[CAUSES AND WAYS OF THE NECK PHLEGMON SPREADING ON MEDIASTINUM WITH A DESCENDING PURULENT MEDIASTINITIS OCCURRENCE].

Results of treatment in 2000-2016 yrs of 183 patients for the neck phlegmon were analyzed. In 60 (32.8%) of them a descending purulent mediastinitis (DPM) was diagnosed. The main causes of the DPM occurrence were tonsilogenic and odontogenous factors. Postoperative lethality in DPM have constituted 25%.

[MORPHOLOGIC CHANGES OF INTRA- AND EXTRAPANCREATIC ARTERIES IN ELDERLY AND SENILE PATIENTS IN ACUTE NECROTIC PANCREATITIS].

In 38 elderly and senile patients, in whom an acute necrotic pancreatitis (ANP) was diagnosed, morphological changes in the walls of intra- and extrapancreatic arteries were studied, including dorsal pancreatic artery, big pancreatic artery (Heller) and their branches. The patients were operated, using open surgical access, on the 10 - 26-th day after admittance to hospital for purulent-septic complications of pancreonecrosis. In total 9 (24%) patients died. Changes of intra- and extrapancreatic arteries causes the essential reduction of the splanchnic blood flow intensity and necrotic changes in pancreatic parenchyma and parapancreatic cellular space.

[MINIINVASIVE AND ENDOSCOPIC METHODS OF TREATMENT OF POSTNECROTIC PANCREATIC PSEUDOCYSTS].

The results of treatment of 89 patients, suffering an acute accumulations of liquid (AAL)and postnecrotic pancreatic pseudocysts (PPP) on background of an acute necroticpancreatitis, were studied. The volume of AAL and PPP have constituted from 65 to2750 cm3. The alcohol abuse and alimentary factor--in 63 (70.7%) patients, biliary calculous disease--in 21 (23.6%), and other--in 5 (5.7%) have constituted the diseasecauses. In 33 (37%) patients miniinvasive interventions were performed, and in the rest--the endoscopic. Miniinvasive and endoscopic interventions for PPP were done in 4-8 weeks from the disease beginning.

[THE PLACE OF PANCREATICODUODENAL RESECTION IN SURGICAL TREATMENT OF COMPLICATED FORMS OF CHRONIC PANCREATITIS].

Results of surgical treatment of 120 patients, suffering complicated forms of chronic pancreatitis, were analyzed. In 5 patients pancreaticoduodenal resection in accordance to Whipple method have constituted the operation of choice. The indications for operation were: impossibility to exclude completely the malignant process inside pancreatic head; enhancement of the pancreatic head, causing duodenal, common biliary duct and the pancreatoduodenal zone vessels compression; cystic changes of pancreatic head with several episodes of hemorrhage inside the cyst and duodenum. The immediate, short-term and intermediate results of the operation were estimated as good and satisfactory.

[SURGICAL TREATMENT OF POSTOPERATIVE STRICTURE OF ANAL CHANNELL].

The results of treatment of 50 patients, suffering postoperative stricture of anal channell (SACH), who were treated in Proctology Department of Ivano-Frankivskiy Rural Clinical Hospital in 2006-2014 yrs, were analyzed. After conduction of hemorrhoidectomy in accordance to Milligan-Morgan method for chronic hemorrhoids grades III-IV a SACH have occurred in 46 (92%) patients, excision of a chronic anal fissura was performed in 3 (6%) and excision of perianal pointed condylomas--in 1 patient. In 2006-2007 yrs 11 (22%) patients were operated in accordance to approaches, which were conventional at that time (comparison group). In 2008 - 2014 yrs 39 (78%) patients were admitted to hospital (main group), in whom new approaches for diagnosis, conservative and surgical treatment were applied, 30 (76.9%) of them were operated. The proposed method on isolated roentgen contrast investigation of anal channell have permitted to determine objectively a form, diameter and grade of the anal channel stricture, and it may be applied as a screening procedure, as additional objective criterion while choosing a surgical tactic. Application of the improved operative technique for SACH have permitted to lower its occurrence rate from 45.4 to 6.7%.

[Endoscopic transpapillary interventions in chronic pancreatitis].

