Objective. To develop a new method of the anastomoses formation, that would allow to form bilio-digestive and entero-entero anastomoses both on unchanged and inflamed tissues. Маterials and methods. In experimental on 50 laboratory rabbits the single-layer everting cholecysto-entero and entero-entero anastomoses on the Roux-defunctionalized loop of small intestine was created by the method of a high-frequency electric welding. The welding anastomoses were formed both on non-inflamed tissues and in the setting of biliary peritonitis. Patency, hermeticity, strength, macroscopic and microscopic pictures of the obtained joints were evaluated at different postoperative periods. Results. All anastomoses, formed by the method of a high-frequency electric welding, were not only patent and hermetic, but also sufficiently strong (40 – 100 mm Hg). The tissues were joined using thermo-adhesion; a coagulation scar was rather narrow, its complete epithelization was accomplished in 3 mo, and a scar maturation completed – in 6 mo. Conclusion. The method of a high-frequency electric welding permits to form both, bilio-digestive and inter-intestinal, anastomoses of equal reliability in the settings of non-inflamed and inflamed tissues.

Досвід неоад’ювантної селективної внутрішньоартеріальної хіміотерапії за схемою FOLFIRINOX, проведеної пацієнту з умовно резектабельним раком правого анатомо-хірургічного сегмента підшлункової залози

The aim — to determine the diagnostic and predictive value of intraoperative study of pancreatic remnant during radical operations in patients with ductal adenocarcinoma of the pancreas. To investigate the role and place of determining the cleanness of the cut and purity of the main pancreatic duct by the method of pathomorphological and cytological research both during the operation stage and in the planned order.Materials and methods. Includes 8 patients with G2 adenocarcinoma of the pancreas treated in the period from 2015 to 2019. Men were 5, women 3. The average age of patients was 62 ± 2.4 years. The patients with I — II stage of the ductal adenocarcinoma of the pancreas were selected. The staging was carried out according to the TNM system, with 5 patients with І stage stage, with ІІ stage 3 patients. Pancreatico‑duodenal resection for Whipple was performed in 6 patients, distal subtotal resection of the pancreas with splenectomy in 2 patients. Patients were divided into 2 groups, the first group included 4 patients with cytologically verified tumor cells on the remnant of the pancreas or main pancreatic duct, and the second — where no tumor cells were detected. The average duration of Whipple was 348 ± 34 minutes, distal resection of the pancreas with splenectomy 168 ± 21 minutes, average blood loss was 560 ± 175 ml, there were no lethal cases, the incidence of complications in the immediate postoperative period was 28.4 %. The following criteria were analyzed such as the validity of the cytological evaluation, the value of the dissemination coeficient at the beginning and at the end of the operation, the duration of the non‑recurrent period, the median survival, and the duration of the period from the moment of surgery to the death of the patient.Results and discussion. Cytological monitoring of peritoneal imprints from 5 zones at the beginning and at the end of the operation was performed. The study analyzed patients with a dissemination rate of 1 — 2. In 4 patients of the control group, cytologically tumor cells were not verified. In 4 patients of the main group, cytologically tumor cells were found on the anterior surface of the pancreatic stump. In three of them, 75 %, tumor cells were found on the surfers of the pancreatic stump. In two of them, 66 %, tumor cells were found in the middle of the duct length, and in one case, 33.3 % tumor cells were found at the end of the main pancreatic duct. The prints taken from the resection plane of the pancreatic stump immediately after removal of 1 mm of the parenchyma thickness for a pathological study of the «purity of the resection edge». After removal of tumor, intraoperative hyperthermic chemotherapeutic lavage and abdominal lavage with 5 to 6 liters of saline were performed, after which the presence of tumor cells in the abdominal cavity was repeated by the method of peritoneal imprints. In the control group, no tumor cells were found in 4 patients, so the dissemination coefficient was 1. In the main group of four patients at the end of the operation 50 % were not found on the anterior surface of the tumor cell stump, the dissemination coefficient in them was reduced from 2 to 1. In 25 % tumor cells were found in the main pancreatic duct, but they were not found on the surface of the gland stump. In the comparison group, life expectancy was 22.4 ± 1.2 months, and the duration of the unrecurent period was 13.8 ± 2.4 months, respectively. In the main group, the life expectancy since the operation was 18.1 ± 2.4 months, and the duration of the unrecurent period was 9.6 ± 1.9 months.Conclusions. In 50 % of patients cytologically tumor cells were found on the surface of the pancreatic remnant and in the main pancreatic duct. Long‑term results in cytologically absent tumor cells and their complexes are better than those in which tumor cells were found on the surface of the pancreatic remnant and in the main pancreatic duct. Intraoperative rapid analysis of cytological imprints of the resection plane and the main pancreatic duct in combination with pathologic study of «purity of the region» can determine the resection area of the organ in order to R0 resection. Further research is needed on more observations in order to statistically validate the prognostic and clinical value of the methodology.

