[Pancreatic pseudocysts in recurrent pancreatitis: traditional and mini-invasive surgery/endotherapy. Problems in the treatment strategy choice].

Introduction of methods of miniinvasive surgery/endotherapy have permitted to widen essentially the possibilities of treatment of complicated recurrent pancreatitis. Miniinvasive interventions on pancreatic gland and neighbor organs, as well as laparotomic interventions, must be regarded not as an alternative, but like interchangeable methods, permitting to improve significantly the treatment outcome in an acute destructive and chronic pancreatitis, including those, which is complicated by a pancreatic pseudocysts formation.

[Complex ultrasonic diagnosis of large and gigantic non-parasitic cysts of liver].

The results of clinical and complex ultrasonic examination of 95 patients with large and gigantic liver non-parasitic cysts (LNC) are analyzed. The morphological examination was performed in all the cases. The mean diameter of large LNC was 105+/-7 mm, of gigantic cysts -- 149+/-33 mm (p<0,05), cyst volume was respectively 600+/-142 and 1721+/-954 ml (p<0,05). Analysis of clinical, ultrasonic and laboratory data allowed to describe three variants of large and gigantic, complicated and non-complicated cysts with 97,9% accuracy. The 3-D US reconstruction permitted to precise the anatomic structure and trace selection during transcutaneous US-assisted treatment.

[Radio-frequency ablation appliance in resection of the liver]. / Ispol'zovanie apparata radiochastotnoi ablatsii pri rezektsii pecheni.

Pilot experience with "Radionics Cool-Tip RF System" appliance for radio-frequency ablation (RFA) in hepatic resection in the patients with focal lesions of the liver is presented. Advantages of RFA as an alternative method for hemostasis are demonstrated. With this technique bisegmentectomy (II - III) was performed in 4 patients, right-sided hemihepatectomy - in 2 patients. RFA permitted to minimize intraoperative blood loss without increase of surgery time. There were no severe complications during surgery and in early postoperative period. The method permits to perform combined surgeries without a significant increase of surgical risk.

[Recurrent pancreatitis as a surgical problem]. / Retsidiviruiushchii pankreatit kak khirurgicheskaia problema.

Experience in the treatment of 1498 patients with alcoholic pancreatitis treated with laparotomic and mini-invasive surgeries both in acute and chronic phases of the disease is presented. In 742 patients surgical treatment was multistaged. Re-operations in 17 patients with "chronic purulent pancreatitis", reconstructive surgeries on the pancreas, pancreatic and bile ducts in 84 patients with "head" pancreatitis were most difficult. Percutaneous puncture-catheter procedures for liquid formations in acute phase of pancreatitis were effective as the first stage of treatment to reduce the danger of subsequent laparotomy. Catheterisation of chronic pseudocysts in alcoholic pancreatitis is associated with frequent complications and recurrences and can not be regarded as alternative to internal drainage surgeries. Pancreatic surgeries must guarantee effective correction of intrapancreatic hypertension for prevention of acute pancreatitis recurrences. In acute phase of pancreatitis surgical methods must ensure prevention of symptoms recurrences and pyoseptic complications of pancreatitis.

[Ultrasound-assisted puncture method of treatment of hepatic hydatid cysts]. / Punktsionnyi metod lecheniia ékhinokokkovykh kist pecheni pod kontrolem ul'trazvukovogo issledovaniia.

Results of treatment of 31 hepatic hydatid cysts in 28 patients were analyzed. The size of the s ranged from 3 to 25 cm. In 26 cases the cysts contained flive es, in 2 cases they were suppurated after US-assisted intraoperative puncture. Simple hydatid cysts (type I by M. Milcevic) were diagnosed in 24 patients (solitary--in 22, multiple--in 2), solitary cysts of type II--in 2 patients. In 23 cases aspiration-catheter treatment with complete removal of chitin membrane by one-stage (4) or two-stage (19) methods was performed. After removal of chitin membrane in 3 patients lateral fistula between spurious cysts cavities and peripheral branches of intrahepatic bile ducts were revealed which spontaneously. Glue composition "Rabrom" was used in 2 cases for closure of the residual cavity. In 4 patients who had cysts less 6 cm in size puncture irrigation of chitin cavity with 30% NaCl (PAIR technique) without it removal was performed. In one patient transcutaneous catheter (PAIR-PD technique) was used for irrigation of the cyst larger than 6 cm. The duration of two-stage aspiration-catheter treatment with removal of chitin membrane was 25.6 +/- 9.6 days. In moderate calcinosis of the fibrous membrane and bile fistulas period of hospitalization was 34 +/- 8.1 days. Treatment with PAIR and PAIR-PD took 1 and 3 days respectively. Complications of percutaneous methods were regarded as mild: hyperthermia (12), right-sided hydrothorax (6), subcapsular hematoma (1), urticaria (1). All the complications were treated conservatively and with US-assisted punctures. Long-term (from 6 months to 9 years) results of treatment were followed up in 26 patients: there were no recurrences. Suppuration of the residual cavity 6 months after the glue occlusion was eradicated by transcutaneous catheter drainage. One lethal outcome was not associated with complications of aspiration-catheter treatment. Both methods of transcutaneous treatment of hepatic hydatid cysts are effective and safe. A hypertonic solution of NaCl I produces a reliable antiscolecidal and sclerosis effect.

[First experience in treatment of hepatic echinococcal cyst by percutaneous puncture drainage]. / Pervyi opyt lecheniia ékhinokokkovykh kist pecheni punktsionnym chreskozhnym drenirovaniem]

The article deals with the new possibilities of bloodless management of parasitic cysts of the liver by means of ultrasonic examination and computed tomography. The authors suggest a puncture-aspiration method of goal-oriented percutaneous drainage of a hydatid cyst which prevents possible complications. The method was applied in four patients with hydatid cysts of the right hepatic lobe. The outcomes in two cases were successful, the death of one patients was associated with the use of the method.

[Intraoperative ultrasonic study in surgery of hepatic echinococcosis]. / Intraoperatsionnoe ul'trazvukovoe issledovanie v khirurgii ékhinokokkoza pecheni.

The authors analyse the results of intraoperative ultrasonic examination (IOUSE) of the liver in 31 patients with echinococcosis of the liver; 21 of them had multiple hydatid cysts in the liver. The authors came to the conclusion that IOUSE is a highly informative method for noninvasive diagnosis in surgery of the liver. IOUSE is indicated when information must be obtained during the operation concerning the location of invisible and nonpalpable pathological structures, the borderlines of their extension, the anatomical relations with the vascular-ductal structures of the liver. Exact echographic localization of these structures and their grading ensure safety of various types of operations in this disease.