[[Development of Surgical Gastroenterology in Prikamye].]

THE PURPOSE: To present the history of surgical gastroenterology in Perm krai. MATERIALS AND METHODS: Narrative, historical, genetic, comparative and structural. RESULTS: In the early 20th century the main method of surgical treatment of peptic ulcer was gastroenteroanastomosis. A significant number of recurrences resulted to distal gastrectomy implementation in the 30s in the Clinic of hospital surgery of Perm medical institute, led by professor M.V. Shats. It was also performed in major cities of the region: Lysva, Kungur, Berezniki, Kizel, Osa. Treatment of ulcer perforation and bleeding was accomplished at the department of surgical diseases of pediatric faculty, led by Professor V. N. Repin. He also developed vagotomy and methods of diagnostics and treatment of diseases of operated stomach. Comorbidity was also researched. The combination of liver and biliary tract diseases was re- searched in the Hospital surgical clinic of Perm, initially led by Professor S. Yu. Minkin and then by academician E. A. Wagner (L. F. Palatova). The results of surgical treatment of cholelithiasis, depending on morphological and biochemical abnormali- ties in liver and chemical composition of gallstones were studied (L. P. Kotelnikova). Indications for surgery in cholelithiasis in conjunction with pathology of stomach, duodenum and liver were defined (A.V. Popov). The results of surgical treatment of biliary pancreatitis and cholangitis (L. B. Guschensky), and diseases of stomach, duodenum and pancreas with cholelithiasis were obtained (D.V. Shvarev). CONCLUSION: The priority trends of research of Perm scientists were treatment of post-resection syndrome, arteriomesen- terial obstruction, pathogenesis of gallstone disease and its combination with other disorders of the digestive system.

[Effectiveness of external drainage of the common bile duct]. / Otsenka éffektivnosti naruzhnogo drenirovaniia obshchego zhelchnogo protoka.

Influence of different methods of external drainage of the biliary tract on dynamics of inflammation in the biliary tracts was evaluated based on the data examination of bioimpedance, specific electric conductivity and general microbial number of bile received during surgery and from drainage of the common bile duct during 9 days after surgery in 197 patients with cholelithiasis complicated by bile outflow disturbances. It is demonstrated that each type of external drainage has own indications depending on the degree of bacterial contamination, macroscopic structure, biophysical parameters of bile, and planned treatment policy after surgery. Right fixation of the drainage tube in the common bile duct improves immediate results of surgical treatment of patients with cholelithiasis.

[The parameters of physico-chemical properties of bile and urine in the diagnosis of pancreatitis associated with cholelithiasis]. / Pokazateli fiziko-khimicheskikh svoistv zhelchi i mochi v diagnostike pankreatita v sochetanii s kholelitiazom.

Specific electrical conductance (SEC) of the hepatic bile in 94 patients with cholelithiasis and concomitant pancreatitis was increased (p < 0.001) and depended on the degree of cholestasis and the morpho-functional state of the liver. The value of SEC of the intraoperative bile higher than 193 S/m is taken for a criterion of the diagnostics of biliary pancreatitis. The electrical conductance of urine during the first 4 days of observation decreased in patients with acute pancreatitis (p < 0.05), impaired carbohydrate metabolism and concomitant renal dysfunction. The value of SEC of urine lower than 238 S/m corresponds to acute pancreatitis. The investigation of physico-chemical indices of biological liquids in patients with a pathology of the pancreato-biliary system allows to objectively control the course of the disease and to correct the treatment methods.

[Biophysical properties of bile and urine in patients with cholelithiasis]. / Biofizicheskie svoistva zhelchi i mochi u bol'nykh kholelitiazom.

The electric conductivity of the hepatic bile received during and 24 hours after surgery from the drainage introduced into the common hepatic duct was studied in 94 patients with cholelithiasis. It is demonstrated that conductivity increases in cholestasis, inflammatory process in the biliary tract and depends on the hepatic morphofunctional status. The specific electric conductivity of intraoperative bile that is more than 192 S/m is considered to be criteria for the diagnosis of cholangitis. The electric conductivity of urine before and in first 4 days after surgery decreases in inflammation of the biliary tract and depends on the degree of concomitant renal dysfunction and electrolyte disturbances. There was a decrease in the conductivity of bile and urine in all studied groups. Detection of biophysical parameters of biological fluids may objectively control the postoperative period and correct treatment policy.

[Antioxidants in the treatment of cholelithiasis patients]. / Antioksidanty v lechenii bol'nykh kholelitiazom.

Results of examination and treatment of 157 patients with cholelithiasis against the background of a liver pathology were summed up. The antioxidant system in such patients was studied. The degree of a decrease of catalase activity in the liver and blood serum as well as the ascorbic acid content were found to depend on the liver state of patients with cholelithiasis. Greatest changes were found in patients with cirrhosis of the liver and chronic active hepatitis. The method of complex treatment of cholelithiasis patients with non-enzymatic antioxidants alpha-tocopherol and ascorbic acid is proposed. Activity of organ specific liver enzymes urokaninase and histidase was used for the estimation of treatment efficiency. Complex administration of ascorbic acid and alpha-tocopherol was shown to improve the liver function in patients operated upon for cholelithiasis.

[Interrelations of changes in liver tissue and chemical composition of the bile and biliary calculi]. / Vzaimosviaz' izmenenii tkani pecheni, khimicheskogo sostava zhelchi i zhelchnykh kamnei.

The correlation between the degree of morphological alterations of the hepatic tissues, changes in the chemical composition of bile and bile stone structure was established after comparing clinico-laboratory findings, results of examinations of liver bioptates, chemical composition of the bile and bile stones in 216 patients with cholelithiasis. The formation of cholesterol and mixed stones in the gallbladder is in correspondence with mild alterations of the liver tissue and colloid stability of the hepatic bile. The formation of pigment stones in the gallbladder and common bile duct is considered to be a symptom of chronic hepatitis followed by deep alterations of the chemical structure of hepatic bile.