Цель обзора – oбобщить данные о применении экстракорпоральных методов детоксикации в терапии печеночной недостаточности. В работе представлен обзор литературы, посвященный истории применения экстракорпоральных методов детокси- кации и их эффективности по отношению к регрессу печеночной энцефалопатии. Данные литературы свидетельствуют о том, что на современном этапе наиболее эффективным является метод экс- тракорпоральной детоксикации – «Молекулярная адсорбирующая рециркулирующая система». Ключевые слова: печеночная энцефалопатия, экстракорпоральные методы детоксикации. Purpose: To summarize literature data on extracorporal detoxication for treating hepatic insufficiency. This work is a review of literature data on the history of extracorporal detoxication and their effectiveness as to the regress of hepatic encephalopathy. Conclusion: The analyzed literature data indicate that currently the most effective technique for extracorporal detoxication is “Molecular adsorbing recirculating system”. Key words: hepatic encephalopathy, techniques for extracorporal detoxication

The aim of the research determine the character and peculiarities of nutritional support in surgical treatment of patients with gastroresection— and total gastrectomy syndromes. Analyzed are the results of the evaluation nourishing status of 68 patients who have had a resection intervention on the stomach. It was noted that the 26.5% of patients with clinical manifestations of diseases of operated stomach arise suband decompensated forms of disorders metabolism and nutrition, entailing numerous violations of homeostasis and requiring compliance with reconstructive surgical interventions. We studied the results of the implementation of the reconstructive operations with the formation of functionally active жомно-valve соустий in 18 patients, suffering from the disease of stomach operated on. It is proved, that the rational nutritional support in the perioperative period allows to avoid gross violations of metabolism and provides a reasonably good compensation digestive function, significantly improving the quality of life of this category of patients.

The aim of the research determine the character and peculiarities of nutritional support in surgical treatment of patients with gastroresection--and total gastrectomy syndromes. Analyzed are the results of the evaluation nourishing status of 68 patients who have had a resection intervention on the stomach. It was noted that the 26.5% of patients with clinical manifestations of diseases of operated stomach arise sub- and decompensated forms of disorders metabolism and nutrition, entailing numerous violations of homeostasis and requiring compliance with reconstructive surgical interventions. We studied the results of the implementation of the reconstructive operations with the formation of functionally active (see text for symbol) in 18 patients, suffering from the disease of stomach operated on. It is proved, that the rational nutritional support in the perioperative period allows to avoid gross violations of metabolism and provides a reasonably good compensation digestive function, significantly improving the quality of life of this category of patients.

The clinical use of esophagogastroplasty with antireflux gastroesophageal anastomosis was analyzed basing on the data of 11 operated patients. All patients had benign strictures of the esophagus were operated on transhiatally. The long-term and early results demonstrated the efficacy of the sphincter-valve gastroesophageal anastomosis in prevention of reflux after distal esophagus resection and primary esophagogastroplasty.

Aim: To determine the chronic cholangitis risk factors and to provide a practically significant diagnostic criteria of chronic cholangitis in patients after cholecystectomy. Materials and methods: Were examined the clinical, anamnestic data, clinical laboratory and instrumental studies of the condition of the hepatobiliary system in 127 patients with chronic cholangitis after cholecystectomy. The determination of microbial contamination of bile was performed during the duodenal intubation. Results: In the bile microbial landscape study were noted the violation of biliary system microbiota in 92.1% of cases. Herewith identified a combination of bacterial factors with parasitic invasion (mixed infection) in 28 (22.0%) patients. Cholangitis develops in the presence of duodeno biliary reflux, duodenal motility disorders and hypotonia of Oddi's sphincter in the early postoperative period. In the late periods after cholecystectomy, cholangitis chronization defines outflow obstruction and cholestasis due to functional or organic causes in most patients. Conclusions: Risk factors for chronic cholangitis should be referred to long history of gallstone disease, performance of cholecystectomy in the emergency order against the inflammatory process of the hepatobiliary system, absence of adequate correction of postoperative hypertension of bile duct, destruction of sphincter apparatus major duodenal papilla during surgery.

