[The multifocal breast cancer].

Survival data of patients with multifocal breast cancer in dependence on surgical resection volume were analyzed. Two types of surgery were performed: the modified radical mastectomy by Madden and radical resection of the mammary gland. It was stated, that organ-preserving operation in combination with complex adjuvant therapy of the multifocal breast cancer stage I-II did not lead to the decrease of the overall and recurrence-free 5 and 10-year survival rate.

[The substantiation of the method of gastrointestinal reconstruction after the gastric resection].

Functional results of 289 major gastric resections and gastrectomies were analyzed. New methods of the gastrointestinal reconstruction after these procedures. The comparative analysis of immediate and long-term results allowed to work out criteria of choice for the reconstructive procedure. Benefits of the suggested reconstructive techniques demonstrated with the use of modern diagnostic means.

[Results of dynamic observation of patients with polyps in the stomach].

This work is based on the analysis of data doing 409 patients with polyps in the stomach. Among them 200 men (48.9%) and 209 women (51.1%) aged 18 to 91 years. The average age of men was 67.4 years, and women 66.8 years. All these patients were find 1034 neoplasms of various sizes. At all of this patients polyps were identified on a background of chronic gastritis, as a rule, has the character of atrophic process. Histological research was conducted 775 (74.6%) polyps, of which focal hyperplasia and hyperplastic polyps detected in 49% of cases, and adenomas in 51% (including adenomas with varying degrees of dyspiasia, and prostatic adenocarcinoma cells). Endoscopic polypectomy performed 367 patients, and the remaining 42 was merely the dynamic monitoring of the identified entities. In 79 (28.8%) patients after polypectomy noted relapse formations and in 10 cases (3.65%) diagnosed with cancer in the intervention area. 4 (0.98%) patients from 409 cancer in polyps detected during the initial survey and in 4 patients the cancer originated in the not associated with polyps of stomach. As a result of the research of the dependence of the size of neoplasms on the nature of destruction and histological structure. For most existing polyps characteristic of the stability of their morphological structure and the absence of its transformation.

[Simultaneous laparoscopic cholecystectomy and gynecologic operative procedures].

Treatment results of 64 patients who had simultaneous laparoscopic cholecystectomy and gynecologic surgery were compared with treatment results of 66 patients after simultaneous laparoscopic cholecystectomy and gynecologic surgery, performed through laparotomy. The influence of carboxyperitoneum on central hemodynamics and terms of its normalization, time of patients' recovery and number of complications were thoroughly studied. Simultaneous laparoscopic surgery proved to be more preferable, allowing manipulations on different levels of the abdominal cavity, lower operative stress, earlier patient activization, better esthetic effect and economic profit.

[Diagnostics and surgical correction of postoperative myofascial defects of lateral abdominal wall and lumbar region].

Myofascial defects of lateral abdominal wall and lumbar region occur chiefly after lumbotomy--the most popular access in urosurgery. Meanwhile lumbotomy remains one of the most traumatic accesses through the lateral abdominal wall. Myofascial defects were diagnosed in 48,9% of operated patients with lumbotomy. Of them true postoperative hernias were found in 35,3%; neuropathic hernias - in 13,6%. Since 2002 the originally developed method of lateral abdominal wall reconstruction had been used for the treatment of such patients. The immediate and long-term results (maximal follow-up period 5 years) showed no hernia recurrence or complications in 26 operated patients.

[Endoscopic examination for diagnosis of cancer of major duodenal papilla].

Endoscopic procedures were used for diagnosis and treatment of cancer of major duodenal papilla (MDP) at 31 patients. Gastroduodenoscopy (with visual assessment) and endoscopic retrograde cholangiopancreatography were performed at all the patients. Morphological study of tissue sampling permitted to confirm preliminary visual diagnosis only in half of patients. Detection of x-ray symptoms and bile passage disorders at retrograde cholangiopancreatography were high informative. All the patients underwent endoscopic papillosphincterotomy which was effective at 26 (83.9%) patients.

[Diagnosis and treatment of sterile pancreonecrosis].

The experience in the treatment of 77 patients with sterile pancreonecrosis is analyzed. The importance of USE as an effective method of screening-diagnosis is emphasized. Computed tomography provides a more accurate diagnosis of pancreonecrosis and complications of it. Lethality in pancreonecrosis correlates with necrosis severity. More than 50% necrosis-affected parenchyma in combination with three and more systemic complications is an unfavorable prognostic factor. Hemofiltration and early management with carbapenem antibiotics arrest progression of multiorgan failure and pyoseptic complications in 75% of cases. Laparoscopic sanation of the abdominal cavity is necessary only for patients with peritonitis. This procedure may be supplemented with laparoscopic cholecystectomy and endoscopic papillosphincterotomy with lithoextraction directly during sanation.

