[The surgical treatment of echinococcosis of the diaphragmatic surface of the liver]. / Khirurgicheskoe lechenie ékhinokokkoza diafragmal'noi poverkhnosti pecheni.

The results of surgical treatment of 628 patients aged 15-76 years operated on for echinococcosis of diaphragmatic surface of the liver have been analysed for period from 1976 to 1996. 333 patients had complicated echinococcosis, 124 combined pathology of other organs. Methods which have been applied for diagnosis of echinococcosis of the liver and its complications are described. Details of surgical treatment of the echinococcosis of the diaphragmatic surface of the liver are elucidated in time course aspects, as a staged treatment, during which various factors were used for antiparasitic treatment of cystic cavity as well as various methods of elimination of the residual cavity. Problems concerning application of laser and plasmatic scalpel during various stages of the operation, as well as low-intensity lasers and low-frequency ultrasound during the operation and in postoperative period are considered. Postoperative complications were detected in 99 (15.8%) patients, lethal outcomes were in 5 (0.8%) cases.

[Diagnosis and treatment of liver echinococcosis complicated by cysto-biliary fistula]. / Diagnostika i lechenie ékhinokokkoza pecheni, oslozhnennogo tsistobiliarnym svishchom.

890 patients with echinococcosis of the liver were operated during 1976-1992. Complicated forms of the disease were li detected in 222 (24.9%) patients, among them 141 (15.8%) patients with cysto-biliary fistulas. Ultrasonography examination and endoscopic retrograde cholangiography were regarded as the most informative methods of preoperative diagnosis of cysto-biliary fistulas. Three-stage management was worked out. The usage of laser, plasmatic scalpel and ultrasound of low frequency substantially contributed to improvement of the results of treatment of these patients.

[The combined treatment of cholangitis in patients with intraoperative damage and posttraumatic cicatricial stricture of the extrahepatic bile ducts]. / Kompleksnoe lechenie kholangita u bol'nykh s intraoperatsionnym povrezhdeniem i posttravmaticheskoi rubtsevoi strikturoi vnepechenochnykh zhelchnykh protokov.

The result of treatment of 196 patients with cholangitis, occurred due to intraoperative trauma and posttraumatic cicatricial stricture of extrahepatic biliary ducts (EBD) was analysed. Methods of extracorporeal detoxication-hemosorption (in 53 observations), plasmapheresis (in 32), biohemosorption (in 21) were applied in the complex of treatment. The EBD decompression was conducted using endoscopic diathermocoagulation and bougienage of cicatricial stricture (in 56 patients) with introduction of a hidden drain (in 9) or nasobiliary catheter (in 47). In all the patients reconstructive and restorative operations were conducted. Postoperative complications occurred in 43 (22%) patients, 31 (15.8%) patients died. Stricture recurrence, necessitated reoperation conduction, was noted in 15 (7.6%) patients.

[Minimally invasive transcutaneous interventions in elimination of suppurative residual cavities in liver after echinococcectomy]. / Maloinvazivnye chrezkozhnye vmeshatel'stva pri nagnoivshikhsia ostatochnykh polostiakh v pecheni posle ékhinokokkéktomii.

The results of treatment of 34 patients with suppurative residual cavities in the liver (SRCL) after echinococcectomy are analyzed. New method of elimination of SRCL consisted in transcutaneous puncture and drainage of the infected cavity followed by transdrainage laser irradiation of its walls by Nitrogen UV laser and Helium-Neon laser of visible spectrum, was applied in 31 patients. Transdrainage irradiation was carried out at the background of daily procedures of transcutaneous laser radiation of the liver (Arsenid-Gallium infrared laser). Minimal traumatism of transcutaneous interventions and pronounced antibacterial, antiinflammatory and stimulating influence of low-energy lasers made it possible to improve significantly the results of treatment of SRCL patients.

[Internal biliodigestive fistulas]. / Vnutrennie biliodigestivnye svishchi.