AIM: To determine the chronic cholangitis risk factors and to provide a practically significant diagnostic criteria of chronic cholangitis in patients after cholecystectomy. MATERIALS AND METHODS: Were examined the clinical, anamnestic data, clinical laboratory and instrumental studies of the condition of the hepatobiliary system in 127 patients with chronic cholangitis after cholecystectomy. The determination of microbial contamination of bile was performed during the duodenal intubation. RESULTS: In the bile microbial landscape study were noted the violation of biliary system microbiota in 92.1% of cases. Herewith identified a combination of bacterial factors with parasitic invasion (mixed infection) in 28 (22.0%) patients. Cholangitis develops in the presence of duodeno biliary reflux, duodenal motility disorders and hypotonia of Oddi's sphincter in the early postoperative period. In the late periods after cholecystectomy, cholangitis chronization defines outflow obstruction and cholestasis due to functional or organic causes in most patients. CONCLUSIONS: Risk factors for chronic cholangitis should be referred to long history of gallstone disease, performance of cholecystectomy in the emergency order against the inflammatory process of thehepatobiliary system, absence of adequate correction of postoperative hypertension of bile duct, destruction of sphincter apparatus major duodenal papilla during surgery.

The study substantiates the efficacy of the Roux reconstruction of the upper gastrointestinal tract in the surgical treatment of postresectional and postgastrectomic syndromes. Such reconstructive operations were performed in 16 patients. There were no postoperative mortality or specific complications registered. The short and long-term follow up demonstrated good compensation of the disorders, caused by the earlier radical gastric surgery. Thus, the method of the Roux reconstruction, amplified by the creation of functionally active sphincters and valves provides the satisfactory relief of the operated stomach disease.

The results of examination and treatment of 174 patients with postcholecytechtomic syndrome are analyzed in the study. Standard methods of research and an original method of ultrasound assessment of bile-excreting system are used. Criteria for selection of method of correction of postcholecystectomic syndrome depending on the mechanism of Сибирский медицинский журнал, 2009, № 6 75 its developments are developed. The effectiveness of differential correction of postcholecystectomic disorders is measured. Introduction of the developed treatment-and-diagnosis algorithm into the clinical practice raised the quality of living for patients of this category.

Are presented results of clinical use of an original way of strengthening antireflux function pyloric sphincter at patients expressed duodenogastroesophageal reflux. The expediency of performance of surgical rehabilitation esophagogastroduodenal canal, including selective proximal vagotomy, correction chronic duodenal obstruction, strengthening antireflux functions of the gatekeeper and formation the mechanism cardium therefore optimum anatomo-physiological conditions for normalization of processes of digestion are created is proved.

The work presents an analysis of results of using an original areflux choledochoduodenoanastomosis in 32 patients with acute cholangitis developed against the background of bile hypertension. The method of correction of mechanical jaundice is supposed to be formed in the area of biliodigestive fistula of the bicuspid invagination valve from the mucosal-submucosal layers (RF Patent No 2302831 of 20.07.2007). The introduction into clinical practice of the developed method of choledochoduodenostomy allowed not only arresting cholangiogenous infection in cases of obturatuional lesions of bile ducts, avoiding lethality and severe complications in the early postoperative period, but also prevention of the development of reflux-cholangitis.

In order to understand characteristics of morphofunctional status of upper gastrointestinal, 72 patients suffered from the gallstone disease were chosen for the recent survey. Factors were determined that stipulated severity of blennosis, nature of the acid produced, and intensity of motor-evacuation disorders of stomach and duodenum. It was proved that dismotor evidence and lowering resistance of the mucus membrane of stomach and duodenum were the main causes to form the GI tract pathology for the mentioned patients.

This article deals with experimental elaboration and clinical employment of anefluxive biliodigestive choledochoduodenoanostomosis in the surgery of mechanical jaundice. The experiment prover that it is possible to form double-door valve in the region of arefluxive choledochoduodenoanastomosis from the mucuos and submucuos layers of the duodenum. The made-up arefluxive valve managed to keep its structure and viability in all scheduled periods of observation, it didn't cause the violation of the bile flow, safely prevented the development of after-operation reflux-cholangit. The results of clinical employment of the given method of surgical correction of mechanical jaundice demonstrate good functional activity of arefluxive biliodigestive anastomoses, rohich contribute to quick rehabilitation of patients after operation.

The complex approach to therapy of pylorobulbar ulcers combined with duodenogastral reflux was developed and introduced into the clinical practice. The treatment stipulates the elements of functional surgery and eradicative antiinflammatory and antisecretory therapy. The use of this complex method permits to obtain the good results providing the food passage close to physiologic one, to prevent the ulcer recurrence, development of gastric mucosa pathology caused by duodenogastral reflux and persistence of Helicobacter pylori infection. As the result the patients' life quality significantly improves.