[Specific development and course of portal hypertension complication in patients with hepatic cirrhosis of HBV and HCV etiology].

During 1976-2007 in the Republican Specialized Center of Surgery named after acad. Vakhidov various types of portosystemic shunting were performed in 669 patients with portal hypertension. The aim was to estimate the influence of HBV- and HCV-cirrhosis on the formation of portal hypertension and the results of portosystenic shunting. An analysis of 115 liver cirrhosis patients with portal hypertension was made to find out which of them had variceal bleeding and high risk of its development. Such operations were performed in all these patients by the period of 2004-2007 years. Various types of portosystemic shunting were performed in all cases. The analysis has shown that unlike HCV-cirrhoses, HBV cirrhoses are characterized by more progressive course with a short period of a compensation pause in relation to progression of hepatocellular insufficiency, but a less pronounced risk of hemorrhagic complications.

[Diagnostics and surgical treatment of tumors of proximal extrahepatic biliary ducts].

147 patients with tumors of proximal extrahepatic biliary ducts were treated. By 118 patients only palliative surgery was possible. Tumor recanalisation and external biliary drainage was performed on 77 patients; 41 patients received transcutaneous transhepatic cholangiostomy as final treatment; endoprosthesis was inserted in 11 patients. Radical and conditionally radical surgical resections were performed in 29 patients: cholecystectomy, common bile duct resection and hepaticojejunostomy was made in 18 patients. The rest 11 had cholecystectomy, liver resection and bi-hepatic jejuno-anastomosis. Postoperative lethality was 10.2%.

[Treatment of esophageal varices bleeding with the use of transformable probes].

Construction of the original transformable esophageal probe is thoroughly described. The innovated construction suggests lesser traumatisation by insertion and spiral expansion, together with secure compression hemostasis. Unlike the traditionally used obturating Blackmore probe, the spiral transformable original construction leaves the esophageal lumen open for further endoscopic hemostatic procedures. The feature provides exclusive advantages of the original construction.

[The results of porto-systemic shunting in patients with liver cirrhosis].

The research is based on the analysis of 500 patients with liver cirrhosis and complicated portal hypertension, treated during 1976--2005. Survival analysis was performed using the Kaplan-Mayer method. Immediate and long-term results of various modifications of porto-systemic shunting procedure are analyzed for stratificated groups. Thus, the highest mortality (12.5-19.5%) is noted during the first 3 years after operation in all groups. The best survival results showed patients with functional class Ch "A" and no varices bleeding anamnestically, with no regard of method of the shunting procedure, ages of patients and cirrhosis morphological type. The 5-year survival-rate after distal spleno-renal anastomosis and central variants of porto-systemic shunting are 89 and 85%, respectively.

[Operations in injuries and strictures of bile ducts].

Analysis of surgical treatment of 336 patients with cicatricial strictures and iatrogenic external fistulas of extrahepatic bile ducts is presented. The causes of these complications were intrasurgical injuries during cholecystectomy (n=302), resection of the stomach (n=21) and echinococcectomy (n=13). In all the cases correction of water-electrolytic balance, treatment and prophylaxis of hepatic and renal insufficiency, control of anaerobic infection were carried out before and after surgery. Restorative operations were performed in 31 (9.2%) patients, reconstructive surgeries -- in 305 (90.7%). Recurrence of the stricture required surgical intervention in 38 (11,3%) patients. Various postoperative complications were diagnosed in 119 (35.4%) patients, 26 (7.7%) patients died. The main causes of death were insufficiency of anastomotic sutures, intoxication, hepatic and renal insufficiency due to purulent cholangitis and cholangiolytic abscesses of the liver.

[X-ray diagnostic parallels in estimation of the degree of portohepatic circulation reduction in patients with liver cirrhosis].

The data obtained in a retrospective analysis, angiographic and hepatoscintigraphic examinations of 86 patients (aged from 12 to 64 years) with liver cirrhosis (LC) treated during the period from 1998 through 2003 were analyzed. Among them there were 64 men and 22 women. The investigations performed have shown that the angiographic data obtained in LC patients determine not only the topographic interaction of the major and collateral vessels of the porto-lienal pool that is of principal significance in the decision for the method of surgical correction in portal hypertension but also allow an estimation of the picture of the hepatopetal blood flow inversion. The data obtained allowed the authors to define three degrees of reduction of the hepatopetal blood flow. A conclusion was made that the degree of reduction of the hepatopetal blood flow when compared was the findings of angiographic and radionuclide examinations were of great prognostic significance for an estimation of the necessary decompression and possible maximal preservation of the hepatopetal blood flow with respect to the preoperative level.

[Use of the glue composition TachoComb in forming the portosystemic anastomosis]. / Primenenie kleevoi kompozitsii "TakhoKomb" pri formirovanii portosistemnogo anastomoza.

