[Preoperative radiation navigation in determining surgical strategy for liver echinococcosis]. / Predoperatsionnaya luchevaya navigatsiya v opredelenii khirurgicheskoi taktiki pri ekhinokokkoze pecheni.

OBJECTIVE: To analyze the technology for diagnostic modeling of liver echinococcosis. MATERIAL AND METHODS: In the Botkin Clinical Hospital, we developed a theory of diagnostic modeling of liver echinococcosis. Treatment outcomes were analyzed in 264 patients who underwent various surgical interventions. RESULTS: A retrospective group enrolled 147 patients. When comparing the results of diagnostic and surgical stages, we identified 4 models of liver echinococcosis. The choice of surgical intervention in the prospective group was based on previous models. Diagnostic modeling reduced the number of general surgical and specific complications, as well as mortality in the prospective study group. CONCLUSION: The technology for diagnostic modeling of liver echinococcosis made it possible not only to identify 4 models of liver echinococcosis, but also determine the most optimal surgical intervention for each of model.

[Preoperative biliary drainage for malignant biliary obstruction: to drain or not to drain? And if drain, in what way?] / Predoperatsionnaya biliarnaya dekompressiya pri opukholevoi zheltukhe: drenirovat' ili net? I esli drenirovat', to kakim sposobom?

On the basis of the conducted literary search, a number of conclusions can be drawn. When performing preoperative biliary drainage (PBD), it is necessary to have a clear understanding: why is this procedure performed (severe liver failure, cholangitis, long preoperative preparation is required due to comorbid status, neoadjuvant chemotherapy is necessary, etc.)? Routine use of PBD is impractical. In the presence of indications for PBB in perihilar cholangiocarcinoma, percutaneous decompression is preferable, in periampullary tumors, endoscopic. Moreover, both methods can be alternative (for example, in case of technical failure of the first priority). There is also no convincing evidence of the superiority of metal stents over plastic ones for PBD (except in cases of long-term preoperative preparation or neoadjuvate treatment) for periampular tumors. To date, a decrease in overall survival and a higher incidence of implantation metastases have not been proven when using the antegrade PBD method. Large multicenter studies are required with differentiation of patients according to the nosological principle in order to more accurately understand the place of each method, as well as to determine clear indications for PBD and those clinical situations when its implementation is impractical.

[Mechanisms and prevention of biliary stent occlusion]. / Mekhanizmy okklyuzii biliarnykh stentov i vozmozhnye sposoby ee profilaktiki.

One of significant achievements of modern endoscopy is development of retrograde biliary stenting for obstructive jaundice. This method ensured widespread application of endoscopic decompression in the treatment of patients with malignant biliary obstruction as preparation before radical surgery and final palliative care. Endoscopic retrograde transpapillary stenting firmly took its place together with antegrade and percutaneous stenting. There are certain advantages of this technique including minimally invasiveness and favorable quality of life. However, this approach is associated with some drawbacks associated with stent occlusion and difficult correction of this complication. The maximum diameter of the plastic stent (PS) is determined by the width of the working channel of the duodenoscope. In this regard, self-expandable metal stents (SEMS) were developed to increase the diameter of bile drainage channel. SEMS are associated with prolonged function. However, there is another problem. It is a germination of SEMS followed by impossible removal of the stent for its subsequent replacement. A further step in development of endoscopic biliary stents was the use of special SEMS coating to exclude tumor or granulation ingrowth. The problem of biliary stent occlusion remains relevant despite some improvement of stenting results. Mechanisms of occlusion of biliary stents and prevention of these events are discussed in this review.

[Optimization of surgical care for the hemorrhagic colorectal cancer]. / Optimizatsiia khirurgicheskoi pomoshchi bol'nym kolorektal'nym rakom, oslozhnennym krovotecheniem.

