Chronic pancreatitis (CP) is a quite common disease with an annual incidence of up to 30 new cases per 100,000 persons in Russia, and 9.6 cases per 100,000 persons abroad. Idiopathic pancreatitis associated with genetic mutations ranks second in frequency. When conservative therapy is ineffective, surgical intervention is considered. Total pancreatectomy reduces pain, but leads to pancreatogenic diabetes mellitus. In case of hereditary pancreatitis caused by mutations in the PRSS1, CFTR, SPINK1 genes, pancreatectomy becomes advisable, including for prevention of pancreatic cancer. Isolation of Langerhans islets from the excised pancreas and their autotransplantation (total pancreatectomy with islet autotransplantation, TPIAT) provides additional treatment options. Such surgical interventions are not performed in Russia as of yet. The aim of the study was to assess the effectiveness of total pancreatectomy followed by restoration of glucose tolerance in treatment of patients with chronic genetically determined pain pancreatitis. Materials and Methods:Two patients with chronic pain pancreatitis with the SPINK1 and PRSS1 genetic mutations were examined and underwent surgical total pancreatectomy. Islets were isolated from the excised glands and implanted into the liver. Postoperative followup included an assessment of quality of life and pain intensity based on questionnaires, as well as determination of the glycemic level. Results:Following total pancreatoduodenectomy and autotransplantation, a significant decrease in pain and an improvement in quality of life were noted. Transplanted islets' function was reduced, due to their insufficient number, which required administration of exogenous insulin. Conclusion:The described experience demonstrates the TPIAT effectiveness in treatment of chronic pancreatitis, which can become a basis for further research and introduction of the technique into domestic clinical practice.

The purpose of the study was to analyze surgical treatment outcomes for renal cell carcinoma (RCC) with inferior vena cava tumor thrombosis (IVC-TT) on the basis of one cancer center.Material and Methods. A retrospective analysis of treatment outcomes of 25 patients with locally advanced and metastatic RCC with IVC-TT, who underwent surgery from 01.2021 to 12.2022, was carried out. The median follow-up was 21 months (95 % CI 14.3–33 months). The patients were divided into groups according to the Mayo IVC-TT classifcation: Type I: 8 patients, type II: 8 patients, and type III: 9 patients.Results. Tangential IVC resection was done in 20 (80 %) cases, circular-in 3 (12 %) cases, and IVC extirpation was done in 2 (8 %) cases. The median intraoperative blood loss was 600 ml (from 250 to 1700 ml). The incidence of postoperative complications was 28 %, distribution by Clavien–Dindo classes was: III – 4, IV – 2, V – 1, an increase in the incidence of complications of class III–IV was revealed in patients with Mayo type III, however, no statistically signifcant differences were found (p=0.153). The most common complication was acute kidney injury. Two (8 %) patients required repeated surgical intervention. One patient died due to sepsis. Statistically signifcant differences were obtained in blood loss (p=0.003), the number of erythrocyte suspension blood transfusions (p=0.006), and the time of surgery (p=0.014) and prevailed in the group with the Mayo III level. However, the median length of hospital stay did not differ in the subgroups (p=0.978) and amounted to 6 bed days in the range from 4 to 20 days in the general group. The 30-day postoperative mortality rate was 4 %.Conclusion. Our experience has shown that surgical treatment of RCC with IVC-TT is feasible and provides acceptable surgical and oncological outcomes. However, the complication rate and postoperative mortality are higher in patients with Mayo III thrombus levels, requiring careful patient selection.

В статье представлен клинический случай лечения пациента с раком прямой кишки, осложнившимся развитием инфицированной биломы. В лечении онкологических заболеваний достигнуты значительные успехи в последние годы. Однако инфекции, связанные с оказанием медицинской помощи, могут ухудшать прогноз после хирургических вмешательств. В таком случае актуальной становится не только борьба с онкологическим процессом, но и с инфекционными осложнениями. Краеугольным камнем лечения становится антибиотикотерапия, которая может быть осложнена развитием резистентности микробной флоры. При назначении антибиотиков следует учитывать наличие факторов риска полирезистентных штаммов, что позволяет оптимизировать стартовую антибиотикотерапию.

