[Causes of nonradical surgical operations for cancer of the proximal part of the stomach].

An analysis of results of treatment of 454 patients operated for cancer of the proximal part of the stomach included the main parameters of the tumor process and radical operations studied on the basis of morphological investigations of the ablated preparations. The vertical and horizontal lines of the gastric resection were thoroughly investigated, the results being introduced in the protocol of the investigation. In 49 of 454 radically operated patients (10.7%) the line of resection passed through the zone of tumor infiltration. It was shown that the frequency of the tumor cells left along the resection line was substantially influenced not only by the growth character, the histological structure of the tumor and involvement of the esophagus, but also by the kind of operative access and surgery. We believe that in patients with poorly differentiated carcinomas (G3-G4) and endophylic-infiltrative forms of tumor growth it is necessary to principally widen the resection zones both in the vertical and lateral directions. It will allow avoidance of making the line of resection in the tumor infiltration zone. Not only the gastric resection zones but also all anatomical structures adjacent to the tumor ablated during the combined surgical operations should be thoroughly morphologically examined. The intraoperative urgent histological investigation of the gastric resection line must be made in all radical operations for gastric cancer.

[Evaluation of surgical traumaticity of standard and extended surgical procedures in cancer of a proximal part of the stomach].

Analysis of the results and evaluation of surgical trauma of 454 various resections for cancer of a proximal part of the stomach were carried out. Proximal subtotal resection of the stomach with resection of the esophagus were performed in 151 patients (33.2% of all the resections). Gastrectomy was performed in 296 (65.2%) patients. Standard resection was carried out in 254 (55.9%) patients, extended -- in 72 (15.8%), combined -- in 64 (14,1%), extended-combined -- in 64 (14,1%). It is demonstrated that number of complications after surgical treatment of cancer of a proximal part of the stomach is high enough due to traumaticity of abdominal-thoracic surgical procedures. Surgical approach, duration of surgery, intraoperative blood loss have significant influence on short-term results. Duration of surgery more than 300 min is the main factor making worse short-term results of extended resection of the stomach. In such duration of surgery postoperative complications were seen in 45.0+/-11.4%, lethal outcome -- in 30.0+/-10.5% cases. Extended surgical procedures demonstrate better long-term results. Five-years survival of patients with cancer of proximal part of the stomach (stage II and III) after extended surgeries is 53.3+/-13.3 and 33.3+/-6.3%, respectively. Standard resection is recommended for elderly patients with low functional reserves.

[Surgical treatment in chronic gastroduodenal ulcers]. / Khirurgicheskoe lechenie pri khornicheskikh gastroduodenal'nykh iazvakh.

Operative treatment was carried out in 1197 patients with chronic gastroduodenal ulcers. Among the most frequent complications of the ulcers there were penetration of the III-IV degree, compensated, subcompensated and decompensated pyloroduodenal stenosis. The operative interventions included Billroth-II resections of the stomach in modification of Hofmeister-Finsterer, Billroth-I, with saving the pyloric sphincter, after Roux and gastrectomies. Postoperative complications developed in 127 (10.6%) patients, postoperative lethality was 0.7%. Excellent and good long-term results were noted in 846 (94.5%) patients, in 14 (1.6%) patients they were estimated as satisfactory and in 35 (3.9%) as unsatisfactory. The causes of unsatisfactory results were recurrent ulcers (0.7%), peptic ulcer of the gastroenteroanastomosis (0.6%), dumping-syndrome of a severe and medium degree (1.5%), diarrhea of a severe degree (0.3%) and erosive-ulcerous reflux-esophagitis (0.3%).

[Surgical strategy in liver hemangiomas]. / Khirurgicheskaia taktika pri gemangiomakh pecheni.

The authors made an analysis of results of surgical treatment of 129 patients with hepatic hemangiomas and of the 9-year follow-up of these patients. The dynamic care of these patients is recommended in cases of 5 cm diameter hemangiomas and the absence of clinical symptoms. The surgical treatment was necessary but in 10% of such patients. In the majority of such patients embolisation of the hepatic artery is expedient if surgical treatment is necessary. Indications for resection of the liver are restricted.

[Dearterialization of the liver as a treatment method in hemangiomas]. / Dearterializatsiia pecheni kak metod lecheniia ee gemangiom.

The article is devoted to the experiences with treatment of hemangiomatous lesions of the liver. Results of palliative treatment of 65 patients by methods of dearterialization of the liver (ligation and embolization of the hepatic artery) are presented. The authors make a conclusion that dearterialization of the liver is a sufficiently effective method of treatment resulting in sclerosing the hemangiomas and substitution of them with the fibrous tissue. It is not followed by the development of pronounced complications and lethality. With clinical manifestations retained after embolization of the hepatic artery it is possible to perform resection of the liver with hemangioma, the operative intervention in this case being accompanied by less blood loss, and it is easier technically than when it is fulfilled without preliminary dearterialization of the liver.