AIM: To optimize surgical care for the hemorrhagic colorectal cancer. MATERIAL AND METHODS: 77 patients diagnosed with hemorrhagic colorectal cancer were reviewed: 9 patients of them were efficaciously treated with conservative therapy (I group); 47 - underwent successful endoscopic coagulation (I); 4 - arterial embolization (I), 2 - ligation of internal iliac arteries (I), 15 - acute resection (II group). 20 of 62 patients I group underwent plan surgery and radiation or chemotherapy during 7-10 days after hemostasis and normalization hemoglobin. The 3-year cumulative survival after resections (acute versus plan) was plotted on a Kaplan-Meier chart in 31 patients. RESULTS: Complications and postoperative mortality was significantly higher after acute resection (II group) compared with plan resection (I): 33,3% vs 20%; 15% vs 5%, respectively. The survival rate was higher after plan than acute resections: 0,8882 and 0,3571, respectively. CONCLUSION: Acute surgery for hemorrhagic colorectal cancer should only be carried out by appropriately trained surgeons in multi-specialty hospital. Endoscopy and arterial embolization are the most effective means of successfully controlling hemorrhage while minimizing potential complications. A bridging strategy may be a valid alternative in some of patients with hemorrhagic colorectal cancer, because a significantly lower postoperative mortality rate.

[Comparative analysis of side-by-side antegrade stenting and Y-biliary stenting for malignant biliary stricture]. / Sravnitel'nyi analiz antegradnogo stentirovaniia side-by-side i Y-stentirovaniia pri zlokachestvennoi zhelchnoi strikture vorot pecheni.

In the time period from 2009 to 2017 in Botkin Hospital (Moscow) bilateral biliary stenting was performed in 43 patients with malignant common hepatic duct stricture. Patients were divided into 2 statistically homogeneous groups: 'side-by-side' stenting in 28 patients and percutaneous 'Y'-biliary stent placement in 15 patients. The causes of malignant obstruction were as follows: in the 1st group 13 (46.4%) patients with extrahepatic cholangiocarcinoma (46.4%), 8 (28.6%) patients with intrahepatic cholangiocarcinoma, 4 (14.3%) patients with gallbladder cancer, 3 (10.7%) patients with metastatic cancer. In the 2nd group 6 (40%) patients with extrahepatic cholangiocarcinoma, 4 (26.6%) patients with intrahepatic cholangiocarcinoma, 2 (13.3%) patients with gallbladder cancer, 3 (20%) patients with metastatic cancer. Characteristics of patients: age - 1st group 71.2±5.1 years, 2nd group 74.3±5.5 years; sex - (m/f) 1st group 18/10, 2nd group 9/6; location of stricture - 1st group Bismuth IIIa/IIIb 17/11, 2nd group Bismuth IIIa/IIIb 11/4; mean level of bilirubin - 1st group 284±8.2 µmol/l; 2nd group 311±7.4 µmol/l. Technically all procedures were successful (100%). No complications and mortality associated with the procedure was recorded. Clinically significant results were achieved in 26 (92.8%) patients in Group 1 and in 13 (86.7%) patients in Group 2 (p=0.043). Following stenting procedures, 23 (82.1%) patients in Group 1 and 11 (68.8%) patients in the Group 2 had chemotherapy (p=0.047). 19 patients from the 1st group and 10 patients from the 2nd group died due to tumor progression of the underlying disease, other patients are under care of a physician. Median survival rate: 1st group (12 patients - 50 days, 7 patients - 100 days, 9 patients are alive at the time of writing); 2nd group (7 patients - 50 days, 4 patients - 100 days, 4 patients are alive at the time of writing). The results of this study showed that 6 (21.4%) patients from the 1st group and 4 (26.7%) patients from the 2nd group had biliary stent occlusion (p=0.041). The average period of stent function in the 1st group was 78±4.5 days, and 63±4.8 days in the 2nd group (p=0.036). Based on the obtained results, it is recommended to use the 'side-by-side' method of bilobar biliary stenting in patients with malignant common hepatic duct strictures.

[Urgent surgical care for patients with colon cancer complicated by hemorrhage]. / Neotlozhnaia khirurgicheskaia pomoshch' bol'nym rakom tolstoi i priamoi kishki, oslozhnennym krovotecheniem.

