[Combined operations for prophylaxis of gastroesophageal bleedings at the patients with portal hypertension].

Results of portocaval bypass (1st group), suture ligation of gastric and esophageal varicose veins (2nd group), and combined operations (3rd group) performed in early postoperative period at 759 patients with liver cirrhosis and extrahepatic portal hypertension are analyzed. Long-term results were studied at 549 patients. Early recurrence of bleeding was occurred at 41 (12.

[Diagnosis and treatment policy in trauma of duodenum].

Experience of treatment of 70 patients aged from 17 to 71 years with trauma of duodenum (TD) was analyzed. Majority of them was men -- 57 (81.4%).

[Late results of portacaval surgical shunt in patients with extrahepatic portal hypertension].

Late outcomes of portocaval shunting (PCS) were analyzed in 135 patients with extrahepatic portal hypertension (EPH). It was established that the methods of choice in such patients should be splenorenal anastomosis, mesentericocaval anastomosis (MCA) "side by side" and H-type with autovenous or synthetic insertions. The best results were detected in a combination of portocaval anastomosis with the suturing pf stomach and esophageal varicose veins, if the diameter of the anastomosed vessel was small and portal pressure was reduced by less than 25% (100 mm of water column).

[Results of suturing of esophageal and gastric varicose veins in patients with extrahepatic portal hypertension].

Experience in gastrectomy with suturing of varicose veins (VV) of the esophagus and stomach (M.D. Patsiora's surgery) in 349 patients with extrahepatic portal hypertension (EPH) is reviewed.

[Surgical treatment of resistant ascites in patients with portal hypertension].

Surgical methods of treatment of diureticoresistant ascites in 198 patients with portal hypertension are analyzed: portocaval bypass (n = 16), lymphovenous anastomosis (n = 64), ductolysis (n = 24), and peritoneovenous bypass (n = 94). The most stable positive results was achieved after portocaval bypass, but it can be performed only in a small part of patients. Peritoneovenous bypass and lymphovenous anastomosis demonstrated shorter effect but they had less risk and were better tolerated than portocaval bypass.

[Vitaflon vascular graft for portocaval shunt: experimental and clinical study].

Native "Vitaflon" vascular graft made of spongeous polytetrafluoroethylene for portocaval shunt was evaluated in patients with portal hypertension. Experimental series in grey rabbits proved high biological inertness of the graft. It was used for portocaval shunt in 13 patients.

[Orthotopic liver transplantation].

Orthotopic liver transplantation is the only method of choice for many severe liver diseases with poor prognosis. The development of liver transplantation programmes is based on medical science achievements and high technology in surgery, anesthesiology and perfusiology. The experience of the Surgery Research Center, Russian Academy of Medical Sciences, made it possible to obtain positive results of liver transplantation and posttransplantation management.

[The donor stage of orthotopic liver transplantation].

First clinical experience of the harvesting (donor) stage of orthotopic transplantation of the liver in Russia is represented. During 5-year period in National Research Center of Surgery RAMS 16 orthotopic transplantations of the liver were carried out. Surgical modes of harvesting of the donor liver are detailed ("standard" and "fast"), the regimes and methods of preservation of the liver were determined.

[The evolution of surgery for extrahepatic portal hypertension].

30 years' experience of elective surgical treatment of 600 patients with extrahepatic portal hypertension is summarized. Insufficient effectiveness of splenectomy in bleeding from varicose veins (VV) of the stomach and the esophagus (40% of relapses) is shown as well as frequent development (25%) of asplenic hemorrhagic thrombocytopenia. Partial esophagogastrectomy also has failed initial hopes due to severe agastric anemia which developed in 49.

[Application of wound coat "Tachocomb" in surgical interventions on liver and pancreas].

From May 1994 to December 1996 the wound coat "Takhocomb" was used in surgical procedures in 23 patients with various diseases of the and the pancreas. "Takhocomb" was mostly applied in various anatomical resections of the liver. Initial hemostasis of the hepatic stump was carried out by careful suturing of bleeding vessels.

[Orthotopic liver transplantation: surgery research center's experience].

