PERFORMANCE OF TOTAL PANCREATECTOMY FOR PANCREATIC MALIGNANCIES.

Lethality, morbidity, survival indices and metabolic consequences of total pancreatec' tomy (TP), performed in patients, suffering pancreatic tumors, were analyzed. There were retrospectively analyzed 35 TP оperations, including 5­ urgent, 30 ­ elective, performed in a single center. General lethality have constituted 20% (7 patients died), and after elective ТP ­ 6.7% (2 died). Complications rate after elective TP have consti' tuted 40%; survival mediana­18 mo; indices of a 3­year survival ­ 40%, and a 5­ year one ­ 13.3%. Most frequently revealed metabolic changes after ТP ­ pancreatic exocrine insufficiency, pancreatogenic diabetes, changes in a lipid metabolism in hepatocytes. Our experience witnesses expediency of ТP introduction into surgical practice in specialized centers of Ukraine with results, which are matching a worldwide.

[Pancreatic-jejuno-duodenostomy by a small isolated intestinal segment: the function-preserving surgery for complicated forms of chronic pancreatitis]. / Pankreatoeiunoduodenostomiia s ispol'zovaniem izolirovannogo segmenta tonkoi kishki -- funktsiesokhraniaiushchaia operatsiia pri oslozhnennykh formakh khronicheskogo pankreatita.

Results of treatment of 26 patients with calcinous fibrous-degenerative chronic pancreatitis, operated in clinic in 2001-2002 years, were analyzed. Standard method, using longitudinal pancreatojejunostomy on excluded loop of small intestine according to Roux, was performed in 12 patients (first group). In 14 (second group) operation of pancreatojejunoduodenostomy was performed, using isolated segment of small intestine according to method proposed by the authors. Data of comparative analysis performed, witness, that during performance of pancreatojejunoduodenoanastomosis in all patients with disappearance of main pathological symptoms of disease the significant improvement of lipid and protein metabolism occurs in comparison with such in patients of control group.

[Drainage or resecting surgery in chronic pancreatitis?]. / Dreniruiushchie ili rezetsiruiushchie operatsii pri khronicheskom pankreatite?

An analysis was done of treatment of 333 patients with complicated forms of chronic pancreatitis (ChP) who had undergone interventions in the pancreas over the period 1996-2001. The draining operations having been performed in the above patients came up to 91.3 percent of the total number of operations while resecting type surgery was 8.7 percent. Efficiency was analyzed of making use of draining operations in different forms of ChP. The authors suggest a number of novel draining operations aimed at preservation of the function of the pancreas and organs of the pancreatoduodenal zone, which fact is found out to qualitatively change results of surgical treatment in the patients under consideration. Resecting operations are performed more frequently in fibrous changes in the pancreas, with the adjacent organs being involved in the pathological process. Indications are determined for performing resecting operations in ChP.

[Modern aspects in the diagnosis of pancreatic lobe and extrahepatic biliary duct neoplasms]. / Sovremennye aspekty diagnostiki opukholei golovki podzheludochnoi zhelezy i vnepechenochnykh zhelchnykh protokov.

There were examined 385 patients with pancreatic head and extrahepatic biliary ducts tumor. Complex of diagnostic measures was proposed using modern methods: ultrasonic investigation, endoscopic retrograde cholangiopancreatography, computeric tomography, magnet resonance tomography, spiral computeric tomography. Diagnostic possibilities of each method in the tumor verification and in revealing of indirect science of disease were studied up. Correct diagnosis was established in 94.3% of observations.

[Classification of tumors of extrahepatic biliary ducts]. / Klassifikatsiia opukholei vnepechenochnykh zhelchnykh protokov.

Basing on morphologic-anatomical peculiarities of extrahepatic biliary ducts (EBD) analysis the classification of their tumors was elaborated. The EBD portions borders were determined: the proximal, with predominant affection of right and left biliary duct, their branching; the central; the therminal; affection of common biliary duct ampulla and large duodenal papilla. Basing on the classification proposed, surgical tactics of the EBD tumors treatment was elaborated.

[New possibilities of the complications prophylaxis after pancreatoduodenal resection]. / Novye vozmozhnosti profilaktiki oslozhnenii posle pankreatoduodenal'noi rezektsii.

