[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.

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.

[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.

[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.

[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.

[The diagnosis and treatment of chromaffinomas].

The results of examinations and surgical treatment of 117 patients with chromaffin tumors are shown: one-sided localization in the adrenal in 88% of the patients, bilateral localization in 4.3%, and extraadrenal in 7.7%.

["Silent" pheochromocytomas].

The results of surgical treatment of 126 patients with "hormonally inactive" and catecholamine secreting tumors of the adrenals were studied. Among them 2 cases (1.6%) of "dumb" pheochromocytoma were diagnosed.

[Clinico-anatomic rationale for the access and technique in video-endoscopic adrenalectomy].

The results of surgical treatment of 60 patients with tumors of the adrenals with the help of endovideosurgical techniques were analyzed and described. The article also presents the data of experimental investigations performed in 31 corpses of subjects of different constitution and topography of the adrenals in the retroperitoneal space and different accesses to them with the help of endovideosurgical technique. The most effective and safe accesses and the method of endovideosurgical adrenalectomy have been developed, substantiated and approbated in clinical practical work.