Aim. To study the presence and localization of the P2X and P2Y receptor subtypes in the human cystic artery and great saphenous vein (with and without varicose disease).Methods. Segments of the human blood vessels were stained using a standard two-step immunohistochemical analysis using primary and secondary antibodies. In the experiments primary antibodies to the following receptors were used: Р2Х1, Р2Х2, Р2Х3, Р2Х4, Р2Y1, Р2Y2, Р2Y4. In order to determine the presence of a receptor in a vessel sample a comparison was made between staining of the experimental and the control samples, which were not treated with primary antibodies.Results. Immunohistochemical analysis of the cystic artery showed the presence of Р2Х1, Р2Х3, Р2Y1, Р2Y2 receptors. All receptor subtypes were found to be located in the muscular layer of the artery, whereas the P2Y1 receptor was also expressed on the surface of the endothelial cells. In the great saphenous vein without varicose disease Р2Х1, Р2Х2 и Р2Y1 receptor subtypes were identified, all of which were found to be located on the smooth muscle cells of the vein. Similarly to the cystic artery, the Р2Y1 receptor was also found within the endothelial layer of the vein. At the same time, only Р2Х2 и Р2Y1 receptor subtypes were expressed in the muscular layer of the great saphenous vein affected by varicose disease. No P2 receptor subtypes were identified on the endothelial layer of the varicose-diseased vein.Conclusion. Different P2 receptor subtypes were found to be present in the smooth muscle and endothelial layers of the human cystic artery and great saphenous vein. The identified differences in the receptor subtypes between samples of great saphenous veins with and without varicose disease are, most likely, explained by the restructuring of the receptor apparatus as a result of varicose disease progression.

Results of the study suggest that the sutureless sublay technique is safe and effective in the treatment of ventral abdominal hernia, especially in small and medium defects.

Aim. To justify the application of surgical access to thyroid and parathyroid glands by means of videoendoscopic equipment. Methods. 14 video-assisted surgeries on thyroid and parathyroid glands were performed during the period of 2011-2014 using low-invasive midline cervical access by means of videoendoscopic equipment. Results. The surgery was carried out with a skin access of less than 3 cm, the section was made 1.5-2 cm above than jugular notch. Tissue dissection was performed by means of «channel» formation with mobilization of tissues while looking for recurrent laryngeal nerve and parathyroid glands up to allocation of the superior pole of a thyroid gland lobe under the laparoscopic control. In case of parathyroidectomy due to adenoma special attention was paid to presurgical topical diagnostics which included neck organs ultrasound examination with the use of expert class equipment as well as thyroid and parathyroid glands scintigraphy. Intrasurgical ultrasound examination of the area of surgery to specify the pathologically changed parathyroid gland location was performed in some cases. Jugular notch of sternum, lower pole of thyroid gland, lateral surface of trachea, tracheo-oesophageal groove, and inferior thyroid artery were used as reference points for identification of recurrent laryngeal nerve and parathyroid glands while using video equipment. As a rule, the recurrent laryngeal nerve was located behind and below the parathyroid glands. The distance from a skin section to a recurrent laryngeal nerve and lower parathyroid glands was 3.6 and 3.1 cm respectively. Conclusion. Use of video endoscopic equipment allows to reduce traumatic surgeries on neck organs and promotes the better visualization of anatomical structures in an area of surgery.

Aim. To assess the effectiveness of preventive measures in endoscopic interventions on the major duodenal papilla.Methods. 1028 transpapillary interventions related to benign and malignant diseases were performed on 575 patients from 2007 to 2015. The analysis of complications rate and structure in different time intervals, taking into account the changing of patients management tactics and the use of different preventive technologies, was performed.Results. During 2007-2015, 30 cases of post-manipulational complications were registered (2.9% of patients) with a mortality rate of 0.09%. In the period from 2007 to 2008 post-manipulational complications rate was 8.5%. The main causes of complications were surgery long duration (up to 2 hours) and the lack of endoscopist experience. During this period, there was only one death, which was caused by acute cardiovascular insufficiency. From 2009 to 2011, the complications number decreased to 3.4% due to the careful patients selection for elective surgery, including the endosonography in diagnostic algorithm, octreotide, and hyoscine butylbromide use, the expansion of indications for the bile ducts stenting, exclusion the main pancreatic duct contrast, nasobiliary drainage in obstructive jaundice and suppurative cholangitis. In the period from 2012 to 2015, in the presence of a high risk of post-manipulational pancreatitis, every fifth intervention was completed by the main pancreatic duct stent placement with reducing of manipulations duration to 25-35 minutes, and increasing the surgery phases number. During this period, post-manipulational complications rate was 1.2%.Conclusion. Analysis of post-manipulational complications allowed to identify the most important measures to enhance the transpapillary interventions safety, thereby reducing the number of complications from 8.5% in the period of 2007-2008, to 1.2% in the period of 2014-2015.

Introduction. When using traditional endoscopic methods of choledocholithiasis treatment, the issues related to the remaining high risk of post manipulative complications remain unsolved. The priority task is the development of new methods of endoscopic treatment, which will prevent the development of postoperative complications. Aim. The aim of the study was to determine the optimal treatment option based on the comparative analysis of different ways of endoscopic interventions in patients with choledocholithiasis. Material and methods. The paper presents the outcomes of endoscopic interventions in 127 patients with choledocholithiasis. Of them 84 patients composed the main group in which choledocholithiasis treatment was performed according to the original method including two operative stages. On the first one we performed partial papillotomy, temporary stenting of common bile duct (in 100%) and main pancreatic duct (in 45%), and papillotomy over the stent to the muscular layer of Oddi sphincter. On the second one after 2–4 days the biliary stent was removed, lithoextraction was performed along with bile duct restenting. Pancreatic and biliary stents were removed after 24 hours and 3–8 weeks respectively. A comparison group was composed of 43 patients who underwent endoscopic surgeries by the classical well-known methods. Results and discussion. The analysis showed that the differences in the groups with classical method of choledocholithiasis endoscopic treatment (CMCLET) and original method of choledocholithiasis endoscopic treatment (OMCLET) between the levels of «Average number of surgeries per patient» (2,05 surgeries ranging from 1 to 4 for CMCLET versus 2,41 surgeries ranging from 2 to 5 for OMCLET; p=0,0176) and «Duration of hospitalization» (10,4 days to 8,95 days; p=0,0377), there was an inverse relationship between the number of surgeries and duration of hospitalization, which was largely due to different levels of the rate of early postoperative complications (p=0,0005). Twenty times higher blood amylase levels in the main group compared to the reference values did not lead to the development of acute pancreatitis, the incidence of which was 7 times lower in the comparison group (p=0,001). Conclusion. Comprehensive study of the outcomes of endoscopic treatment in patients with choledocholithiasis using different variants of interventions has shown convincing superiority of the original method of surgical aid.