The article presents the results of investigation and treatment 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 gastroenterological diseases. Thus, the terms of detection would be prolonged during pre-admission stage and this validated the reasonability of well-timed application of current laboratory methods of diagnostics. An appropriate clinic neuroendocrine syndrome could be confirmed in 93-96% of patients. The authors showed that available diagnostic technique of NET P were the helical computer tomography and endoscopic ultrasound study with sensitivity 75% and 91%, respectively. It was rational to complete study with the data of intraoperative sonography for final tumor localization and its assessment in relation to the connection with pancreas duct and vessels. At the same time, it could be used in case of suspicion to multiple neoplasia. Angiography in combination with arterial-stimulated blood sampling from the hepatic vein and positron emission tomography with 18-fluorodeoxyglucose were the additional methods of diagnostics concerning the main forms of limited hyperinsulinism and generalized forms of NET P. Immunohistochemical study of removed pancreas tumor was the main method of morphological verification of the diagnosis and it’s used to develop the further strategy of postoperative treatment for patients. The surgical method of treatment of patients with NET P allowed elimination of clinical laboratory manifestations of neuroendocrine syndrome and getting general cumulative 5-year survival (69,3±4,7%) of radically operated patients.

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. Injuries of the main bile duct were detected intraoperatively (n=14). The complete intersection was in 10 patients (the first group) and the edge intersection - in 4 cases (the second group). Iatrogenic injuries of the bile-excreting ducts were revealed in 37 patients in postoperative period. There were the complete intersections in 28 cases (the third group) and the edge intersections - in 7 cases (the fifth group). Injuries of additional bile ducts were determined in 2 patients (the fifth group). An analysis of the main qualifying features of iatrogenic injuries of the bile-excreting ducts allowed defining indications to reconstructive-restorative surgery in 60,8% patients, restorative operations - in 29,4%, an external drainage - in 5,8% and reclipping of additional bile ducts in relaparoscopy - in 3,9%. The rational surgical approach allowed obtaining perfect results in 65,8% and good, satisfactory results in immediate and long-term period with low postoperative lethality of 1,95%. The study of diagnostics results and treatment of the patients with iatrogenic injuries of the bile-excreting ducts indicated about reasonability of assessment of main factors, which are based on iatrogenic injuries according to the EAES classification. An individual program of examination and more rational variant of surgery could be chosen due to this approach, which provides minimization of negative results and good quality of life.