AIM: To evaluate an effectiveness of various hemostatic methods in patients with colon and rectal cancer. MATERIAL AND METHODS: 77 urgent patients with colon and rectal cancer complicated by bleeding were enrolled. Medication was effective in 11 patients (group 1), endoscopic hemostasis in 47 patients (group 2), vascular embolization in 2 cases (group 3), internal iliac arteries ligation in 2 patients (group 4), 15 patients underwent emergency resection (group 5). Twenty out of 62 patients in groups 1-4 underwent elective radical procedures and radio- or chemotherapy in 7-10 days after hemostasis and normalization of hemoglobin. 3-year Kaplan-Meier survival was assessed after emergency (group 5) and elective surgery (groups 1-4) in 31 patients. RESULTS: Effectiveness of various hemostatic methods was 14.3% in group 1, 79.7% in group 2, 28.6% in group 3 and 100% in groups 4 and 5. Postoperative morbidity and mortality were higher after emergency (group 5) compared with elective (groups 1-4) procedures: 33.3 and 20%; 15 and 5% respectively. 3-year survival was better after elective than emergency operations - 0.78 and 0.57, respectively. CONCLUSION: Management of bleeding should be carried out by highly qualified specialist at multi-field emergency care hospital. Endoscopy and arterial embolization are the most effective methods of hemostasis with minimal risk of complications. In hemorrhage patients endoscopy and embolization ("bridge to surgery") are an alternative to conditionally radical operations, since they allow to reduce mortality.

[Urgent surgical care for patients with colon cancer complicated by hemorrhage]. / Neotlozhnaia khirurgicheskaia pomoshch' bol'nym rakom tolstoi i priamoi kishki, oslozhnennym krovotecheniem.

AIM: Comparative evaluation of the effectiveness of various hemostatic methods in patients with colon and rectal cancer complicated by bleeding. MATERIAL AND METHODS: We examined 77 hospitalized patients with colon and rectal cancer complicated by bleeding. Conservative therapy was effective in 11 patients (group I), endoscopic hemostasis in 49 cases (group II), 17 patients underwent emergency surgery (bowel resection/ internal iliac arteries ligation) (group III). Vascular embolization was performed in 2 patients. 20 out of 77 patients in groups I-II underwent elective surgery and radiochemotherapy in 7-10 days after hemorrhage and normalization of hemoglobin. 3-year Kaplan-Meier survival was assessed after emergency (group III) and elective (I-II) interventions in 37 survivors. RESULTS: The effectiveness of various methods of hemostasis was 14.3% in group I, 80.3% in group II and 100% in group III. Embolization was ineffective (patients underwent surgery). Complications were observed in 4.9% (II) and 29.4% (III), respectively. Mortality was significantly higher after conditionally radical surgery than after endoscopy: 17.6% vs. 0. 3-year survival was better after elective interventions compared with emergency surgery (0.79 vs. 0.64, respectively). CONCLUSION: Endoscopy is the most effective method to stop colonic bleeding with minimal complications. It is a 'bridge to surgery' and alternative to conditionally radical operations in order to reduce mortality. Treatment of bleeding should be carried out in multi-field hospital by highly qualified specialists.

[Metal self-expanding stents for malignant obstruction of stomach outlet and duodenum]. / Opyt primeneniia metallicheskikh samorasshiriaiushchikhsia stentov pri zlokachestvennoi obstruktsii vykhodnogo otdela zheludka i dvenadtsatiperstnoi kishki.

