[INDIVIDUAL SURGICAL ТАCTICS IN PATIENTS, SUFFERING CHRONIC PANCREATITIS].

Results of surgical treatment for various clinic-morphological forms of chronic pancreatitis were presented. Efficacy of surgical treatment of the patients, using elaborated individual tactics, was analyzed. There was noted, that morphological changes in the pancreatic gland tissue determines peculiarities of surgical tactics for individual patient. Оperative interventions must be performed for the pain syndrome, for the foregut and common biliary duct impaction, as well as acidic affection of pancreatic gland, fibrous pancreatitis. Indications for miniinvasive operations for chronic pancreatitis were substantiated. While estimating efficacy of miniinvasive and radical operative interventions for chronic pancreatitis a lesser postoperative morbidity and lethality rate was noted, when miniinvasive procedures were applied.

[LIFTING LAPAROSCOPY IN SIMULTANT SURGERY].

Results of treatment of 84 patients, to whom simultant operative interventions on abdominal, the small pelvis and retroperitoneal organs were performed for concomitant somatic diseases, were analyzed. The author's technology of laparolifting was applied in 36 patients, and classical technology with carboxyperitoneum adjustment - in 48. Variants of optimal operative accesses were determined, structure and rate of postoperative complications, peculiarities of the early postoperative period course studied. Indisputable advantages of the lifting laparoscopic operations were established, including reduction of the postoperative complications rate and severity, the postoperative pain syndrome intensity, the concurrent chronic diseases exacerbation rate, and postoperative stationary stay.

[Experience of simultaneous laparoscopic cholecystectomy and gynecologic operations performance in conditions of "withous gas" laparoscopy in patients of high operation-anesthesiology risk].

The results of laparoscopic cholecystectomy performance in a combination with laparoscopic gynecologic operation on the background of concomitant cardiovascular and pulmonary diseases were analyzed in 67 patients. In 26 patients (main group) the original lifting system was used, 41 (control group)--operated on classical technology. Optimal operative accesses variants a defined, carboxyperitoneum influence on the central hemodynamics in the postoperative period, time of restoration of patients, frequency of postoperative complications is studied. It is revealed that simultaneous lifting laparoscopic operations possess have conclusive advantages: frequency and severity of postoperative complications decrease, intensity of a postoperative pain syndrome, frequency of concomitant chronic diseases exacerbations, and duration of hospital treatment after operation.

[Influence of membrane plasmapheresis on the course of endotoxemia in acute destructive pancreatitis].

The results of complex treatment analysis in 147 patients with acute destructive pancreatitis from 2006 to 2012 was made. In membrane plasmapheresis application the reduction of pain and improvement of general condition observed rapidly. By the end of the second day the activity of amylase decreased by 53% urea and creatinine level--by 62 and 56% compared with baseline. Decreasing of the necrotic suppurative complications rate in the main group--15.4%, in control--32.8%, mortality--accordinty 14.1 and 27.6%.

[Functional state of the hemostasis system in patients, operated for pancreatic pseudocysts].

Operative treatment of pancreatic pseudocysts coincides with the indices of the blood coagulation system change, which are characterized as a hypercoagulative. These disorders are noted in 12-24 h postoperatively, their rate is reducing substantially while application of pentoxyphylline. Most significant lowering of intraoperative hypercoagulation was noted while application of endoscopic drainage with the pseudocysts cavity stenting.

[Reconstructive-restorative operations in patients after obstructive resection of the large intestine].

There were analyzed the results of treatment of 85 patients, in whom colostomy with obstructive resection of large bowel (Hartmann type operations) was performed. Optimal terms (two months after the first stage) of reconstruction-restoration operations were proposed as an important factor of social and psychological rehabilitation of the patients. The anastomosis sutures insufficiency have had occurred in 3 (3.5%) patients, two patients died.

[Comparative efficacy of various variants of pancreaticoduodenal resection according to the results of early postoperative period].

