[Preoperative portal vein embolization: dynamics of portal pressure].

The pressure dynamics was studied in a portal vein (PV) in patients, suffering focal hepatic pathology, to whom portal vein embolization (PVE) was performed as a stage of preparation to radical hepatic resection. In 236 patients the immediate measurement of pressure in a PV was performed intraoperatively before and after PVE, in 26 - catheter for control portography and monitoring of pressure in a PV was left in its trunk for 24 h postoperatively. There was noted a pressure rising in a PV immediately after its embolization by 86.7%, positive correlation was established between PVE volume and pressure gradient in a PV before and after it. While doing monitoring during 24 h there was observed the pressure rising in a PV during 3 h after its embolization with subsequent lowering down to initial. Application of PVE as a preparation procedure for performance of extended hepatic resection, together with enhancement of residual liver minimizes sharp postresectional pressure rising in PV, what constitutes essential factor of the hepatocytes damage of residual hepatic part in immediate postoperative period.

[Prognostication of efficacy of simultant laparoscopic operations in accordance to the risk estimation scale, and the method of establishing of indications and contraindications].

Experience of surgical treatment was summarized and its results were analyzed in patients, suffering biliary calculous disease, coexistent with other surgical diseases of abdominal organs. Main aspects of diagnosis and prognosis for efficacy of simultant operations were presented, and there were also adduced the method of prognosis of the operative treatment results in such patients, the proposed principle of determination of indications and contraindications for performance of simultant laparoscopic operations, a scale of the risk estimation for performance of such operative interventions.

[Results of preoperative embolization of portal vein in patients with biliary hepatic tumors].

The results of preoperative embolization of portal vein (EPV) in 90 patients, operated on for biliary hepatic tumors, were analyzed. In 47 patients Klatskin tumor was revealed, in 29--peripheral cholangiocarcinoma, in 14--tumor of a gallbladder. In all the patients a radical major hepatic resection was planned, a checking hepatic volume (CHHV) did not exceed 40% of a noninvolved parenchyma. The EPV volume have corresponded generally to the planned resection volume. After performance of EPV a pressure in a portal vein have risen by 75%, and later it have had lowered step by step during 24 h. The CHHV index have raised from (354 +/- 72) up to (462 +/- 118) cm3, or from (33 +/- 7) up to (45 +/- 11)%, permitting to perform radical hepatic resection in 79 (87.8%) patients. Thus, application of EPV in patients, suffering biliary hepatic tumors, have permitted to increase the CHHV index after radical resection, and to raise resectability of such tumors.

[Experience of ASVS-test application in diagnosis of insulin-producing pancreatic tumor].

In 2009-2013 yrs in 7 patients, suffering insulin-producing pancreatic tumors, the ASVS-test was conducted, the result of which was compared with data of standard methods of investigation, including abdominal ultrasound, computer tomography and magnetic resonance imaging. The insuloma enucleation was performed in 3 patients, distal subtotal pancreatectomy with splenectomy--in 1 and the completed total pancreatectomy--in 1. The ASVS-test conduction is indicated in patients with diagnosed hyperinsulinism while impossibility to perform a topic diagnosis of insulinoma, in accordance to data of other noninvasive methods of diagnosis.

[Simultant laparoscopic operations for biliary calculi disease and hernia of the anterior abdominal wall].

The results of treatment of patients, in whom biliocalculous disease and hernia of anterior abdominal wall were diagnosed, were analyzed. The main aspects of diagnosis and prognosis of simultant operations in such patients, some technical procedures of operative interventions were depicted. Indications for performance of simultant completely laparoscopic and simultant laparoscopic combined operations in these patients were determined.

[Remote results of endoprosthesis of the infrarenal aorta aneurysm].

Endovascular endoprosthesis of infrarenal aorta aneurysm (EEIAA)--is miniinvasive highly technological method of treatment of a life-threatening disease. The rate of the endovascular interventions conduction for aortal aneurysm enhances every year in the world, the prosthesis construction and operative technique are upgrading constantly. The experience of the EEIAA endoprosthesis in 75 patients, aged 51-80 years old, 70 men and 5 women, was presented. The aneurysm size was from 4.3 to 8 cm. Preoperative examination of the patients have included the ultrasound scanning, computeric tomography (CT). Among existing complications there is haemorrhage from the access site more than 500 ml in volume, demanding the erythrocytic mass transfusion in 2 patients. The patients were followed up from 1 mo till 7 yrs. A hospital lethality was absent. Major cardiovascular accidents in the terms of observation up to 30 days postoperatively were absent. During the follow up period the mortality, connected immediately with the abdominal aorta aneurysm rupture, was absent.

[The role of transjugular hepatic biopsy in preparation of the patients for the large hepatic resection].