The results of application of a new method of the pancreatic stump processing after pancreatoduodenal resection performance in 16 patients, operated on for cancer of pancreatic head and periampullar zone, were adduced. Application of the proposed method of invagination pancreatojejunostomy formation, using three-raw suture, have permitted to escape the sutures insufficiency and to shorten duration of the patient hospital treatment after the operation by 7.8 days at average.

[The application of laferon in a combined therapy of purulent cholangitis]. / Primenenie laferona v komplekse terapii gnoinogo kholangita.

Results of treatment of 160 patients, operated on for nontumoral biliary ducts impassibility, complicated by purulent cholangitis, were analyzed. In 60 patients intraoperatively and after the operation in complex of treatment laferon solution was injected into biliary ducts in dosage 500,000--1 million IU a day, permitting to reduce the frequency of the postoperative complications occurrence from 62.2 to 36% and of postoperative mortality--from 13 to 6%. Regional immune therapy using laferon stimulates the factors of organism inflammatory reaction and hepatocytes functional state restoration.

[Interleukin-6 content in the blood serum and bile duct in patients with obturative jaundice of different origin]. / Soderzhanie interleikin-6 v syvorotke krovi i protokovoi zheltukhoi razlichnogo geneza.

There were examined 19 patients with nontumoral disease and 13--with hepatopancreatoduodenal zone organs tumor. In nontumoral disease interleukin-6 (IL-6) was revealed in 83.3% of patients in the blood serum and in 88.9%--in ductal bile; in nontumoral impassability of biliary ducts IL-6 was revealed in the blood serum in 53.8% of patients, in ductal bile--in 87.5%. It was established, that bilirubinemia degree did not correlate with IL-6 content in the blood serum, but was directly influenced by its concentration in ductal bile.

[Biochemical investigation of patients with jaundice of tumor genesis]. / Biokhimicheskoe issledovanie u bol'nykh s mekhanicheskoi zheltukhoi opukholevogo geneza.

The study comprised surgical patients presenting with tumours of the extrahepatic biliferous ducts. The above patients revealed a high activity of gamma-glutamyltransferase, alkaline phosphatase at the expense of the hepatic isoenzye, to a lesser extent--of asparaginaminotransferase, alaninaminotransferase, a high level of conjugated bilirubin, an insignificant increase in the level of cholesterol and triglycerides. The above biochemical indices combined with results of other methods of investigation can be used for early diagnosis of mechanical jaundice of the tumour genesis.

[Complex detoxication therapy in obstructive jaundice of tumor genesis]. / Kompleksnaia detoksikatsionnaia terapiia pri obturatsionnoi zheltukhe opukholevogo geneza.

An experience has been analyzed gained with conducting of detoxication therapy in 34 patients with mechanical jaundice of tumour genesis with making use of complexes of measures that include intravenous infusion therapy involving the use of multi-ogran plasma extenders and extracorporeal sorption methods (hemosorption, extracorporeal use of freeze-preserved sections of xenospleen). Correction of purulent cholangitis was done with III-IV generation cephalosporines, taking account of antibioticogrammes, combined with metrogig, and cholesorption with the sorbent polysorp combined with laferon. The adopted policy of administering complex detoxication therapy treatments in patients with obstructive jaundice of tumour genesis permitted the early postoperative case-fatality rate to be reduced by 8.4 per cent.

[Clinical signs, diagnosis and surgical treatment of extrahepatic biliary duct tumors]. / Klinika, diagnostika i khirurgicheskoe lechenie opukholei vnepechenochnykh zhelchnykh protokov.

Experience of surgical treatment of 271 patients the extrahepatic biliary ducts tumor for the 1992-1999 yrs period is presented. Indirect signs of extrahepatic biliary ducts tumor were revealed in 84% of observations. Depending on the tumor localization the trustworthiness of the endoscopic retrograde pancreatocholangiography method had constituted from 79.8 to 96.4%. Correct diagnosis was established before the operation in 94.3% of patients. Radical operation was done in 93 (34.3%) of patients, including 22 with proximal localization of tumor, 13--with central one, 10--distal, 48--terminal. Palliative operation was performed in 178 patients, in 76 of them biliodigestive anastomosis was done. Total postoperative mortality was 14.8%.

