[Clinical and economic justification of icg-cholangiography in «difficult» laparoscopic cholecystectomy].

Objective: To prove from a clinical and economic point of view the expediency of using ICG cholangiography in patients with «difficult» laparoscopic cholecystectomy for the prevention of damage to the bile ducts.

Material And Methods: The results of treatment of 173 patients with cholelithiasis at various levels of health care providing were analyzed with regard to assessment of indicators of surgery complexity, developed complications and economic costs.

Results: The effectiveness of the original scale of «difficult» laparoscopic cholecystectomy has been proved.

[Implementation of the «safe cholecystectomy» program in the Leningrad Region].

Objective: To present a treatment program for patients with cholelithiasis in the region in accordance with modern requirements for the quality of medical care in the realities of a three-level system of surgical care.

Material And Methods: The results of treatment of patients with cholelithiasis at various levels of medical care were analyzed with an assessment of the indicators of operational activity of performing cholecystectomy by laparoscopic and open methods, the development of complications of surgery and inpatient mortality.

Results: A programmatic approach has been developed to assist patients with cholelithiasis in the conditions of regional healthcare at different levels of surgical care.

[Enucleation of pancreatic tumors: a multiple-center study].

Objective: To evaluate the immediate results of enucleation of pancreatic neuroendocrine tumors (pNETs).

Material And Methods: The results of enucleation of pancreatic neuroendocrine tumors (pNETs) were analyzed in 95 patients between 2016 and 2021. Functioning tumors (mean size 16.

[How necessary to perform neoadjuvant chemoradiotherapy for rectal cancer in geriatric patients?].

A comparative analysis of the efficacy and safety of neoadjuvant chemoradiotherapy (CRT) in colorectal cancer patients older and younger than 60 years has been performed. It was determined that the risk of complications of neoadjuvant CRT, as well as the degree of its adverse effect on outcomes after surgical treatment, are not significant for the age of patients. However, the use of preoperative CRT in elderly patients is associated with a less significant increase in recurrence-free survival in comparison with younger patients.

SURGICAL TREATMENT FOR PATIENTS OF ELDERLY AND SENILE AGE WITH LOCALLY ADVANCED COLON CANCER.

The article analyzed the results of radical operative treatment of 102 patients aged 35-85 years old. It was shown that combined operations on patients of 60 years old and older were associated with high risk of somatic complications in postoperative period. However, these operations provided more higher rate of survival compared with patients younger than 60 years old and improved the quality of life.

CYTOREDUCTIVE OPERATIONS IN TREATMENT OF THE PATIENTS OF ELDERLY AND SENILE AGE WITH DISSEMINATED FORMS OF COLORECTAL CANCER.

Late diagnostics of colon cancer along with high specific weight of the patients of elder age groups indicated the urgency of study of application of cytoreductive surgery in elderly and senile patients of with colorectal cancer. A comparative assessment of the results of cytoreductive operations (primary tumor resection) was made in two groups of patients with disseminated colon cancer (younger and older than 60 years old). It was stated, that the performance of palliative resection allowed them to obtain of encouraging remote results, provide more higher survival rates than in patients of young and mean age groups.

APPENDICEAL MASS: DIAGNOSTICS AND TREATMENT STRATEGY.

One of the frequent complications of acute appendicitis is appendiceal mass (AM). This research aimed to specify the criteria of AM diagnostics and determine the rational treatment strategy. It was stated that the duration of disease more than 3 days in combination with palpable infiltrate in the right iliac region and absence of positive appendiceal signs allowed formation of the clinical diagnosis of dense AM and definition of the following diagnostics program.

[Geriatric aspects in oncocoloproctology (review)].

Severe comorbidity significantly limits the use of active surgical tactics in patients of older age groups suffering from colorectal cancer (CRC), leading to the abandonment of the necessary operations in 20 % of cases. The low use of radical surgical tactics are not always related to objective difficulties, but often can be due to the stereotypical approach to solving the question of the treatment of the elderly patient, which leads to unreasonable refusal of surgical intervention. Today is not defined by a single concept of surgical treatment of patients with colon cancer in elderly and senile age.

[RESULTS OF DIAGNOSTICS AND TREATMENT OF ADRENOCORTICAL CANCER].

The results of examination and treatment of 96 patients with adrenocortical cancer (ACC) were analyzed. Local forms of ACC (I and II stages (T1-2N0M0) were found in 19 patients, locally advanced forms (III stage (T1-4NIM0; T3-4N0M0) - in 62 cases and metastatic forms of ACC (IV stage (TxNxM1) - in 15 patients. The diagnostic approach to ACC was optimized.