Objective. To improve the results of treatment of pancreatic cancer, using modification of volumes of lymphadenectomy and application of multidisciplinary approach. Materials and methods. Into the investigation 16 patients, suffering a moderately differentiated (G2) adenocarcinoma of the pancreatic gland head (II stage of the disease) were included. There were 10 men and 6 women. The average age of the patients have constituted 62.4 yrs old. The patients were divided into two groups – the main and the comparative one, equally - by 8 of every group. In all the patients pancreaticoduodenal resection was done. All the patients in postoperative period have obtained gemcitabine in combination with 5-fluorouracyl. In patients of the main group a dynamical personalized intraoperative lymphadenectomy in accordance to our elaborated scheme, was performed. In patients of the comparison group lymphadenectomy was performed in accordance to the volumes adjusted, and it is called a standard one. Results. Average duration of the operation have constituted (347 ± 48) min, lymphadenectomy – (42 ± 12) min in the main group, and (31 ± 9) in the comparison group. Average volume of the blood loss have constituted (342 ± 272) ml. Average duration of hospitalization have constituted (8.2 ± 4.3) days, general rate of postoperative complications – 24.3% in both groups. After the operation the mortality was absent. Clinically significant lymphorrhea was observed in 3 patients in the main group, and in 5 – from the comparison group. In patients of the main group 9 ± 2 lymph nodes were excised, and in a comparative one – 13 ± 2, there were revealed 7 ± 1 (77.7%) and 9 ± 2 (60%) lymph nodes affected, accordingly. Postoperative diarrhea have occurred in 4 patients: in 3 – from comparative group, and in 1 – from the main group. Duration of the recurrence-free period in the main group have constituted (18 ± 2.3) mo, and in a comparative one – (13 ± 1.5) mo. Two years have survived 12/16 (75%) patients. In the main group one patient died, and in a comparative one - 3. The two-year survival in the main group have constituted 87.5%, and in a comparative one – 62.5%. Conclusion. Dynamical lymphadenectomy as a component of multidisciplinary approach gives possibility to reduce the quantity of the lymph nodes excised, unaffected by the tumor, to enhance the quantity of the excised lymph nodes trustworthily affected by the tumor, to lower the morbidity rate and to prolong the duration of the recurrence free period.

Національний інститут xipyргiї та трансплантологiї ім. О.О. Шалімова НАМН України, м. Київ Резюме. В експерименті на 50 кролях, які були розподілені на основну групу (n=35) та групу порівняння (n=15), проводили формування холецистоентеро-та ентероентероанастомозів на вилученій за Ру петлі тонкої кишки. В основній групі формували однорядні евертуючі анастомози методом ВЧ-електрозварюва-ння тканин, у групі порівняння накладали однорядні шовні анас-томози. Формування зварювальних та шовних анастомозів проводили як на незапалених тканинах, так і на фоні жовчного перитоніту. Для встановлення змін, які відбуваються в тканинах під час зварювання, проводили гістологічне дослідження ділянки зварювального шва та навколишніх тканин у різні терміни післяопераційного періоду. Встановлено, що при проведенні ВЧ-електрозварювання ціліс-ність з'єднання досягалась за рахунок термоадгезії. Зона елект-ротравми практично не поширювалась за межі ділянок безпо-середнього термічного впливу, коагуляційний рубець вузький, термічне пошкодження оболонок локальне, у межах 2700-3000 мкм. Процеси регенерації в ділянці зварювального шва проходили аналогічно, як і при накладанні анастомозів традиційним шовним методом. Повністю формування рубця та його епітелізація завершувались у терміни від 3 до 6 місяців.Ключові слова: біліодигестивний анастомоз, жовчовивідні протоки, жовчний перитоніт, ВЧ-електроз-варювання, гістологічне дослід-ження, експеримент.