AIM: To compare different types of self-expanding stents (partially coated or uncovered) for malignant pyloroduodenal obstruction (MPDO). MATERIAL AND METHODS: 89 MPDO patients underwent stenting at the Botkin City Hospital (Moscow) for the period 2008-2016. The causes of malignant obstruction were: stomach cancer - 53 (59.5%), pancreatic cancer - 31 (34.8%), compression by retroperitoneal lymph nodes - 3 (3.4%), duodenal cancer - 2 (2.2%). Patients were divided into two homogeneous groups. In group 1 (32 patients) partially coated stents were used, in group 2 (57 patients) - uncovered stents. Mean age was 68.3±6.2 and 64.3±5.7 years in both groups respectively; male/female ratio 18/14 in group 1, 32/25 in group 2. Length of stricture was 51±5.1 mm in group 1, 48±4.8 mm in group 2. GOOSS score in group 1: 0-8, 1-13, 2-11, 3-0, in group 2 0-14, 1-25, 2-18, 3-0 (p=0.03). RESULTS AND DISCUSSION: Technical success was achieved in 32 patients of group 1 (100%) and in 57 patients of group 2 (100%). There were no procedure-associated complications and mortality. Clinical success was observed in 29 (90.6%) patients of group 1 and in 50 (87.7%) patients of group 2. GOOSS score of group 1: 0-8, 1-8, 2-10, 3-12, group 2: 0-3, 1-15, 2-19, 3-20. There were 3 distal dislocations of the stent within 1 - days in group 1, in group 2 dislocations were absent. Postoperative chemotherapy was prescribed in 20 (62.5%) patients of group 1 and 38 (66.7%) patients of group 2 (p=0.08). 27 patients of group 1 and 49 patients of group 2 died due to progression of the disease, others are under observation. Mean life expectancy: group 1 (18 patients - 50 days, 9 patients - 100 days, 5 patients were alive by the moment of study); group 2 (32 patients - 50 days, 100 days - 17 patients, 8 patients were alive by the moment of study). 3 patients (9.4%) in group 1 and 7 (12.3%) patients in group 2 had stent dysfunction (p=0.02). Mean period of partially covered stent function was 138±3.9 days, uncovered stent - 96±4.8 days (р=0.003). CONCLUSION: Our study showed that time of stent function corresponds to median survival. Greater number of stent migration in group 1 is due to stent coverage, higher incidence of stent dysfunction in group 2 - due to malignant invasion.

[Efficacy of transcutaneous endobiliary procedures in patients with obstructive jaundice].

Transcutaneous endobiliary procedures (TEP) were performed in 378 patients with obstructive jaundice (OJ). External decompression of the biliary ducts was carried out as the first stage of treatment in all the patients with OJ of various etiology. This procedure led to reduction of cholangitis symptoms and hepatic failure, improvement of general condition of the patients before radical surgery. Endoprosthesis of the bile ducts made in 121 patients allowed physiological passage of bile into the intestine and improved quality of life especially in inoperable patients with hepatic and pancreatoduodenal tumors. During external drainage in 27 (7.1%) patients dislocation of drainage of the common bile duct occurred. Postoperative lethality was 8.5%. After open surgeries 2 (1.2%) patients died.

[Minimally invasive methods of surgical treatment for diseases of liver, biliary tract, and pancreas]. / Miniinvazivnye metody khirurgicheskogo lecheniia bol'nykh s zabolevaniiami pecheni, zhelchnykh putei i podzheludochnoi zhelezy.

Results of examination of 324 biopsies from hepatopancreatoduodenal zone were analyzed. The biopsy was performed as roentgentelevision- or US-guided procedure with Pro-Mag 2.2 device. There were no complications. Percutaneous endoprosthesis of biliary ducts was performed in 127 patients (89% of them were older than 65 years) with obstructive jaundice. Roentgen- or gastroscopy-guided hepaticogastroanastomosis was formed in 36 patients with different diseases. The follow-up was to 18 months in malignant tumors, and to 26 months in benign strictures. Video-assisted drainage of gall bladder in acute cholecystitis was performed in 436 patients with cholelithiasis and severe concomitant diseases. Results of many-stage treatment of 207 patients with choledocholithiasis were analyzed, residual disease was revealed in 11 (5.6%) patients.

[Hormone-mediated reactions in the endosalpinx epithelium]. / Gormonal'no obuslovlennye reaktsii épiteliia éndosal'pinksa.

The epithelium of normal uterine tubes resected in 38 young women of the child-bearing age during the periods of the maximal physiological fluctuations of the ovarian steroid hormones levels has been studied. The correlative dependence between the morphometrical data and the results of quanitative biochemical analysis of the estrogen excretion has been investigated. The morphometric method reliably reflects the hormone-dependent variabilities of the oviduct epithelium and makes it possible to perform an objective morphological evaluation of the ovarian functional activity. The height and specific density of cells in the epithelial layer, portion of the aciliary cells and nuclear volume of the ciliary cells are the most important for diagnosis as compared to the excretory level of the estrogenic hormones.