From 1990 to 1996, 178 patients with severe diffuse and advanced focal liver diseases with grave prognosis were observed for indications to orthotopic liver transplantation (OLT). According to the revealed indications and contraindications, 95 patients were enrolled for the procedure. Eighteen patients underwent 19 OLTs, including 1 urgent retransplantation and 3 living related graftings.

[The system of hemostasis in experimental liver transplantation].

The status of haemostatic factors in 28 pigs after orthotopic liver transplantation was evaluated. The major changes took place in fibrinolytic system during the "non-liver" stage: rapid increase of fibrinolytic activity, plasmin activity, plasmin activator activity. From the moment of blood supply restoration to a transplanted liver the tendency to normalisation of fibrinolysis was detected.

[Iron metabolism in patients with portal hypertension].

Ninety-four patients with portal hypertension (48 with cirrhosis of the liver and 46 with pathological changes of the portal vein trunk) were examined. The main parameters of iron metabolism were determined by the radioimmunoassay and the iron deports in the liver and spleen biopsy material were revealed. Tissue iron deficiency was found in all patients.

[Traumatic injuries of the pancreas].

Retrospective analysis of surgical treatment of 153 patients with traumatic damage to the pancreas is discussed. The injury was closed in 67.3% and open in 32.

[Use of a gastrointestinal tube in the treatment of gastric and duodenal ulcer].

The trial of a gastrointestinal tube in gastroduodenal ulcer indicates its high efficiency for enteral tube feeding in serious ulcer cases and as a therapeutic modality in noncomplicated cases. The tube introduction in 55 patients out of 89 promoted the defect healing within 2-3 weeks, in 30 out of 36 cicatrization occurred on week 3-5. The presence of the tube produced no effect on acid production in the stomach, cicatrization of the ulcer took place without basic therapy in remaining hypo-achlorhydria and hyperchlorhydria.

[Orthotopic liver transplantation (first clinical experience)].

The article deals with the results of work conducted according to the orthotopic liver transplantation (OLT) program from January 1990 to January 1992. To select the patients for OLT, 54 persons (24 males and 30 females aged from 12 to 55 years) with diffuse (34) and focal (20) diseases of the liver were examined. OLT was indicated for 19 patients who were registered in the waiting list.

[Diagnosis and therapy of acute cholecystitis in liver cirrhosis].

The article deals with information on 12 patients with acute cholecystitis and cirrhosis of the liver (class A--with maintained hepatic function in 3, class B--with subcompensated hepatic function in 8, and class C--with decompensated stage of cirrhosis of the liver in one patient). The clinical picture was atypical and the course severe (purulent complications, hepatic insufficiency). Nonoperative management of the attack should be limited to 24 hours.

[Perioperative correction of hypochromic anemia and iron metabolic disorders in patients with liver cirrhosis and portal hypertension].

Forty eight patients with liver cirrhosis and portal hypertension have been examined, most of them had hypochromic anemia. Serum iron and ferritin levels, total and latent iron binding capacity have been radioimmunoassayed. All the patients developed hyposiderosis, the study of liver and spleen bioptates showed tissue iron deficiency.

[Re-evaluation of the opinions regarding vascular portacaval anastomosis in the surgical treatment of portal hypertension].

Experience in the establishment of vascular portocaval anastomoses in 66 patients with cirrhosis of the liver and 52 patients with extrahepatic portal hypertension was studied. Selective portocaval anastomoses produced the best immediate and late-term results in cirrhosis of the liver, side-to-side or H-type splenorenal anastomoses were found to be optimal, they were marked by minimal trauma to the pancreas and adequate decompression of the gastroesophageal channel with maximal maintenance of the portohepatic blood flow. Maximal decompression of the portal system is expedient in extrahepatic portal hypertension; this is mostly accomplished by means of H-type mesentericocaval anastomosis with an autograft formed from the internal jugular vein.

[Study of central and porto-hepatic hemodynamics before the surgical treatment of patients with liver cirrhosis and portal hypertension].

Basing on the results of hemodynamic findings related to the heart and liver in 41 patients with hepatic cirrhosis and portal hypertension (33 of them were operated on for portal hypertension), it is suggested that when deciding on the type of surgery in such patients, initial status of central and portal hemodynamics as well as expected changes in these parameters due to surgery should be taken into consideration. Pathogenetic grounds for some routine interventions in hepatic cirrhosis and portal hypertension are thought open to question.