Pancreatoduodenal resection (FOR) was performed in 131 patients: in 105--for pancreatoduodenal zone cancer and in 26--for fibrous chronic pancreatitis. The elaborated procedure for pancreatojejunoanastomosis formation, performed on reconstructive stage of PDR, secures the total complications rate lowering, comparing with such in conventional procedure with end to end aniastomosis suturing and after terminolateral anastomosis formation in 1.42 and 1.62 times, according. Cryodestruction secures the lowering of the total complications rate and the complications rate while usinn various variants of the PDR on reconstruction state.

[Comparative efficacy of pancreatoduodenal resection using intraoperative cryo-techniques].

In 61 patients pancreaticoduodenal resection (PDR) was performed: for pancreatic gland head cancer-in 29, periampullar zone cancer--in 20, chronic pseudotumoral pancreatitis--in 12. In 10 patients, suffering pancreatic gland and periampullar zone cancer, complicated by solitary hepatic metastases, PDR was added by cryodestruction of metastases. Cryoaffection on pancreatic gland stump during PDR performance have resulted in lowering of early postoperative complications frequency (pancreatic fistula, parapancreatic septic inflammation and an acute pancreatitis) and of chronic pancreatitis acute phase evolvement risk in the late postoperative period. Cryodestruction of hepatic metastases have promoted the patients survival median increase.

[The change of the patients organism immune reactivity in complicated chronic pancreatitis while performance of complex treatment].

The indices of the operated patients organism immune reactivity were studied in complicated chronic pancreatitis. Optimal restoration of the cellular and humoral immunity indices was noted in application of laparoscopic technologies together with pentoxiphylline, which promotes the reduction of proinflammatory cytokines freeing.

[Functional state of the liver in patients with an acute destructive pancreatitis in the early postoperative period].

The efficacy of conventional complex treatment and such, including pentoxyphylline, lipoic acid and the aminoacids mixture, was studied in early postoperative period in 64 patients with an acute destructive pancreatitis. The highest levels of general and direct bilirubins, the aminotransferases activity were established initially in those patients, in whom the polyorgan insufficiency syndrome (PIS) occurred subsequently. More significant normalization of the indexes under the influence of treatment was observed in patients without PIS, in patients with PIS the pharmacological resistance was registered. More favourable course of postoperative period was observed in patients, in whom pentoxyphylline, lipoic acid and the aminoacids mixture were included in complex of treatment.

[Changes of cytokine levels in the serum in patients with acute pancreatitis as an early symptom for diagnosis]. / Zminy kontsentratsiï tsytokiniv syrovatky krovi na hostryi pankreatyt iak rannii diahnostychnyi kryterii.

Changes of concentration of proinflammatory cytokines--tumor necrosis factor (TNF), interleukin-1, growth transforming factor, granulocyte--macrophage colony stimulating factor in the blood serum of patients with probable diagnosis of an acute pancreatitis (AP) were examined. Seven days before the disease occurrence the TNF concentration rise was observed, what proved, by the authors opinion, its significance as an early diagnostic criterion for AP. Other diagnostic methods did not prove their information value in determination of the disease occurrence during the 7 day premorbid period.

[Changes in free amino acid plasma levels in patients with acute pancreatitis and their correction with early parenteral feeding]. / Izmeneniia urovnia svobodnykh aminokislot v plazme krovi bol'nykh ostrym pankreatitom i ikh korrektsiia s pomoshch'iu rannego parenteral'nogo pitaniia.

The lowering of general pool of free amino acids in the blood plasma by 54.9%, comparing with their content in practically healthy persons, was observed in 17 patients with an acute pancreatitis. And by this the content of the majority of amino acids was lowered, excluding glutamate, phenylalanine and methionine, the level of which had raised. Under the conventional treatment influence the amino acids concentration had enhanced and constituted 60% from such in the control group, while in application of parenteral nutrition (intravenous infusion of the infezol 40 solution)--85.9%. By that the formation of the polyorganic insufficiency syndrome was not noted and the level of each amino acid had normalized.

