[MORPHOLOGICAL CHANGES OF THE LIVER IN OBTURATION JAUNDICE, CAUSED BY CHOLEDOCHOLITHIASIS, DEPENDING ON ITS DURATION].

Abstract The results of surgical treatment of 184 patients for obturation jaundice, caused by choledocholithiasis, were analyzed. Morphological changes of the liver were studied in 20 patients. There were three groups of patients delineated, depending on the obturation jaundice duration: up to 7 days, from 8 to 14 days, more than 15 days, and also a group of patients after the bile outflow restoration. The obturation jaundice occurrence in choledocholithiasis is accompanied by significant morphological changes in the liver, severity of which is enhancing while the obturation jaundice persistence increasing. While persistence of obturation jaundice through 8 days and more the connective tissue volume is enhancing, a relative volume of hepatocytes is reducing and a stromal-parenchymatous index is increasing. The bile outflow restoration secures significant reduction of intensity of alterative and inflammatory changes in hepatic parenchyma, as well as activation of reparative processes in the tissue. In cholangitis, caused by P. aeruginosa and E. coli, according to morphological investigations data, in the liver a diffuse purulent cholangitis on background of chronic changes in accordance to duration of the obturation jaundice persists.

[SURGICAL TREATMENT OF ACUTE CHOLANGITIS IN CHOLEDOCHOLITHIASIS].

The results of surgical treatment of 184 patients for obstructive jaundice and an acute cholangitis in choledocholithiasis were analyzed. Acute cholangitis was diagnosed in 62 (33.7%) patients. Sensitivity of a Tokyo Guidelines (2013)--TG 13 criteria for diagnosis and estimation of the course severity of an acute cholangitis was studied. Dynamics of postoperative laboratory parameters was studied. There was established, that occurrence of obturation jaundice and cholangitis coincides with pronounced hepatic function disorders, which are preserved after a bile outflow restoration also, and changes in peripheral blood. Severity of inflammatory reaction reflects hematological indices, the most informative of which is an intoxication index.

PROGNOSIS IN CHRONIC PANCREATITIS AND CANCER WITH A PRIMARY LESION OF THE PANCREATIC HEAD.

Analyzed the results of surgical treatment of 132 patients, including 68 ­ for cancer of the pancreatic head (in 46 ­ with jaundice) and 64 ­ chronic pancreatitis (CP) with a primary lesion of the pancreatic head (16 ­ with jaundice). The distribution of patients into groups was carried out with a maximum value of classification functions calculated by special formulas. Next studied indicators of endothelial dysfunction for differential diagnosis. A certain threshold of VEGF = 346 pg / ml, in which the patients were divid' ed into groups: СP and cancer on the pancreatic head. It was even more accurate indi' cator threshold VEGF = 248 pg / ml. To predict the severity of the pathological process, along with the use of diagnostic data, using the method of classification trees. Pancreatoduodenal resection for Whipple was performed in 23 patients, for Traverso­ Longmire ­ in 8, subtotal right sided pancreatectomy for Fortner ­ in 3, hepaticoje' junostomy by Roux ­ in 8, duodenopreserving resection for Beger ­ in 6, her Bernese option ­ in 7, operation Frey ­ in 51. In 26 (19.7%) patients, minimally invasive inter' vention for removal of bile were spread through the final primary pathological process and severe general state. Postoperative complications occurred in 18 (13.6%) patients, died 3 (2.3%).

[Diagnosis and surgical treatment of mirizzi syndrome].

Retrospective analysis of the surgical treatment results in 34 patients, operated for intraoperatively diagnosed Mirizzi syndrome (MS), was done. Analysis of intraoperative changes have witnessed, that while transition occurrence of MS from the first to the fifth type a severity of morphological changes in a gallbladder-biliary ducts-duodenum system enhanced with duodenal integrity loss and development of cholecystobiliary or cholecystodigestive fistula. Surgical correction of MS have envisaged cholecystectomy performance or subtotal resection of gallbladder, plastic closure of biliary fistula, using various procedures, external biliary draining and formation of hepaticojejunostomy in accordance to Roux method.

[THE STATE OF HEPATIC AND SPLANCHNIC BLOOD FLOW IN VARIOUS TYPES OF COMPLICATED PANCREATIC PSEUDOCYSTS].

Investigations were conducted in 37 patients, suffering complicated pancreatic pseudocysts. In accordance to data of ultrasound Doppler flowmetry for the blood flow along portal vein, a. hepatis communis, a. mesenterica superior in complicated pancreatic pseudocysts compensatory--adaptive reactions on level of hepatic--spanchnic blood flow are directed towards restriction of the blood inflow through the portal vein system. This is accompanied by the common peripheral vascular resistence raising in basin of a. mesenterica superior, which have depended upon the patients' state severity, caused by reduction of the volume blood flow in a certan vascular collector. The oxygen debt of the liver in these patients is compensated by the volume blood flow enhancement along a. hepatis communis.

[DYNAMICS OF CHANGES OF PROINFLAMMATORY AND ANTIINFLAMMATORY CYTOKINES, AS WELL AS SOME INDICES OF THE BLOOD PEROXIDATION SYSTEM, IN THE PATIENTS WITH VARIOUS PANCREATIC PSEUDOCYST TYPES].

The investigation was performed in 47 patients, operated on for pancreatic pseudocysts (PP). The PP type was established in accordance to A. D'Egidio, M. Schein (1991) classification. The blood plasma contents of proinflammatory and antiinflammatory cytokines, including interleukins (IL): IL-6, IL-8, IL-10, IL-18, as well as malonic dialdehyde and activity of glutationperoxidase, were determined for estimation of the immune state disorders. Mostly expressed changes in IL-8 content were registered in complicated PP in 72 h postoperatively, what was have characterized by more expressed raising of its level in systemic blood flow, than in a splanchnic one, in all types of PP and witnessed a hepatic capacity to guarantee a cytokine's clearance in all the patients. The contents of glutationperoxidase and IL-18 in the blood serum in various types of PP have correlated immediately with pancreatitis severity. Close correlative connection between these indices while unfavorable prognosis of postoperative period course was established.

[TG13: THE UPDATED TOKYO'S CLINICAL RECOMMENDATIONS FOR TREATMENT OF AN ACUTE CHOLANGITIS AND CHOLECYSTITIS].

Basing on analysis of the multicenter clinical investigations results, as well as meta-analysis and consensuses, the main suggestions of the updated Tokyo's clinical recommendations for the treatment of an acute cholangitis and an acute cholecystitis (TG13), diagnostic criteria and the scales of estimation for the patients' state severity, were elaborated. Indications and the drainage methods of a gallbladder were substantiated - in an acute cholecystitis, and of biliary ducts - in an acute cholangitis, as well as peculiarities of surgical treatment of an acute cholecystitis. Empirical antibacterial therapy was enlightened, taking into account the characteristics for biliary infection microorganisms and the disease severity.