[A comparative assessment of the effectiveness of dearterialization of the liver and intraorgan chemotherapy in patients with liver cancer]. / Sravnitel'naia otsenka éffektivnosti dearterializatsii pecheni i vnutriorgannoi khimioterapii u bol'nykh rakom pecheni.

An experience with treatment of 90 patients with primary (42) and metastatic (48) carcinomas of the liver who were treated by ligation of the hepatic artery (in 24 patients), embolisation of the hepatic artery (in 21 patients) in combination with intraarterial and intraportal chemotherapy or without it is analyzed. It has been shown that these methods are more effective in metastatic carcinoma of the liver, longer terms of life of the patients were obtained when dearterialization of the liver was combined with chemotherapy.

[The use of dioxadet in chemoembolization of the hepatic artery in primary and metastatic cancer of the liver]. / Ispol'zovanie dioksadéta dlia khimioémbolizatsii pechenochnoi arterii pri pervichnom i metastaticheskom rake pecheni.

An evaluation of the treatment of 42 patients with extended primary hepatic tumors and multiple intrahepatic metastases of colorectal carcinoma established the effectiveness of a newly-developed fat-soluble cytostatic drug--dioxadet, used for chemoembolization particularly, when foci fed from small arterial vessels were located along the periphery.

[Scintigraphic evaluation of the results of treatment of alcoholic liver cirrhosis]. / Stsintigraficheskaia otsenka rezul'tatov lecheniia alkogol'nogo tsirroza pecheni.

The results of static and dynamic scintigraphy in patients with alcoholic liver cirrhosis showed changes in liver sizes, a decrease in the RL/LL ratio, an increase in spleen sizes, the reduction or distortion of the L/S ratio, extrahepatic uptake of RP, and predominance of the arterial component of the blood flow over the portal one. However the main scintigraphic signs of alcoholic liver cirrhosis were undetectable. After therapy (lymphovenous anastomosis, embolization of the hepatic artery) the recovery of functions was more rapid in patients with cirrhosis of alcoholic etiology who discontinued alcohol consumption than in those with cirrhosis of some other etiology.

[Variations of internal drainage of the thoracic duct in cirrhosis of the liver]. / Varianty vnutrennego drenirovaniia grudnogo limfaticheskogo protoka pri tsirroze pecheni.

The experience with 100 operations of the internal drainage of the thoracic lymphatic duct has shown technical difficulties of the procedure. In relation with concrete topographo-anatomical conditions the authors recommend to use reimplantation of the thoracic lymphatic duct and plastic operations on its orifice in addition to the lymphovenous anastomosis. Their technique is described.

[Indications for lymphovenous anastomosis for ascites in cirrhosis of the liver]. / Pokazaniia k limfovenoznomu anastomozu po povodu astsita pri tsirroze pecheni.

The analysis of outcomes after the lymphovenous anastomosis on the neck of 52 patients with ascites due to cirrhosis of the liver are presented. In 16 cases ascites was arrested, in 15 patients there was a considerable elimination of ascites. In 14 cases the lympho-venous anastomosis resulted in stabilization of the ascitic syndrome, in 7 patients operation proved to be ineffective. In the nearest postoperative period 3 patients died. Two patients died of hemorrhage from the varicose-dilated veins of the esophagus an stomach, and one patients died of acute hepatic insufficiency. In the postoperative period and improvement of the functional state of the liver was noted. The authors propose to divide ascites into three stages which allowed to prognose results of the operation in the postoperative period and make the indications more definite.

[Lymphovenous anastomosis in correcting for ascites in liver cirrhosis]. / Limfo-venoznyi anastomoz v korrektsii astsita pri tsirroze pecheni.

In 26 of 30 patients operated for ascitis in cirrhosis of the liver cervical lymphovenous anastomosis was performed. It gave positive effects on the treatment of ascitis in cirrhosis of the liver in cases when the purposeful complex of conservative measures was little effective. When ascitis is associated with varicose veins the authors recommend to combine lympho-venous anastomosis with temporary drainage of the duct by bringing the catheter onto the skin through the lympho-venous anastomosis and the jugular vein.

[Modified method for catheterization of the umbilical vein]. / Vidoizmenennaia metodika kateterizatsii pupochnoi veny.

A modified method of catheterization of the umbilical vein differs from other methods, for at the dismissal of the patient from the hospital the peripheral end of the polyvinylchloride catheter filled with maiodil is sealed and inserted under the skin, which permits to keep the catheter in the umbilical vein for several years, taking out its end periodically from under the skin for introduction of necesary drugs in case of cancer and liver cirrhosis. The catheter does not cause any discomfort and prevents the umbilical vein and surrounding tissues against infection. The suggested method has been applied in 64 patients without any related complications.