[Modern tendencies in diagnosis and treatment of an acute destructive pancreatitis].

The problem of an acute pancreatitis was one of "key" ones in investigations of A. A. Shalimov and his school. While the knowledge concerning the disease pathogenesis improved, diagnostic and treatment algorhythm elaborated, modern medicinal preparations and surgical treatment introducted, including miniinvasive technologies, so also approaches to treatment of patients, suffering an acute pancreatitis, have changed.

[Radical surgical treatment of cancer of periampullar zone organs].

Experience of treatment was analyzed of 862 patients with cancer of periampullar zone organs, to whom radical tumoral excision was performed in 1972-2005 yrs. Performance of radical operative intervention have permitted to achieve satisfactory late results in patients with tumor of duodenal major papilla and distal part of common biliary duct. Last years better immediate results of operative treatment were achieved due to postoperative mortality lowering.

[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.

[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.

[The treatment of acute pancreatitis]. / Lechenie ostrogo pankreatita.

Experience of surgical treatment of 721 patient with necrotic pancreatitis was summarized. Indications and tactics of treatment of patients with an acute pancreatitis (AP), methods of their conservative and operative treatment were substantiated. Classification of an AP was elaborated.

[The partial portosystemic shunting and its hemodynamic consequences]. / Partsial'noe portosistemnoe shuntirovanie i ego gemodinamicheskie posledstviia.

Complex hemodynamical investigations were done in 32 patients in 1985-1999 yr. period before the operation, in 6-8 and 12-24 mo after performance of the partial portosystemic shunting operation (in 8 patients mesentericocaval anastomosis was formed, in 10--central splenorenal anastomosis, in 12--splenorenal anastomosis side to side and in 2--lowermesentericorenal anastomosis). The performance of shunting operation had promoted the lowering of the blood flow volumetric velocity and of the pressure in v. cava as well, its diameter reduction, the lowering of general hepatic blood flow. The lowering of blood flow in the v. cava system after the shunting operation performance caused the arterial hepatic blood flow enhancement occurrence.

[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.

[Splanchnic circulation after distal splenorenal anastomosis in hepatic cirrhosis]. / Splankhnicheskoe krovoobrashchenie posle nalozheniia distal'nogo splenorenal'nogo anastomoza pri tsirroze pecheni.

While the result estimation of the distal splenorenal anastomosis formation operation, done in 12 patients according to the W. D. Warren method and in another 12 patients--according to the method, modified by K. Inokuchi, it was established that the hepatic portal perfusion loss causes compensational enhancement of blood flow in a. hepatica, including while the standard method application--by 22% and the modified one--by 8%. Doing the splenorenal venous disconnection improves the patients' quality of life due to the incidence rate of portosystemic encephalopathy reduction by 8.3%, and in this circumstances the life span and the hemorrhage recurrency rate do not differ with such while using the standard method.

[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.

[Modified strategy of the treatment of patients with necrotic pancreatitis]. / Modifitsirovannaia taktika lecheniia bol'nykh s nekroticheskim pankreatitom.

New principle of choice of the surgical treatment method in patients with necrotic pancreatitis was proposed: different operative procedures don't compete one another but are applied in accordance with the disease stage in dynamics. Such tactics permits to choose an optimal surgical approach in every phase of pathologic process course. From 1989 till 1992 the surgical treatment for necrotic pancreatitis was conducted to 54 patients. Pancreatic resection was done to 14 (25.9%) of patients, 4 of whom died. In necrotic focus delimitation or pancreatic tissue sequestration, observed in terms of more than 2 weeks since the disease beginning, necrectomy was conducted in 40 (74.1%) of patients, 4 of whom died.

[Cholecystectomy using minimal laparotomy approach]. / Kholetsistéktomiia s ispol'zovaniem minimal'nogo dostupa.

The results of operative treatment of 36 patients with chronic calculous cholecystitis with the use of minor laparotomy approach are presented. Early postoperative rehabilitation of the patients due to reduced trauma of the operative intervention permitted to shorten 2-times the duration of treatment. There were no postoperative complications.