The aim of the study was to analyse safety and benefits of laparoscopic common bile duct (CBD) exploration compared to open. Prospective randomized trial included a total of 256 patients with CBD stones operated from 2005 to 2009 years in a single center. There were two groups of patients: group I-laparoscopic CBD exploration (138 patients), group II-open CBD exploration (118 patients). Patient comorbidity was assessed by means of the American Society of Anesthesiology (ASA) score; i.e. ASA II-109 patients, ASA III-59 patients. Bile duct stones were visualized preoperatively by means of US examination in 129 patients, by means of ERCP in 26 patients, by magnetic resonance cholangiopancreatography in 72 patients. Preoperative evaluation was done through medical history, biochemical tests and ultrasonography. There was no statistical significant difference between 2 groups of patients. No mortality occurred. The mean duration of laparoscopic operations was 82 min (range, 40-160 min). The mean duration of open operations were 90 min (range, 60-150 min). Mean blood loss was much less in laparoscopic group than in open group (20 ± 2 vs. 285 ± 27 ml; p < 0.01). Postoperative complications were observed is nine patients of laparoscopic group and in 15 patients in open group (p < 0.01). There were 102 attempts to perform transcystic exploration of CBD. External drainage was used in 25 (32.8%) patients with transcystic approach. Conversion to laparotomy was performed in two patients. Open operations were performed in 118 patients with choledocholithiasis. External drainage was used in 85% of patients. Morbidity in open group was higher (12.7%) than in laparoscopic group (6.5%). Laparoscopic CBD exploration can be performed with high efficiency, minimal morbidity and mortality. Laparoscopic procedures have advances over open operations in terms of postoperative morbidity and length of hospital stay.

Introduction. The problem of improving early diagnosis and prognosis of breast cancer remains one of the most actual for current oncological practice. Taking into account a close correlation between the general prevalence of breast neoplasms and mortality from breast cancer, this problem is not only of professional interest, but also has medical-social and socio-economic significance. The purpose of the study is to improve the quality of the sentinel lymph node detection in patients with breast cancer using ICG. Material and methods. At the period 2009–2016, 400 patients with T1-T3N0M0 breast cancer were operated on. All the patients were divided into two groups using two dyes – Patent Blue and ICG. The patients after mastectomy with a sentinel lymph node biopsy had a clinical diagnosis of T2-T3N0M0 breast cancer more often. In group I, 100 patients had the sentinel lymph node biopsy. Lymph node staining was performed using Patent Blue dye. In group II, sentinel lymph nodes biopsy was conducted with the Patent Blue dye and another fluorescent dye — ICG, which was also injected on the affected side of the breast. After ICG dye introduction, in 15 minutes the stained green lymph nodes were detected using special equipment. Criteria for inclusion of patients in the clinical trial: 1) breast cancer patients of any age with T1-3N0M0, I-II AB disease stage; 2) patients with clinically unaffected lymph nodes N0 after examination. Criteria for exclusion of patients from the clinical trial: The exceptions were T3-T4 tumors > 5 cm in diameter, or the skin and chest wall invasion, as well as palpable axillary lymph nodes, 3 or more affected lymph nodes with sentinel lymph node biopsy; 3) patients after radiation therapy. Results. The tumor histology was performed after the node trephine biopsy. The main aims of sentinel nodes detection were staging and improving the breast cancer patients’ life quality after surgical treatment. The post-mastectomy syndrome, the main manifestation of which is swelling of the upper extremity is a big problem for patients because it affects their life quality and disturbs their usual lifestyle. The sentinel lymph node detection, in contrast to axillary lymph node dissection of I-II level, significantly minimizes all the risks of postmastectomy syndrome, in particular, impaired lymphatic drainage in the form of lymphatic edema of the upper extremity, impaired venous outflow in the form of stenoses or the axillary and/or subclavian veins occlusion, rough scars which limit the function of the extremity in the shoulder joint, and brachioplexitis. Conclusions. The study of sentinel lymph nodes significantly improves the results of surgical treatment of breast cancer patients. Based on the clinical-laboratory and histological examinations, new data were obtained concerning the sentinel lymph node detection using two dyes, the choice of the surgical intervention volume and reduction of complications rate at the postoperative period. We found that fluorescent lymphography is highly effective, which allows to recommend it for implementation into the clinical practice. The frequency of sentinel lymph node detection in breast cancer patients is 98% in the control group, 100% – in the main group. On the basis of the obtained results, the sentinel lymph node detection algorithm and the surgical management of patients with breast cancer was developed and implemented into practice, which allowed to reduce the number of complications with using two dyes for the sentinel lymph node detection from 19% to 2% (χ2 =15.37, p<0.001). Recurrence of breast cancer fell from 13% to 8%.