[Rapid diagnosis of early pregnancy by the method of "crushed specimens"]. / Ekstrennaia mikroskopicheskaia diagnostika beremennosti malogo sroka metodom "razdavlennykh preparatov".

Urgent diagnosis of uterine pregnancy of short duration by the method of "squashed preparations" is described. The unfixed pieces of tissue were stained with toluidine blue and squashed between two transparent plates. Subsequent microscopy could reveal the outlines of chorion villi.

[Characteristics of the microvascular bed of the uterine tubes in women]. / osobennosti mikrososudistogo rusla matochnykh trub u zhenshchin.

A histological investigation of the fallopian tube vascular bed has been performed in women at various phases of the menstrual cycle (28 observation) and at early uterine pregnancy (6 observations). Topographic isolated mechanisms of blood shunting and deposition participating in cyclic changes in the uterine tube functional activity have been revealed. The blood shunting is performed by the occlusive arterioles and arteriolo-venular semi-shunts situating, mainly, in the tubular isthmus. The blood deposition occurs in the infundibular-ampular portion, at the expense of the postcapillary sinus system, convoluted and occlusive venules. The role of hemomicrocirculatory pathways and the lymphatic sinuses of fimbrias to perform physiological "mechanism of the ova acceptance" is also noted.

[Cyclic changes in the uterine tube epithelium in women]. / Tsiklicheskie izmeneniia épiteliia matochnykh trub u zhenshchin.

Morphometric and histochemical investigations have been performed in epithelium of the fallopian tubes in 108 women operated on various gynecological diseases. Among them the following groups have been detected: with a constant menstrual cycle, uterine pregnancy, chronic estrogenia, menopause and a prolonged age menopause. The data obtained demonstrate that the height of the epithelial covering, part the relative amount of the cilial cells and contents of glycogen and lipids in their cytoplasm depend on the character of the ovarian hormonal activity. During the folliculin phase of the menstrual cycle, a certain proliferation of the cilial cells and accumulation of glycogen (in the fimbrial part) and lipids (in the ampullar part) of their cytoplasm is noted. At a chronic estrogenic stimulation, this process can turn into a glandulo-papillary epithelial hyperplasia of the endosalpinx. Administration of yellow body hormones during the lutein phase of the menstrual cycle produces focal desquamation of the cilial epithelium, which acquires a diffuse character in the fallopian tubes of pregnant women and is accompanied with a decreased amount of glycogen in cytoplasm of epitheliocytes and release of lipids into the oviductal lumen.

[Cyclic changes in mast cell response and capillaries in the wall of the Fallopian tubes of women]. / Tsiklicheskie izmeneniia tuchno-kletochnoi reaktsii i krovenosnykh kapilliarov v stenke matochnykh trub u zhenshchin.

Mast cells reaction in the wall of the normal fallopian tubes has been studied morphometrically in 48 women subjected to the operation for a uterine myoma and ovarian retention cyst. It has been stated that volume and degree of the mast cell degranulation depends on the menstrual cycle phase, age and part of the fallopian tube. The changes of the mast cells reaction correlate with the capillary diameters in the ampulla and the isthmus of the oviduct. Labrocytes participate in regulation of the microcirculatory blood stream of the fallopian tubes.

[Pathogenetic basis of shock reaction in ectopic (tubal) pregnancy]. / Patogeneticheskie osnovy shokovykh reaktsii pri éktopicheskoi (trubnoi) beremennosti.

The clinico-morphological study of pathogenetic features and stages of shcok was carried out in 95 women with disturbed tubal pregnancy which made 38% of 250 patients with ectopic pregnancy. The casual relationship was revealed between the development of shock reactions and the volume of hemorrhage into the abdominal cavity. The role of the intensity and duration of internal hemorrhage, patient's age and previous inflammatory alterations of the oviduct was also shown.