[Modern technologies and diagnostics in treatment of neuroendocrine tumors of the pancreas].

The article presents the results of investigation and treat- ment of 124 patients with neuroendocrine tumors of the pancreas (NET P): insulinima (68 cases), gastrinoma (43 cases), rare forms of tumor (13 patients). It was stated that clinical manifestations of NET P resembled the signs of neurological and gastroentero- logical diseases. Thus, the terms of detection would be prolonged during pre-admission stage and this validated the reasonabil- ity of well-timed application of current laboratory methods of diagnostics.

[SUBSTANTIATION OF SURGICAL APPROACH IN IATROGENIC INJURIES OF THE BILE-EXCRETING DUCTS].

The results of examination and treatment were analyzed in 51 patients with iatrogenic injuries of the bile-excreting ducts. Patients were divided into 5 groups according to international classification (EAES, 2013). It depended on the time of detection, the nature and scale of damage of the bile ducts, mechanism of injury, development of infectious and septic complications.

[Variants of choice of surgical treatment of chronic pancreatitis in consideration of morphological changes in the pancreas].

The results of examination and treatment of 445 patients with chronic pancreatitis were analyzed. It was established, that 298 (67%) patients had indications for treatment in the conditions of surgical hospital. The patients were divided into three groups according to the modified pancreatitis classification of Marseilles-Rome 1988.

[Surgery in the Academy: history, achievements and prospects].

The 215th anniversary of the Imperial Medical and Surgical Academy (now Military Medical) is a reason not only for celebration, but also is the moment of truth, connecting the great history of surgical development in Russian and its prospects in 21st century. The Kirov Military Medical Academy is the center of professional education for military surgeons. There is not only military medical research and practice, but also clinical.

[Exenteration of the small pelvis in treatment of local tumors].

The authors analyzed the experience at the period from September 2000 to January 2014. The total exenterations of the small pelvis were performed on 23 patients (12 men and 11 women) at the age from 37 to 71 years old. Supralevator total exenterations with full visceral reconstruction were carried out in 13 cases out of 23.

[Features of chronic pancreatitis pathomorphism in the validity of surgical approaches].

The results of examination and surgical treatment of 298 patients with chronic pancreatitis and the original morphological investigations of material of the pancreas were studied. The data allowed the detection of additional criteria features of inclusion of the patients with chronic pancreatitis to be made in groups according to foreign Marseilles-Roman classification (1988). It is shown, that the basis of study of morphogenesis of chronic pancreatitis is immunohistochemical method, which let the authors diagnose not only the pathological changes of exo- and endocrine sections of pancreas, but at the same time the structural features of nervous apparatus and vessels of microcircular bed.

[The diagnostic algorithm in patients with severe chronic constipaton without aganglionosis of the large intestine].

The algorithm of special study in patients with severe chronic constipations includes the chronometry of passage of sulphate barium along the gastric tract with the assessment of evacuation function of each part of the large intestine, the irrigoscopy, the fibrocolonoscopy, the investigation of motor function of sigmoid colon. The proposed diagnostic algorithm allows the determination of part or parts of the large intestine with incompetent motor and evacuation functions and decision on the necessary extent of resection of the colon.

[New approaches in treatment of patients with perforated duodenal ulcer].

The results of examination and treatment of 152 patients with perforated duodenal ulcer were analyzed with the aim to make the ground of systemic approach to their surgical treatment in consideration of contemporary achievements of laboratorial and instrumental diagnostics and the opportunities of minimally invasive surgery. The results of conducted clinical study showed that in order to establish the correct preoperative diagnosis and the choice of rational treatment of patients with perforated duodenal ulcer it is necessary to conduct a purposeful complex investigation, including an assessment of general somatic state and the operative-anaesthetic risk of patients and changes of pyloroduodenal zone and the severity of peritonitis and prediction of lethality. The diagnostic algorithm let the authors make a diagnosis of perforated duodenal ulcer before the operation and decide on an adequate volume of surgical intervention.

[Programmed approach to the treatment of secondary hyperparathyroidism in chronic renal disease].

Prevalence and course of secondary hyperparathyroidism were studied in 616 patients with chronic renal disease. Disorders of mineral metabolism, which develop when person has chronic renal disease, appear at the early stage of the disease. They practically cannot be corrected on predialytic stage of treatment and lead to the development of parathyroid adenoma in patients with substitutive renal therapy by hemodialysis, that requires surgical treatment.