki.

Fifty-three operations were conducted on 48 patients for tumors of the extrahepatic bile ducts and the major duodenal papilla. Early diagnosis of this pathological condition is very difficult, which affects directly the results of treatment; 18% of patients underwent radical operations. Modern diagnostic methods--computer tomography, ultrasonic examination, and endoscopic retrograde pancreatocholangiography made it possible to detect neoplastic diseases in all of the examined patients. Radical surgical treatment is expedient in distal localization of the neoplastic process and in the absence of metastases. Endoscopic and puncture methods of decompression of the bile ducts are indicated in diffuse forms of the disease.

[Diagnosis and therapeutic tactics in polycystic liver]. / Diagnostika i lechebnaia taktika pri polikistoze pecheni.

The results of clinical observations of 60 patients with polycystosis of the liver who had been treated or examined by the authors in the period from 1964 to 1989 were summarized. The clinical course of the disease was featured by scanty clinical signs: pains in the upper half of the belly and hepatomegaly were most frequent. The combination of diagnostic techniques for verification of surgical intervention necessity was established. Besides, it was stated that the diagnosis of polycystosis of the liver should be complex and based on anamnestic data and the results of clinical, laboratory and instrumental investigations. Preference should be given to ultrasonography and computed tomography. Cysts with diameter of 5 cm and more, complicated polycystosis of the liver (bleeding, suppuration, malignancy) and cystic compression of the extrahepatic bile ducts and vessels (portal and cava inferior veins) were found to be indicative signs for surgical treatment of hepatic polycystosis. A total of 41 patients were subjected to surgical treatment with 49 operational procedures employed. Fenestration of hepatic cysts (42), that were organosparing operations, predominated. Resection of the liver was performed in 2 patients who had total cyst substitution for the whole of the left lobe. The improvement registered in 85.7% of operated on patients evidenced the favorable results of surgical treatment.

[Surgical treatment of polycystic disease of the liver]. / Khirurgicheskoe lechenie polikistoza pecheni.

The authors analyse 60 cases of polycystic disease of the liver; 41 patients underwent operation, 19 were kept under dynamic follow-up. The diagnosis of polycystic disease of the liver is based on the results of ultrasonic examination and computed tomography; serological tests are conducted for differential diagnosis with hydatid disease. Twenty (33.3%) patients had affection of the kidneys, pancreas, ovaries, and brain. As the result of surgery the condition improved in 30 (85.7%) and became worse in 5 (14.3%) patients in follow-up periods of 6 months to 23 years. Complications occurred in the postoperative period in 10 patients, the mortality rate was 4%. Fenestration of the cysts is the main type of intervention, which allows maximum preservation of the functioning hepatic parenchyma. The left hepatic lobe was resected in only 2 patients with its complete cystic degeneration. Defocused laser beam and bipolar rotor electrocoagulator were used for ++de-epithelialization of the cystic walls. Experience shows the expediency of surgical treatment for decompression of the maintained hepatic parenchyma.

[Methods of correction and prevention of cicatricial strictures and fistulas of the bile ducts]. / Metody korrektsii i profilaktika rubtsovykh striktur i svishchei zhelchnykh protokov.

Two hundred and eighty one patients with cicatricial biliary strictures were examined to reveal external biliary fistulas in 72 of the patients. The strictures and fistulas developed after surgery on the stomach and biliary ducts due to an accidental surgical injury to these organs, or at later terms after a ++hepato-choledochal intervention. The biliary lesions were repaired with 149 operations with formation of a biliodigestive anastomosis without tube drainage, 117 with tube drainage (mostly transhepatic), six plastic operations with reconstruction of the ++hepato-choledochal integrity, and 47 ++radio-endoscopically guided interventions. Complications after cavitary++ operations were observed in 36.9 per cent cases with the fatal outcome in 13 of the patients (4.7 per cent). ++Radio-endoscopically guided interventions included: radioendobiliary prosthetics of the biliary ducts, recanalization, balloon dilatation of short strictures with endoscopic guidance, elimination of concretions by means of external drainage, and endoscopic papillosphincterotomy in distal choledochal strictures. Long-term findings were related to the level of the biliary lesion, the period that had elapsed since the stricture formation, and the number of operations in the medical history. Good or satisfactory results were achieved in 87.9 per cent cases. Considering the results of treatment for biliary strictures and fistulas disappointing, the main effort should be aimed at their prophylaxis. With this purpose, measures to prevent surgical injury to the biliary tract have been elaborated.

[Surgery of chronic hepatitis]. / Khirurgiia khronicheskogo gepatita.

The article deals with the diagnosis and results of surgical treatment of 203 patients with chronic hepatitis. It is shown that complex pre- and intraoperative examination of the organs of the hepatobiliary area is necessary in order to detect the disease and choose the adequate surgical tactics. Intraoperative biopsy of the liver with emergency histologic study of the collected material is said to play the determinant role in the diagnosis of chronic hepatitis. To achieve the best hemodynamic effect of the operation, the authors believe it expedient to conduct arteriolysis and desympathization of the hepatic arteries at the whole length of the common and proper hepatic arteries. The immediate and late results of surgical treatment of chronic hepatitis were favourable. The immediate outcomes were good and satisfactory in 92.3% of cases, the late results, in 89% of cases.

[Possibilities of complex radioendoscopic examination of the pancreatoduodenal zone after choledochoduodenostomy]. / Vozmozhnosti kompleksnogo rentgenoéndoskopicheskogo issledovaniia pankreatoduodenal'noi zony posle kholedokhoduodenostomii.

A complex examination of 76 patients subjected to choledochoduodenostomy has shown that unsatisfactory results of the operation were due to various pathological alterations of anatomical structures and the created anastomosis. The state of distal parts of the cholangiopancreatic system should be necessarily studied by means of endoscopic pancreaticocholangiography when investigating the reasons of unsatisfactory results of choledochoduodenostomy.