The results of treatment of 12 patients, suffering complicated forms of chronic pancreatitis (CHP), in a General Surgery Department of Ivano-Frankivsk regional clinical hospital in 2011 - 2013 yrs, were analyzed. There were 10 (83.3%) men and 2 (16.7%) women, ageing 22-57 yrs old. Previously 6 (50%) patients were treated for an acute necrotic pancreatitis. The changes in a pancreatic duct (PD) type IV in accordance to Cambridge classification was established in 7 patients, type III--in 3, type IIa--in 2, type IIb--in 1. Virsungolitoextraction with previous pneumodilatation without stenting of PD was accomplished in 4 patients, stenting with pneumodilatation for stricture of PD--in 6, stenting for defect in PD--in 2. Good and satisfactory results were achieved in all the patients. The pain syndrome was absent in 10 (83.3%) patients, 2 (16.7%)--suffered from periodic moderate pain in epigastric region. Endoscopic interventions on the PD must be considered the first stage of surgical treatment in patients with CHP. They must be applied wider due to their reduced invasiveness than open procedures. Open operative intervention must be considered as a second stage of surgical treatment in patients with previous unfair or ineffective endoscopic treatment.

[Prognostication of acute-pancreatitis-associated pulmonary injury based on determination of cytokines levels].

The results of examination of 68 patients, admitted to hospital for an acute pancreatitis during 48 h from its occurrence, were analyzed. In all the patients the cytokines (IL-8, IL-10, TNF-alpha) content was determined in the blood, using immunoenzymal analysis. Algorithm of prognostication of an acute pancreatitis-associated pulmonary injury, basing on determination of the cytokines contents, was elaborated.

[Peculiarities of treatment of the aged and elderly patients with acute pancreatitis].

The results of treatment of 99 elderly and senile patients, suffering an acute pancreatitis in period of 2005 - 2013 yrs, were analyzed. Interstitial acute pancreatitis was diagnoses in 36 (36.3%) patients, focal pancreatic necrosis--in 32 (32.3%), total-subtotal pancreonecrosis--in 31 (31.3%). Miniinvasive interventions were performed in 40 (63.4%) patients, the open--in 24 (38%). The main indication for laparotomy conduction were purulent-septic complications, which is impossible to eliminate while miniinvasive methods application. Due to application of the staged treatment tactics with predominant application of miniinvasive methods, extracorporeal detoxication and improvement of the intensive therapy measures postoperative lethality in necrotic acute pancreatitis have had lowered from 16.7 to 10.3%.

[Thoracoscopic fenestration of pericardium during the treatment of patients, suffering exudative pericarditis].

There were examined 67 patients, treated in the Thoracic Department of Rural Ivano-Frankivsk Clinical Hospital for exudative pericarditis in 2005-2009 yrs. In 27 (40.2%) patients a fenestration of pericardium was performed, using videoassisted thoracoscopy (VATHS), and in 40 (59.8%) - a pericardium cavity puncture according to Larrey method. The results of surgical treatment were analyzed, comparative estimation of the every method efficacy was conducted. The advantages of VATHS application with pericardium fenestration in patients, suffering exudative pericarditis, were proved. Indications for the VATHS application in patients, suffering exudative pericarditis, were determined.

[Surgical treatment of sacrococcygeal epithelial fistula and dermoid cysts].

The results of surgical treatment of 246 patients in Department of Proctology of Ivano-Frankivsk regional clinical hospital in 2000-2008 yrs were analyzed. There were 232 men and 14 women ageing 18-46 years old. There were admitted to the hospital 38 (15.4%) patients for coccygeal epithelial fistula (CEF) abscess and 6 (2.9%)--for atypical localization of CEF. In 12 (5.8%) patients dermoid cyst of sacrum region was diagnosed. Radical excision of all CEF with suturing of the cutaneous--subcutaneous layers edges to the yellow ligaments edges or periosteum of cristae sacralis medianae in the wound bottom was performed in 76 (84.6%) patients. In 32 (15.4%) patients, after radical excision of CEF, the operation was concluded by mildly approximating interrupted suturing with the wound tamponade, using the gauze band. In 12 (4.9%) patients the radical excision of dermoid cyst with suturing of the skin edges and subcutaneous layer to the wound bottom was made. The abscess revision and restricted necrectomy was performed, the wound was managed, using open method, in 38 (15.4%) patients, suffering CEF abscess. Radical operative intervention was performed in 2 - 4 months. The disease recurrence had occurred in 3 (1.28%) patients due to performance of insufficiently radical excision of ECF.

[Mini-invasive methods in the treatment of abdominal sepsis caused by abdominal cavity abscess].

In 2002-2008 yrs 85 patients were treated for abdominal cavity abscess (ACA). Hepatic abscess was revealed in 41 (33.6%) patients, subhepatic one--in 14 (16.5%), right-sided subdiaphragmatic--in 12 (14.1%), left-sided--in 18 (21.2%). In 42 (49.4%) patients abdominal sepsis was diagnosed, of them in 25 (29.4%)--severe one, in 18 (21.2%)--polyorganic insufficiency syndrome. For ACA in 67 (78.8%) patients the puncture--drainage interventions under ultrasonographic guidance were performed and in 18 (21.2%)--laparotomy. Miniinvasive interventions application in 48 (56.5%) patients had permitted to remove the sepsis signs already on the third--fifth day. In 19 (22.4%) patients in severe sepsis veno--venous hemodyafiltration was used for extracorporeal detoxication performance. Twelve (14.1%) patients died.

