[Diagnosis and surgical treatment of gallbladder cancer].

Retrospective analysis of 72 patients with diseases of gall bladder cancer was conducted. The difficulty of differential diagnosis of tumors of the biliary tract, the rapid progression of tumors and a high postoperative mortality (19.6%) were noted. Presented recommendations for early detection of disease and improve treatment outcomes.

[Pancreatoduodenal resection in treatment of cancer of pancreatic head and periampullar zone]. / Pankreatoduodenal'naia rezektsiia v lecheniia raka golovki podzheludochnoi zhelezy i periampuliarnoi zony.

Results of 120 pancreatoduodenal resections are analyzed. Early postoperative period complications were seen in 51 (42.5%) patients. Overall lethality during 30 days after surgery was 13.3%. Over the last decade lethality reduced to 5%. Life time was studied in 91 patients with cancer of the pancreas (PS) and periampullar zone (PAZ) with Kaplan-Meyer method. Median of life of patients with cancer of PS was 14 months, Vater's papilla (VP)--37 months, terminal part of common bile duct (TPCBD)--30 months, duodenum--30 months. One-, 3-, 5-year survival in cancer of PS was 53, 11 and 3%, in cancer of VP--80, 50 and 31%, in cancer of TPCBD--80, 20% and 0, in duodenal cancer--80, 50 and 33%, respectively. Prognosis factors correlating with the survival were following: 1) primary location of tumor; 2) size of tumor; 3) radicality of surgery; 4) regional lymphatic metastases; 5) invasion of vessels by tumor; 6) index of oncomarker CA 19-9. Early diagnosis of cancer of PS and PAZ, optimization of surgical policy and techniques, using other methods in complex improve results of pancreatoduodenal resections.

[Diagnosis of chronic duodenal obstruction]. / Diagnostika khronicheskoi duodenal'noi neprokhodimosti.

The results of examination of 111 patients with chronic duodenal obstruction (CDO) were analyzed. CDO makes up 3.8% in the whole structure of the diseases of the organs of gastro-intestinal tract, and in the structure of the diseases of pancreato-duodenal area--6.1%. Mechanical form of CDO was revealed in 43.6% of patients, functional--in 51.4%; the disease in compensated stage was detected in 38.7% of patients, in subcompensated stage--in 52.3% and in decompensated stage--in 9.0%. Clinical manifestations of the disease are characterized by diversity of symptoms, which necessitates the use of the complex of instrumental examinations. For establishment of the causes of CDO, besides the routine methods USE and computed tomography were used. In simultaneous contrast of the duodenum, the aorta and superior mesenteric artery computed tomography in comparison with other methods makes it possible to make more precise diagnosis of mechanical CDO caused by arteriomesenterial compression.

[Pancreatoduodenal resection in cancer of the head of the pancreas]. / Pankreatoduodenal'naia rezektsiia pri rake golovki podzheludochnoi zhelezy.

The nearest results of surgical treatment of 375 patients with carcinoma of the pancreatic head and of 104 patients with cancer of other organs of the pancreatoduodenal area are described. Radical operations were made on 62 of them. Resectability was 16.5%, lethality--9.7%, postoperative complications were noted in 35.5% of the patients.

[The surgical treatment of chronic duodenal obstruction in combination with chronic pancreatitis and tumors of the pancreaticoduodenal area]. / Khirurgicheskoe lechenie khronicheskoi duodenal'noi neprokhodimosti pri sochetanii s khronicheskim pankreatitom i opukholiami pankreatoduodenal'noi zony.

Results of 102 surgical interventions were analyzed. In 39 patients chronic duodenal obstruction was associated with benign diseases, 63 patients had malignant tumours. The chronic duodenal obstruction resulted from diseases in the pancreatoduodenal area in 80 patients, in 22 patients it proved to be the cause of chronic pancreatitis. The adequate surgical correction of the duodenal obstruction is believed to be sufficient for normalizing the pancreas functions in patients with primary chronic duodenal obstruction. Direct surgical interventions are preferable for secondary chronic duodenal obstruction. Prophylactic formation of gastroenterostomy during the biliodigestive surgery can relieve the symptoms of the developing duodenal obstruction and allows to avoid another operation at the advanced stage of chronic duodenal obstruction.

[Application of plasma scalpel for cholecystectomy]. / Kholetsist'ektomiia s primeneniem plazmennogo skal'pelia.

Plasma scalpel SUPR-M was used in operative treatment of calculous cholecystitis. Two variants of cholecystectomy with plasma scalpel have been worked out in experiment. It was determined, that the influence of plasma spurt is innocuous for hepatic tissues, it helps to achieve complete demucosation of the mucous membrane of the gall bladder in atypical variants of cholecystectomy, prevents bleeding and bile leakage from the bladder bead in typical cholecytectomy. In clinics the operation procedures were carried out in 176 patients, in 20 of them cholecystectomy was performed atypically, leaving gall bladder wall, adjacent to hepatic surface, in place. In postoperative period were no complications connected with the use of plasma scalpel as well as there were no lethal outcomes. Long-term follow-up of the patients for 5 years showed favourable clinical effect.

[Optimal timing of radical surgery for tumors of the pancreaticoduodenal zone associated with jaundice]. / Optimal'nye sroki radikal'noi operatsii pri opukholiakh pankreatoduodenal'noi zony, soprovozhdaiushchikhsia zheltukhoi.

In cancer of the pancreatoduodenal zone complicated by obturative jaundice it is expedient to perform pancreatogastroduodenal resection in two steps: the first step is laparoscopic hepatocholecystostomy, the second step should be fulfilled 10-12 days after normalization of bilirubinemia. The data obtained were taken into consideration in pancreatogastroduodenal resection performed in 20 patients.

[Pancreatogastroduodenal resection with decompression of the anastomosis area]. / Pankreatogastroduodenal'naia rezektsiia s dekompressiei zony anastomoza.

The author describes the operative technique used in 18 patients with pancreatic tumor. Decompression of the anastomoses was made through laparoscopic hepatocholecystostomy, jejunostomy and nasogastral probe. Two patients died after operation.

[Angiographic and endoscopic diagnosis of pancreatic cancer]. / Angiograficheskaia i éndoskopicheskaia diagnostika raka podzheludochnoi zhelezy.

The report discusses the results of 60 angiographic and 25 angioscintigraphic examinations of the pancreas, 129 endoscopic retrograde pancreatocholangiographic examinations and 226 standard and combined laparoscopies carried out in 276 cases of diseases of the pancreas and extrahepatic biliary ducts. Pancreatic cancer was identified in 119 cases. Angiographic and angioscintigraphic examination established the correct diagnosis of pancreatic carcinoma in 85.2% of patients, endoscopic retrograde pancreatocholangiography--93.9%, and complex examination (angiography, endoscopic retrograde pancreatocholangiography and laparoscopy) in 98.7%.