[Comparative analysis of different methods in the treatment of patients with acute calculous cholecystitis and choledocholithiasis].

In the patients with different forms of cholelithiasis 1988 operations were performed, 597 of them - on account of acute calculous cholecystitis. In 118 (19%) patients with acute calculous cholecystitis choledocholithiasis was diagnosed. All the patients were divided into two groups. Group 1 consisted of 52 (44%) patients who have undergone conventional "open" operation with choledocholithotomy. Group 2 consisted of 66 (56%) patients treated with endoscopic techniques. In group 1 complications were seen in 4 (7.6%) patients, lethal outcome -- in 3 (5.7%), residual choledocholithiasis -- in 7 (13.4%). Mean hospital stay was 24.7 days. In group 2 complications were seen in 1 (2%) patient, residual choledocholithiasis -- in 1 (2%), there were no lethal outcomes. Mean hospital stay was 15.1 days. It is concluded that minimally invasive technologies in the treatment of acute calculous cholecystitis and choledocholithiasis improve results of treatment and shorten hospital stay.

[Triangular anastomoses in surgery of the stomach]. / Trianguliarnye anastomozy v khirurgii zheludka.

The mode of triangulation in the anastomoses of the stomach and the duodenum (thrice-repeated usage of linear suturing apparatuses in shaping anastomoses) is a perspective way for improvement of the results of surgical treatment of these organs. The results of 216 cases have shown that the use of the triangular anastomoses in gastric surgery allows a decrease in the rate of complications because of anastomosis failure in early postop period more than 3.5 times. The healing of such anastomoses proceeds by primary intention and in short terms and is accompanied by minimal inflammatory reaction. The course of restoration of the motor and evacuation function of the stomach after creation of such anastomoses is characterized by early, partial and timely evacuation. In remote postoperative period mechanical everted anastomoses, made up by linear suturing apparatuses, provide absence of the tendency for cicatricial strictures and stipulation of motor and evacuation functional characteristics of the stomach. The authors believe that beneficial impact of this method on gastric function allows to recommend it for wider use in surgery of the stomach.

[Difficulties, errors and complications in laparoscopic cholecystectomy]. / Trudnosti, oshibki i oslozhneniia pri laparoskopicheskoi kholetsistéktomii.

The work deals with the specific features of surgical techniques in laparoscopic cholecystectomy. It discusses in detail the most frequently encountered difficulties, errors, and complications developing at various stages of the operation. From their own experience the authors describe the causes and mechanisms of their occurrence. A greater part of the article is concerned with rational surgical tactics in a complicated course of laparoscopic cholecystectomy. It is emphasized that the indications and contraindications for laparoscopic cholecystectomy must be strictly observed, all stages of the intervention must be technically carried out with great care and scrupulously, the surgeon must evaluate adequately his own possibilities, sufficient technical equipment must be provided.

[A comparative evaluation of different methods of forming a colonic anastomosis in repeat surgical interventions]. / Sravnitel'naia otsenka razlichnykh sposobov formirovaniia anastomoza obodochnoi kishki pri povtornykh operativnykh vmeshatel'stvakh.

The results of repeated operations on the large intestine, mainly reconstructive operations, are analysed. Surgical interventions with the performance of a triangular anastomosis, including that by a method modified by the authors, were carried out on 50 patients. The operative results, particularly those in the last group of patients, are very promising. The number of complications, such as suppuration of the postoperative wound and incompetence of the anastomosis sutures, reduced from 28.8% to 10%, which allows the method to be recommended for wide application in the clinic.

[The management procedure for patients with cholelithiasis and the results of rehabilitative treatment after cholecystectomy based on polyclinic observations]. / Taktika vedeniia bol'nykh s zhelchnokamennoi bolezn'iu i rezul'taty vosstanovitel'nogo lecheniia posle kholetsistéktomii po nabliudeniiam v poliklinike.

Based on an analysis of the dynamic ultrasonic, biochemical and hormonal data on 550 patients operated on for cholelithiasis and comparison of preoperative and pathomorphological diagnoses, indications for surgical treatment of cholelithiasis patients in the stage of so-called "lithocarriership" were developed and a group at risk for cancer was identified as well. A comprehensive analysis of the clinical and instrumental data on 185 patients operated on for cholelithiasis, made in the long-term periods (from 1 to 3 years) after cholecystectomy indicates the efficacy of differentiated rehabilitation treatment, including elderly subjects and the necessity of early surgical treatment of cholelithiasis before there may develop irreversible alterations in the choledochus, liver and pancreas and in the gallbladder itself. Comparison of the dynamic ultrasonic data, liver and pancreas functions and factors such as sex, age, obesity and physical exercise makes it possible to predict the course of cholelithiasis to a certain degree of probability at the asymptomatic stage and to specify the policy of managing such patients under ambulatory conditions.