[Cholecystectomy by mini-laparotomy access. Retrospective analysis of the 10-year work]. / Kholetsistéktomiia minilaparotomnym dostupom. Retrospektivnyi analiz 10-letnei raboty.

Ten-year experience of operative treatment of cholelithic disease using mini-access cholecystectomy (MACH) in 920 patients was summarized. There were operated on 167 patients for an acute cholecystitis, chronic calculous cholecystitis--716, gall bladder polyposis--36, gall bladder cancer--1. In 48 patients the MACH was matched with choledochus drainage, in 9--choledocholithotomy was performed, in 1--choledochoduodenostomy. In 6 observations the MACH were done simultaneously inguinal herniotomy, in 10--umbilical herniotomy, in 7--uterine extirpation, in 13--operation for ovarial cyst. The bile leakage from gall bladder bed occurred in 3 observations, the operative wound suppuration--in 4. Duration of stationary treatment was 4.1 days at average.

[Novel method for the surgical treatment of retropancreatic pseudocysts]. / Novyi metod khirurgicheskogo lecheniia retropankreaticheskoi psevdokisty podzheludochnoi zhelezy.

There has been developed and adopted the author's method for surgical treatment of the retropancreatic cyst of the pancreas. The method involves a one-stage internal drainage of the cyst and pancreatic duct through cystoductopancreatojejunostomy on the isolated loop of the small intestine. Overall three patients have been operated on. The immediate and late results are good. The method is defended by the inventor's certificate.

[Surgical strategies in the treatment of complicated forms of chronic pancreatitis]. / Taktika khirurgicheskogo lecheniia oslozhnennykh form khronicheskogo pankreatita.

For the period from 1992 to 1998 years 554 patients with complicated chronic pancreatitis were operated on. In 248 patients the longitudinal pancreatojejunostomy was performed, in 113--pancreatojejunostomy in 75--external drainage of the cyst, of them in 12--under the ultrasonic investigation control. In 21 patients pancreatoduodenal resection was conducted, pancreatic gland (PG) distal resection--in 41. In 4 patients with the PG head calcinosis the pancreatic resection according to Beger was done, in 3--the Frey operation. In the total PG calcinosis in 9 patients the modified Frey's operation was performed in conjunction with platitude PG resection along posterior wall of her duct. The indirect operation on PG were done in 40 patients. Nine (1.6%) of patients died.

[Application of the compression biliary-digestive anastomosis in surgical treatment of the biliary ducts obstruction]. / Primenenie kompressionnogo biliodigestivnogo anastomoza v khirurgicheskom lechenii neprokhodimosti zhelchnykh protokov.

The methods of formation and the surgical instruments for the biliodigestive compression anastomoses (BDA) doing were elaborated in the clinic. For the 1997-2000 years period 137 patients were operated on for the biliary ducts impassibility, in 36 of whom the compression BDA was formated. In 69% patients the rejection was noted on 7-10th day after the operation. The result of treatment was studied in 6 month-4 years term and estimated as good in 32 (94.12%) patients.

[The surgical treatment of pancreatic pseudocyst]. / Khirurgicheskoe lechenie psevdokisty podzheludochnoi zhelezy.

Experience of surgical treatment of 370 patients with chronic pancreatitis, complicated by pancreatic pseudocyst occurrence, was analysed. Differentiational approach to operative intervention permitted to reduce the frequency of conduction of resections by 21.5%, replacing them by enhancing the quantity of drainage operations, what permitted to lower the occurrence of postoperative complications and to improve late follow-up result of treatment.

[The diagnosis and surgical treatment of complicated forms of chronic pancreatitis]. / Diagnostika i khirurgicheskoe lechenie oslozhnennykh form khronicheskogo pankreatita.

The experience of surgical treatment of 517 patients with complicated forms of chronic pancreatitis (CP) was analyzed. In patients with the fibrotic CP without ductal hypertension, while involvement in the process of neighboring organs, the operations were conducted for the biliary and duodenal impassability elimination. The drainage operations of various types are indicated in fibrotic CP with ductal hypertension. In patients with fibrotic-degenerative CP the resectional methods were applied. Postoperative mortality have constituted 1.9%. Good and fair result of treatment in the late follow-up period was achieved in 75.7% of patients due to application of the proposed differentiative tactics.