Aim. To analyze the complications of liver and pancreas surgeries, including infectious complications, and to describe the evolution of microbial flora in the hepatopancreatobiliary surgery unit.Materials and methods. The study involved 650 patients who underwent pancreatoduodenectomy and 1253 patients after liver resection. Types of preoperative biliary drainage were evaluated in terms of their influence on the treatment results. The incidence and nature of postoperative bile leakage were studied. The study included an analysis of microbial flora in the hepatopancreatobiliary surgery unit for 10 years.Results. The rate of significant complications, including infectious complications, appeared to be unaffected by a type of bile ducts drainage with potential infection at a standard course after pancreatoduodenectomy. A pancreatic fistula is considered to be a major factor in the development of abdominal infectious complications and the main cause of unfavorable outcomes. A bile leakage was most often revealed after liver resection in 95 observations (7.5%), and significantly more often after extensive liver resections. Gram-negative flora prevailed in bile from external drains of bile ducts and wound exudates in two thirds of cases. Gram-positive microorganisms were detected in one third of patients, fungi – in less than 5% of cases. The drainage fluids mostly obtained polyresistant gram-negative microorganisms. The majority of strains revealed resistance to cephalosporins, fluoroquinolones, penicillins, and an increasing resistance to carbapenems in dynamics.Conclusion. Bacterobilia after bile duct drainage significantly determines a microbial landscape of a hepatopancreatobiliary surgery unit. Pancreatodigestive anastomotic leakage is recognized as an important predictor of infectious complications in the area of intervention after pancreatoduodenectomy. Cases of this kind require the antimicrobial therapy with respect to the initial flora of the biliary tract. A bile leakage is considered to be a main contributor to infectious complications after liver resection. Extensive liver resection can lead to a sepsis-like state in the early postoperative period, predisposing to infectious complications.

There has been described a clinical case to demonstrate the capabilities of transcranial duplex scanning (TCDS) in brain death diagnosis. The feature of the technique is the detection of brain circulation stagnation staging: from alternating circulation to a total absence of Doppler spectrum in all intraand extracranial arteries of brachiocephalic system including all standard imaging approaches, among them transorbital imaging of intracranial vessels. The identification of alternating circulation in extracranial vessels enables to verify stagnation of brain circulation regardless intracranial blood flow indices that is of great importance in case of bad quality of bone window for TCDS.

The dynamics of microbial endotoxemia in group of 149 patients with cholelithiasis complicated by obstructive jaundice has been studied as dependent on the perioperative tactics of infusion therapy. The perioperative period in obstructive jaundice patients is complicated by a significant increase in lipopolysaccharidemia caused by translocation mechanisms and disorders of the liver detoxification function. In Group 1, 47 patients received infusion therapy including Ringer's solution and 10% glucose solution at a 1:1 ratio. In group 2, 55 patients received infusion therapy with only Sterofundin G-5 solution. In Group 3, 47 patients received the infusion therapy with remaxol in a dose of 800 ml/day. It is established that the infusion of Sterofundin G-5, and to a greater extent the infusion of remaxol, reduces the early postoperative degree of decompensation and accelerates recovery of the detoxifying function of Kupffer cells with respect to microbial endotoxin.

There have been analyzed the results of surgical treatment of 128 patients with metastases of colorectal cancer in the liver operated in the Privolzhsky district medical center of Federal Medico-Biologic agency of Russia (Nizhny Novgorod). There has been carried out the comparative assessment of the results processed by means of international register LiverMetSurvey (www.livermetsurvey.org) with collective data of the project published. All main aspects were compared. Age, primary tumour localization, the number, size and localization of hepatic metastases, the presence of associated pathologies, as well as the volume of surgeries performed in the compared groups had differences representing the work of Regional Hepatology Centre. The main difference was in postoperative survival of such patients: according to International register, two-year survival amounts to 76%, and in our centre - 57%. The obtained results of the analysis show the approaches to the treatment of this difficult group of patients in the Privolzhsky district medical center correspond to the international protocol.

The aim of the investigation is to estimate shortand long-term results of the treatment of ductal adenocarcinoma of the head of pancreas after conventional and extensive pancreatoduodenal resection. Materials and methods. There were performed total 27 conventional and 27 extensive interventions. The groups under study were comparable by sex, age, and the degree of tumour differentiation. Mean time of surgery, the volume of blood loss and hemotransfusion, the frequency of postoperative complications, and mortality did not differ significantly. Results. After extensive pancreatoduodenal resection, local recurrence occurred significantly more rarely (7.4 versus 33.3% after conventional surgery). Broadened lymphadenectomy in ductal adenocarcinoma of the head of pancreas did not lead to the increase of postoperative complications, mortality and overall survival. In the meantime, extensive gastropancreatoduodenoal resection enables to decrease significantly recurrence rate.