The Tachocomb plates were used by the authors in 15 patients for forming the proximal splenorenal anastomosis and selective decompression of the portal system. The data of sonography have shown the valuable functioning of the shunt in all the patients within the period from 6 months to 3 years. The proposed method provides reliable hemostasis during operation and prevents thrombosis of portosystemic anastomoses.

[The characteristics of the surgical procedure in treating subcompensated portal hypertension in liver cirrhosis]. / Osobennosti khirurgicheskoi taktiki v lechenii subkompensirovannoi portal'noi gipertenzii pri tsirroze pecheni.

The priority of the surgical correction of portal hypertension in patients with liver cirrhosis belongs to proximal spleno-renal anastomosis. The investigations performed have proved that preliminary embolization of the splenic artery with a metallic spiral should be carried out before placing this anastomosis. It has positive effects on the course of the nearest postoperative period. In addition, the preliminary embolization of the splenic artery may be used as a test of endurability of great cavitary operation on the vessels.

[Complications and reoperations after peritoneo-atrial shunting in patients with liver cirrhosis and diuretic-resistant ascites]. / Oslozhneniia i povtornye operatsii pocle peritoneoatrial'nogo shuntirovaniia u bol'nykh s tsirrozom pecheni i diuretikorezistentnym astsitom.

The analysis of postoperative complications, which developed in 33 patients after peritoneoatrial shunting (PAS), was carried out. The effectiveness of PAS is determined by proper choice of the indications, adequate performance of surgical intervention. The use of intraoperative teleroentgenoscopy for control of the venous catheter situation is recommended. Reoperations for postoperative complications are to be performed in presence of a pressure gradient in the valvular system and in patients with shunt infection after elimination of the inflammatory process.

[Combined use of peritoneo-atrial shunting and endoscopic sclerotherapy of esophageal varicose veins in treating liver cirrhosis with portal hypertension and resistant ascites]. / Sochetannoe primenenie peritoneoatrial'nogo shuntirovaniia i éndoskopicheskoi skleroterapii varikozno-rasshirennykh ven pishchevoda v lechenii tsirroza pecheni s portal'noi gipertenziei i rezistentnym astsitom.

The authors in 39 patients with liver cirrhosis and intractable ascites performed peritoneoatrial shunting (PAS), in 16--PAS in combination with prophylactic endoscopic sclerotherapy (ES) of gastric varices (GV). Prophylactic use of ES before PAS permitted to reduce more than 3-fold the incidence of postoperative bleeding from EV.

[Indicators of hepatic and intracardiac hemodynamics in the surgical treatment of liver cirrhosis]. / Pokazateli pechenochnoi i vnutriserdechnoi gemodinamiki pri khirurgicheskom lechenii tsirroza pecheni.

Under analysis are results of operative treatment of 54 patients with cirrhosis of the liver. Most satisfactory hemodynamic results were obtained after endovascular embolisation of the splenic artery as the increased general hepatic blood flow and simultaneously decreased splenic blood flow, better indices of intracardiac hemodynamics. The method of peritoneoatrial shunting is most perspective in patients with cirrhosis of the liver at the stage of decompensation of portal hypertension. But possible overloading of the heart must be borne in mind.

[Changes in hemodynamics and angioarchitecture of the hepatolienal basin after embolization of the splenic artery in liver cirrhosis]. / Izmeneniia gemodinamiki i angioarkhitektoniki gepatolienal'nogo basseina posle embolizatsii selezenochnoi arterii pri tsirroze pecheni.

Complex investigations of regional hemodynamic changes in the spleno-hepatic basin in 72 patients with cirrhosis of the liver after the embolization of the splenic artery have shown that in most patients the embolization of the splenic artery is followed by pronounced alterations in the portal system, decreased portal pressure, inversed blood flow in the main trunk of the splenic vein. The ESA used in the complex surgical treatment of patients facilitates the compensation of the portal blood circulation.

[Embolization of the splenic artery in liver cirrhosis with portal hypertension and splenomegaly]. / Embolizatsiia selezenochnoi arterii pri tsirroze pecheni s portal'noi gipertenziei i splenomegaliei.

Results of subacute embolization of the splenic artery with a metallic spiral obtained in 22 patients with cirrhosis of the liver with splenomegaly were studied at the stage of sub- and decompensation of the portal blood circulation. Results of the study and their clinical evaluation suggest that the subacute embolization of the splenic artery is a relatively safe, atraumatic and effective method of surgical treatment of splenomegaly, hypersplenism resulting from liver cirrhosis with portal hypertension. The method allows to decrease hypersplenism, splenomegaly, portal hypertension, to eliminate the pain syndrome due to splenomegaly.