Introduction: Laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis is a popular option in many surgical institutes. Decompression of biliary system via T-tube post supraduodenal choledochotomy has been the traditional surgical practice. Primary closure of common bile duct (CBD) has been shown to reduce hospital stay but bears a risk of bile leak. We conducted a prospective randomized trial to compare complications and length of stay in patients undergoing biliary stent insertion versus T-tube drainage following LCBDE via choledochotomy. Methods and Procedures: The study involves 52 patients with choledocholithiasis who underwent LCBDE and decompression of the biliary system by either antegrade biliary stent or T-tube insertion. A 7 French biliary stent (9 "10 cm long) have been placed in 27 patients (group I), T-tube insertion have been used for 25 patients (group II). The length of hospital stay and complications were recorded. All transcystic explorations were excluded. Results: There were no significant differences between groups with respect to age, sex, comorbidities, number and size of CBD stones. Postoperative complications have been observed in 4 patients (16%) in the T-tube group (one patient needed reoperation for dislocation of T-tube),

27 О р и г и н а л ь н ы е р а б о т ы Введение Н ервная булимия (НБ) описана в 1979 г. G.F. Russel как одна из разновидностей нарушений пищевого поведения у боль-ных, опасающихся развития ожирения при употребле-нии огромных количеств пищи [28]. НБ характеризу-ется следующими особенностями [13]:-повторяющимися эпизодами быстрого поглоще-ния огромных количеств пищи в дискретный период времени, обычно-менее 2 часов;-cнижением контроля за количеством съедаемой пищи во время эпизодов переедания;-регулярным искусственным вызыванием рвоты, приемом слабительных средств или диуретиков, использованием строгих диет, голодания либо интен-сивных физических упражнений с целью нивелирова-ния последствий переедания;-частыми эпизодами переедания-не менее двух раз в неделю на протяжении как минимум 3 месяцев;-постоянной озабоченностью своим внешним видом, состоянием фигуры и наличием избыточной массы тела (МТ). НБ наблюдается у 1-3% [2], а по отдельным данным-до 5-8% [3, 33] населения и наиболее характерна для девочек-подростков и молодых женщин, проживающих в индустриально развитых странах. Специ фическими факторами риска являются ожирение и психические рас-стройства. Кроме того, на вероятность развития НБ могут указывать такие преморбидные признаки, как ран-нее менархе, наблюдаемое в детстве ожирение, стрессы, тревожные состояния, заниженная самооценка [11]. Этиология и патогенез НБ до конца не ясны. Традиционно НБ рассматривалась как психическое расстройство, подверженное влиянию главным обра-зом социальных факторов. Однако в последние годы наряду с социально-культуральными причинами воз-никновения НБ стала более очевидна роль биологиче-ских и генетических факторов [9]. Вероятность разви-тия НБ выше в некоторых профессиональных группах (балерины, спортсмены, студенты, топ-модели) [1, 35]. Очень сходный с НБ тип нарушения пищевого пове-дения-«binge-eating»-синдром (BE-синдром) или син-дром «обжорства»-более характерен для больных мор-бидным ожирением (МО) и сверхожирением. НБ отли-чается от BE-синдрома в первую очередь наличием ком-пенсаторного «очистительного» поведения после эпизо-дов пищевой перегрузки. Подобные действия пациентов могут носить характер своеобразного ритуала самобиче-вания [2]. Устойчивое «очистительное» поведение может предотвращать развитие МО и сопутствующих ожире-нию заболеваний (артериальной гипертензии, сахарного диабета 2 типа, синдрома ночных апноэ и др.), но в ряде случаев становится важ-ной негативной составляющей образа жизни и превращается в мучительное состояние как для пациентов, так и для их окружения. Постоянная озабоченность поисками пищи и бесконечная непреодолимая тяга к еде, характерные для НБ, ведут к социальной изоляции и снижению тру-доспособности [5]. НБ часто сопровождается развитием таких заболеваний, как фарингит, гастродуоденальные язвы, кровотечения, стома-тологические заболевания, паротит и др. Описаны и смертельные осложнения НБ: некроз желудка [26], разрыв желудка во время булими-ческой атаки [31], рак пищевода и пищевод Баррета [25], тяжелая гипокалиемия и почечная недостаточ...

years (range 27 to 87 years). There were two groups of patients. Group I: laparoscopic CBD exploration (138 patients). Group II: open CBD exploration (118 patients). Patient comorbidity was assessed by means of the American Society of Anesthesiologists (ASA) classification; ASA II -109 patients, ASA III -59 patients. Bile duct stones were visualized preoperatively by means of US examination in 129 patients, by means of ERCP in 26 patients, and by magnetic resonance cholangiopancreatography (MRCP) in 72 patients. Preoperative evaluation was done through medical history, biochemical tests and ultrasonography. Results: The mean duration of laparoscopic procedures was 82 min (range 40-160 min). The mean duration of open procedures was 90 min (range 60-150 min). Mean blood loss was much lower in the laparoscopic