There have been analyzed the results of surgical treatment of 128 patients with metastases of colorectal cancer in the liver operated in the Privolzhsky district medical center of Federal Medico-Biologic agency of Russia (Nizhny Novgorod). There has been carried out the comparative assessment of the results processed by means of international register LiverMetSurvey (www.livermetsurvey.org) with collective data of the project published. All main aspects were compared. Age, primary tumour localization, the number, size and localization of hepatic metastases, the presence of associated pathologies, as well as the volume of surgeries performed in the compared groups had differences representing the work of Regional Hepatology Centre. The main difference was in postoperative survival of such patients: according to International register, two-year survival amounts to 76%, and in our centre 57%. The obtained results of the analysis show the approaches to the treatment of this difficult group of patients in the Privolzhsky district medical center correspond to the international protocol...

The aim of the investigation is to estimate short-and long-term results of the treatment of ductal adenocarcinoma of the head of pancreas after conventional and extensive pancreatoduodenal resection.Materials and methods. There were performed total 27 conventional and 27 extensive interventions. The groups under study were comparable by sex, age, and the degree of tumour differentiation. Mean time of surgery, the volume of blood loss and hemotransfusion, the frequency of postoperative complications, and mortality did not differ significantly.Results. After extensive pancreatoduodenal resection, local recurrence occurred significantly more rarely (7.4 versus 33.3% after conventional surgery). Broadened lymphadenectomy in ductal adenocarcinoma of the head of pancreas did not lead to the increase of postoperative complications, mortality and overall survival. In the meantime, extensive gastropancreatoduodenoal resection enables to decrease significantly recurrence rate.

The influence of the infusion therapy content on a hepatic function of bile outflow (HFBO), a bilirubin content and the enzymes activity in obturation jaundice in 139 patients was studied up. In 54 patients (the first group) a Ringer solution and 10% solution of glucose in 1:1 ratio were applied; in 37 patients (the second group) - a sterofundin-G-5 solution; in 48 patients (the third group) - remaxol in a dose of 800 ml/day. Application of sterofundin-G-5 and remaxol as a component of infusion therapy have promoted a bile outflow intensity enhancement in early postoperative period in comparison with such while Ringer solution and 10% solution of glucose application. Remaxol more effectively have eliminated a hyperbilirubinemia, enzymemia and a HFBO disorder, than sterofundin-G-5.

114 liver resections in patients with the colorectal metastases were performed within the period of 2005-2010. 52 patients (48,14%) with bilobar mulpiple metastatic liver lesion were operated. In 11 patients liver resection was supplemented with metastases destruction by the device developed on the basis of local impact of ultrahigh frequencies energy. The reliable differences were not revealed while studying and comparison of the survival rate of patients after performed operations in monolobar and bilobar metastatic liver lesion. With that the survival term of the operated patient was amounted to 22,8 months. Some variants of one stage and two stages surgical treatment were suggested.

The investigations were performed in 139 patients divided into 3 groups and who were given similar volume of infusion therapy (1600 ml/day). In the first group consisting of 54 patients the solution of infusion therapy included the Ringer solution and 10% of glucose solution in the ratio 1:1. In the second group (37 patients) the infusion therapy was performed with a solution of sterofundin-G-5. In the third group (48 patients) remaksol in dose 800 ml/day was included in infusion therapy. The inclusion of sterofundin-G-5 and remaksol in the infusion therapy increased the rate of bile outflow at the early postoperative period as compared with the solutions of Ringer and 10% of glucose. Remaksol is better for arresting endotoxicosis and bile excreting function of the liver as compared with infusion of sterofundin-G-5.

Domestic device for destruction of tumors by microwave power was designed. Initial series of laboratory experiments were performed with microwave liver ablation. Primary series of patients with colorectal cancer metastases to the liver demonstrate positive results. Short-term exposure, programmable shapes and sizes of ablative zones are the distinctive advantages of microwave thermoablation (MTA). 329 patients underwent liver resections during 2005-2010 years.108 patients had colorectal cancer metastases to the liver. 52 (48,14%) patients had bilobar liver lesions. Among them 11 patients underwent liver resection combined with MTA of contralateral liver lesions. Reliable differences in survival rates among patients with monolobar and bilobar metastatic lesions were not observed. Median of survival rate amounted 22.8 months in patients operated for metastatic colorectal cancer. Variants of surgical treatment are proposed.