Experience in surgical treatment of 53 patients with internal biliodigestive fistulas is analysed. The formation of the fistula in all cases was caused by cholelithiasis with obstruction of the bile ducts, purulent cholangitis, angiocholitis, cholangiolytic abscesses of the liver, pancreatitis, hepatitis, as well as cholelithic ileus. Cholecystectomy, removal of the stones from the bile ducts, restoration of the main route of bile drainage, elimination of the pathological communication, and closure of the defect in a hollow organ should be considered the operation of choice. In cholelithic ileus operation for correction of the intestinal obstruction is also expedient. Postoperative complications were encountered in 35.8% of cases. Hepatorenal insufficiency developed in 8, incompetence of the choledochus sutures in 3, an external biliary fistula in 2, hepatic abscess in 1, pancreatitis in 2, and suppuration of the postoperative wound in 3 patients. Among the 53 patients treated by operation, 49 (92.5%) recovered and 4 (7.5%) died from various postoperative complications.

[External respiration in patients with craniocerebral injury]. / Funktsii vneshnego dykhaniia u bolnykh s cherepno-mozgovoi travmoi.

One hundred and twenty patients with a severe craniocerebral trauma were examined to study disorders of external respiration function (ERF) in this injury. The static and dynamic parameters of ERF were determined daily for the first week and on the 10th, 14th, 21st, and 28th days after the trauma. It was found that the underlying factors of ERF disorders in trauma of the brain were diminished volumes and capacities of the lungs, impaired bronchial patency with subsequent development of atelectasis of the lungs and the pulmonary shunt, which were determined by the severity and level of damage of the brain structures. The pharmacological test conducted in the posttraumatic period showed that bronchospasm persisting for a month developed twice more frequently in patients with a severe trauma than in those with a moderately severe injury.

[Respiratory and hemodynamic changes in patients with craniocerebral injuries]. / Dykhatel'nye i gemodinamicheskie izmeneniia u bol'nykh s cherepno-mozgovoi travmoi.

The interaction of ventilation and hemodynamics in the posttraumatic period has been studied in 131 patients with severe craniocerebral trauma. Indexes of respiratory function, central and pulmonary hemodynamics were determined over the first week and on days 10, 14, 21 and 28 after trauma. The data obtained have shown that respiratory function and circulation damages during brain trauma are predetermined by the reduction in pulmonary volume and capacity, impaired alveolar ventilation and bronchial patency, followed by development of atelectasis of the lungs and pulmonary shunt. Patients with severe brain injury more often develop bronchospasm and disorders of central and pulmonary hemodynamics, as compared to patients with moderate injury.

[Prospectives for using the extracorporeal connection of a xenospleen in treating patients with liver cirrhosis and obstructive jaundice complicated by liver failure]. / Perspektivy ispol'zovaniia ékstrakorporal'nogo podkliucheniia ksenoselezenki v lechenii bol'nykh tsirrozom pecheni i obturatsionnoi zheltukhoi, oslozhnennykh pechenochnoi

Results of using extracorporeal connection of the hog spleen for detoxication and correction of immune disorders in 73 patients with severe forms of hepatic insufficiency are analyzed. It was shown that extraorganic connection of the xenospleen in complex with other methods of treatment considerably improved results of the operative intervention for liver cirrhosis and obstructive jaundice. However, the results obtained were noted in patients with the I-II stages of hepatic insufficiency.

[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.

[Lasers and plasma scalpel in the surgery of hepatic echinococcosis]. / Lazery i plazmennyi skal'pel' v khirurgii ékhinokokkoza pecheni.

A plasma surgical device and a CO2-laser device were used in operative treatment of 46 patients with hydatid disease of the liver; in 25 in the patients these measures were combined with exposure to low-energy helium-neon laser radiation. The patients' condition improved more rapidly, the frequency of postoperative complications reduced, the term of postoperative hospital stay of the patients decreased. The fibrous capsule was studied morphologically before and after manipulations with the laser and plasma scalpel.

[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.

[Respiratory failure in patients with severe craniocerebral trauma]. / Dykhatel'naia nedostatochnost' u bol'nykh s tiazheloi cherepno-mozgovoi travmoi.

To study the pathogenesis of respiratory insufficiency in a severe craniocerebral injury the authors examined 120 patients. The results showed bronchospasm, diffuse collapse of alveoli, and the occurrence of atelectasis to be the underlying factors of respiratory insufficiency in severe craniocerebral injury. The effect of analgesics, neuroplegics, barbiturates, and heliox on this condition was studied.

[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.

[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.