[Surgical techniques in complicated chronic pancreatitis]. / Khirurgicheskaia taktika pri oslozhnennom khronicheskom pankreatite.

The experience of surgical treatment of 77 patients with complicated chronic pancreatitis was summarized. Among the operations conducted were: internal drainage, including cystogastrostomy-in 24, cystoduodenostomy-in 9, cystojejunostomy-in 12, fistulojejunostomy-in 2, longitudinal pancreatojejunostomy-in 17, and pancreatic gland resection (proximal-in 2 and distal one-11). After the operation 4 (5.1%) patients died.

[The change of interleukin-1 levels in the blood of patients operated on for an acute pancreatitis]. / Izmenenie urovnia interleikina-1 v krovi patsientov, operirovannykh po povudu ostrogo pankreatita.

During 42 patients examination, operated on for an acute pancreatitis it was established, that while favorite postoperative period course the interleucin-1 level had lowered substantially, and while unfavourable-rised.

[Changes in blood enzyme activity and tumor necrosis factor level in the treatment of experimental pancreatitis with pentoxifylline]. / Izmenenie aktivnosti fermentov krovi i urovnia faktora nekroza opukholi pri lechenii éksperimental'nogo pankreatita s primeneniem pentoksifillina.

It was established in an acute experiment on rats of Wistar line while an acute pancreatitis simulation using the pancreatic tissue freezing that the level of a tumor necrosis factor (TNF) in a blood serum was maximal in 4 hours from the cold action onset, the activity of amylase and trypsin was heightened and trypsin activity inhibitor (TAI) had lowered. Intraperitoneal application of pentoxifylline in 100 mg/kg dose twice daily have promoted the significant lowering of TNF contents, the amylase and trypsin activity as well, and the TAI concentration increase.

[The function of the thiol-disulfide and ascorbate systems in patients operated on for acute pancreatitis after the use of low-intensity infrared laser radiation and pentoxifylline]. / Sostoianie tiol-disul'fidnoi i askorbatnoi sistem u bol'nykh, operirovannykh po povodu ostrogo pankreatita, posle primeneniia nizkointensivnogo lazernogo izlucheniia infrakrasnogo diapazona i pentoksifillina.

In patients with an acute destructive pancreatitis the lowering of sulphhydride (SH) groups in proteinic and nonproteinic fraction of the blood plasma, the reduction of the ascorbic acid level and increase of its oxidized forms concentration was noted. After the operation the disordered indexes have restored, moreover, and after the programmed relaparotomy conduction--as after a single operative intervention. Acceleration of the disordered indexes restoration was promoted by application of pentoxifylline and low-intensity laser irradiation as well.

[Changes in lipid metabolism and indicators of immunological reactivity in programmed relaparotomy in acute pancreatitis]. / Izmeneniia zhirolipidnogo obmena i pokazatelei immunologicheskoi reaktivnosti v usloviiakh programmiruemoi relaparotomii pri ostrom pankreatite.

The increase of low-density lipoproteids contents, high-density lipoproteids level lowering, reduction of the lymphocytes blast transformation reaction indexes, IgG level lowering, the rosette formation reduction were noted in patients with an acute pancreatitis. While the programmed relaparotomy application of the lipid-aliphatic metabolism restoration was noted, and the immunological reactivity as well with the dynamics higher than after single operative intervention conduction.

[The method of integral estimation of a functional status of the hemostatic system]. / Sposob integral'noi otsenki funktsional'nogo sostoianiia sistemy gemostaza.

The instrumental method of the integral assessment of functional state of the hemostasis system using piezoelectric hemoviscosigraphy was elaborated.

[Performance of simultaneous operations in surgery]. / Primenenie simul'tannykh operatsii v khirurgii.

The experience of conduction of simultaneous operations in 183 patients is summarized. The indications and advantages of their application are substantiated.