[Modern strategies in surgical treatment of acute necrotic pancreatitis]. / Suchasna taktyka khirurhichnoho likuvannia hostroho nekrotychnoho pankreatytu.

The experience of surgical treatment of acute necrotic pancreatitis (ANP) in 172 patients in 1997-2002 were summarized. We started therapy from conservative treatment. In 43 (25%) patients with ANP video laparoscopic intervention in enzyme-toxic period were performed. In 32 of them we avoided laparotomy. Percutaneous intervention under the control of ultrasound imaging was conducted in 130 (75.6%) patients. This procedure was final in 81 patients, 58 (33.7%)--underwent laparotomy, in 42 of them concerning ANP. Postoperative mortality was 11.1%. Individual approach, strict following the tactics chosen, wide use of miniinvasive techniques in deferred period when necessary, laparotomy ensures significant progress in the treatment of ANP.

[Dynamic biliary manometry: display modelling and graphic interpretation]. / Dynamichna manometriia: stendove modeliuvannia ta hrafichna interpretatsiia.

Tendencies of development of biliary manometry have been analyzed. Key advantages and problems of manometric investigation of biliary tracts have been summarized. New method of graphic registration and pressure monitoring in biliary tracts called biliary manometry has been suggested. Characteristic types of manometric curves were determined using stand modelling, their physical and mathematical analysis was conducted, clinical analogues have been suggested. The emphasis has been made on expediency of its further elaboration and clinical application.

[Diagnosis of the pancreonecrosis using the gas chromatography method]. / Diahnostyka hlybyny pankreonekrozu z vykorystanniam metodu hazovoï khromatohrafiï.

In 62 patients with various forms of an acute pancreatitis (AP) the contents of methane, oxygen, nitrogen, carbon dioxide gas in the blood, using the gas chromatography method, was studied up. In 55 patients with pancreonecrosis the changes of concentration of methane, oxygen and nitrogen had correlated with the disease course severity, the data of ultrasound investigation and bolus computer tomography. Basing on the investigations performed in 62 patients with an AP, in 12--with other acute surgical diseases of abdominal cavity and in 20 healthy persons, it was established the possibility of determination of the methane level in the blood as a criterion of the various forms of pancreonecrosis diagnosis and the method of its diagnosis was proposed.

[Minimally invasive interventions for concurrent diseases of extrahepatic biliary ducts and pancreas]. / Miniinvazyvni vtruchannia z pryvodu poiednanykh zakhvoriuvan' pozapechinkovykh zhovchnykh protok ta pidshlunkovoï zalozy.

The results of treatment of 689 patients with calculous cholecystitis and of 12 with cholecystogenic acute pancreatitis (AP), to whom laparoscopic interventions were performed, are adduced. In 50 patients the indexes of operative stress were studied up. The laparoscopic cholecystectomy efficacy was established in patients with cholecystogenic AP in the absence of obturational jaundice.

[Possibilities of transcutaneous intervention under ultrasonographic control in comprehensive treatment of severe necrotizing pancreatitis]. / Vozmozhnosti chreskozhnogo vmeshatel'stva pod kontrolem ul'trazvukovogo issledovaniia v komplekse lecheniia tiazhelogo nekroticheskogo pankreatita.

In 46 patients with an destructive acute pancreatitis (AP) the invasive intervention under control of ultrasonography, in 38 of them--in stage of purulent complications, was performed. It had promoted stabilization of state in 39 (89.8%) patients, normalization of clinic--laboratory indexes, that had permitted to realize radical operative intervention with minimum risk in perspective. Invasive intervention under control of ultrasonography--highly effective primary surgical manipulation in complex of treatment of the destructive AP severe forms.

[Surgical treatment of an acute destructive pancreatitis using laparoscopy and peritoneal dialysis]. / Khirurhichne likuvannia hostroho destruktyvnoho pankreatytu z vykorystanniam laparoskopiï ta perytoneal'noho dializu.

Laparoscopic intervention was performed in early stages of acute destructive pancreatitis in 34 patients. In 23 patients after draining of the abdominal cavity the laparoscopic intermitting peritoneal dialysis with application of the "Gambro" firm solutions during 2-4 days was done. Efficacy of the proposed method of detoxication in complex treatment of patients was established.