[POSSIBILITY OF ENHANCING OF THE TRANSPAPILLARY INTERVENTIONS EFFICACY, APPLYING OPTIMIZATION OF THEIR ANESTHESIOLOGICAL SUPPORT].

In 2015 yr еndoscopic transpapillary interventions (ЕТI), performed for diseases of the hepatopancreatoduodenal zone organs, were done in 697 patients. In 315 (45.2%) of them ЕТI were diagnostic, in 382 (54.8%) ­ performed with treatment objective. Меdicinal support for the ЕТI conduction in 631 (90.5%) patients have included conduction of superficial sedation and local anesthesia of pharynx. Аnesthesiological support was applied in 66 (9.5%) patients, including total intravenous anesthesia ­ in 11 (16.6%), еndotracheal narcosis ­ in 55 (83.4%). Using of general anesthesia in comparison to superficial sedation creates more favorable conditions for the ЕТI performance, what have permitted to reduce their duration and complications rate twice.

[TRANSPAPILLARY INTERVENTIONS FOR AN ACUTE PANCREATITIS].

Experience of the endoscopic retrograde pancreatocholangiography performance in emergency (in 4-6 h after admittance to hospital) in 513 patients with suggestion for biliary acute pancreatitis (AP) presence was adduced. In 451 (87.9%) patients preliminary diagnosis was confirmed: in 402 (89.1%)--calculous cholecystitis, complicated by choledocholithiasis, was revealed, in 49 (10.9%)--residual choledocholithiasis. Establishment of biliary genesis of an AP assumes performance of endoscopic papillosphincterotomy and choledocholithextraction. Biliary causes of an AP were excluded in 62 (12.1%) patients, in 34 (54.8%) of them characteristic changes in duodenum were revealed, in 13 (21.0%)--destructive changes of pancreatic ductal system. While diagnosis of an AP of nonbiliary origin a conservative tactics of treatment was selected.

[ENDOSCOPIC PAPILLECTOMY].

Experience of performance of endoscopic papillectomy in 7 patients, suffering benign tumors of duodenal papilla magna, was adduced. The tumors were revealed while conducting endoscopic retrograde pancreatocholangiography, the diagnosis was verified, basing on morphological investigation data on the biopsy material. Endoscopic ultra-sonographic investigation was conducted with the objective to reveal the process spread. While intestinal extramucosal tumoral spread on a distal part common biliary duct, pancreatic duct the endoscopic papillectomy is contraindicated. In 4 (57.1%) patients endoscopic papillectomy was performed in accordance to method of the loop electroexcision, and in 3 (42.9%)--in accordance to the method, elaborated in the clinic.

[ENDOSCOPIC DIAGNOSIS AND TREATMENT OF INJURIES OF BILIARY DUCTS IN LAPAROSCOPIC OPERATIONS].

The results of endoscopic diagnosis and treatment of 127 patients for iatrogenic injuries of biliary ducts while laparoscopic cholecystectomy performance are adduced. Taking into account a necessity to follow principles of miniinvasiveness while performing laparoscopic cholecystectomy, it is expedient to apply miniinvasive methods for elimination of its possible complications as well. In presence of clinical signs of an acute abdomen, free liquid in abdominal cavity (in accordance to ultrasonographic investigation data), application of endoscopic methods of diagnosis and treatment of the biliary ducts iatrogenic injuries is not indicated. Rational application of miniinvasive (endoscopic and under ultrasonographic control) interventions have permitted in all the patients to achieve closure of a partly external biliary fistulas and to sanate intraabdominal foci of biliary accumulations.