The results of transjugular hepatic biopsy (TJHB) were analyzed in 32 patients, in whom the performance of hepatic radical resection was planned for the focal hepatic diseases. The biopsy procedures have had succeeded in 100% of observations. The severe complications were absent. The specimen length have constituted 12 mm at average, fragmentation was noted in 32% of observations. All the specimen were recognized as affordable for histological studying. In 24 patients in terms of 2-4 weeks after biopsy the embolization of lobar branches of portal vein was performed with the objective to enhance the assumed residual hepatic volume. In all the patients in terms of 2-8 weeks the spacious radical hepatic resection was succeeded. The data obtained witness that application of TJHB is expedient in the patients, who are prepared for spacious radical hepatic resection, for estimation of the organ parenchyma state and prognostication of postoperative hepatic insufficiency.

[Diagnosis and treatment tactics for complicated pancreatic pseudocysts].

Experience of 84 patients treatment for complicated pancreatic gland pseudocysts is presented. Tactics of diagnosis and treatment for complicated pancreatic gland pseudocysts was elaborated and substantiated. Individualized treatment-diagnosis approach provides, first of all, the complications elimination, an adequate surgical treatment of pancreatic gland pseudocyst is possible in late period. For complicated pancreatic pseudocysts treatment miniinvasive methods were used predominantly, when their application is impossible or fails the open procedure is performed.

[A portal vein branch embolization as a method of preparation for liver resection].

The results of preoperative transcutaneous transhepatic embolization of portal vein (PTTEPV) were analyzed in 86 patients, suffering malignant hepatic tumors. Depending on a planned hepatic resection (HR) volume there was conducted embolization of a right lobar portal vein (in 45 patients), right vein with a vein of C(IV) segment (in 32), lobar portal vein with anterior right vein (in 9). In 3-4 weeks after PTTEPV there was noted the enhancement of ratio of a planned residual hepatic volume/total hepatic volume from 16.3 to 27.5%, permitting to perform HR successfully in these patients. In 4 (4.7%) patients HR was not performed because of progressing of the tumor development or a total thrombosis of portal vein. The data obtained witness, that PTTEPV constitute an effective method of the patients preparation for HR while presence of a planned small residual hepatic volume.

[Roentgeno-endovascular surgery of tumoral and traumatic injuries of the liver]. / Rentgenoéndovaskuliarnaia khirurgiia opukholevogo i travmaticheskogo povrezhdeniia pecheni.

In 17 patients with primary and metastatic hepatic cancer there was performed roentgenoendovascular occlusion (REO) of a. hepatica propria using fine disperse embolizing substances. In 30 patients regional infusion therapy (RITH) was conducted using preparations of platinum. In 11 patients REO was performed, and than--RITH. Chemical embolization of a. hepatica propria using cisplatinum in 200 mg dose, suspensed in 12 ml of mayodil or ethiotrast was done in 12 patients. The survival index for patients, to whom REO was conducted, had constituted at average (15.3 +/- 3.3) months, RITH--(14.4 +/- 2.6) months, REO and RITH--(20.6 +/- 3.2) months, chemical embolization--(18.3 +/- 1.5) months. REO of a. hepatica propria was conducted also to the patients with posttraumatic hemobilia. Of 16 examined patients REO using polyurethane emboli 2-2.5 mm in diameter was conducted in 14, in 2 trans-hepatic injection of ethanol in the pseudoaneurysm cavity was applied. Hemorrhage was stopped in all the patients. In 1 patient in 3 months after REO conduction recurrency occurred, which was eliminated by repeated REO. REO of tumoral and traumatic hepatic affection constitutes an effective miniinvasive method when operative intervention is ineffective or not possible to perform.

[Mini-invasive endovascular procedures in patients with complicated portal hypertension]. / Vypolnenie miniinvazivnykh éndovaskuliarnykh vmeshatel'stv u bol'nykh s oslozhnennoi portal'noi gipertenziei.

Experience of application of endovascular methods of treatment of complicated portal hypertension--embolization of hepatic, splenic and left gastric arteries--was summarized, their efficacy was estimated, indications to their conduction was substantiated. Most effective method of endovascular treatment of patients with complicated portal hypertension is durable parenchymatous--truncular embolization of splenic artery.

[The measurement of linear dimensions from the x-ray image on a video monitor]. / Izmerenie lineinykh razmerov po rentgenovskomu izobrazheniiu na videomonitore.

The proposed method for measuring the linear dimensions of viscera from their X-ray image on a video monitor is that a uniform X-ray contrast is placed on a recording screen, which fixes the image of a point object (for example, a catheter tip) which is situated in the plane of the required size. The patient is transferred in parallel with the screen at a given distance. Before and after transfer, a ratio of the scale change in the position of a point object image to its actual change is calculated. The ratio is used to measure any linear dimensions in the plane of an object.