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Исследована функция почек у больных с компенсированным и декомпенсированным течением цирроза печени. Дана оценка роли почечной дисфункции в развитии осложнений цирроза.

A. S. Tugushev, D. I. Mikhantyev, V. V. Neshta, V. P. Akinshin, A. N. Kaulko, A. N. Petrash Aim. Elaboration of the uniform tactical installations concerning questions of rational therapy of patients with renal dysfunction in cirrhosis and its complications is actual.Methods and results. Effectiveness of the treatment of 48 patients with renal dysfunction was studied. As basis therapy terlipressin (Remestip) and albumin were used. It was established that treatment of renal dysfunction improves survival rate of patients and allows to extend terms of complications development.Conclusion. It testifi es the infl uence of correction of renal dysfunction in patients with decompensative course of cirrhosis on duration and quality of their life.

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Проведена оценка влияния разобщающих оперативных вмешательств на характер изменений висцеральной гемодинамики у больных циррозом печени в сравнении с неоперированными больными в стадии декомпенсации. Показано, что характер изменений висцеральной гемодинамики после спленэктомии, в отличие от неоперированных больных, характеризуется снижением воротного давления вследствие уменьшения объема притекающей к печени висцеральной крови Ключевые слова: цирроз печени, портальная гипертензия, висцеральный кровоток, спленэктомия, ультразвуковое сканирование, допплерография Splenectomy in patients with cirrhosis presupposes an increase of blood inflow into portal system to decrease the portal pressure. At the same time there are different opinions about splenectomy. So it is actual to study the character of changes of blood flow in vessels of abdominal cavity in pre-and postsurgical periods and assessment of an influence of these changes on the clinical course of cirrhosis. Aim of research. To assess an influence of splenectomy on the character of changes of splanchnic hemodynamics in patients with cirrhosis comparing to non-operated patients with compensated and decompensated clinical course.Materials and methods. There were examined 190 patients with cirrhosis: gastrointestinal bleeding from oesophagus varicose veins took place in 133 patients, diuretic resistant ascites -in 57 ones. 19 patients underwent splenectomy: 7 -in association with sewing of the left gastric vein and artery, 6 -with "skeletonization" of the lesser curvature of stomach with Nessen's operation, 2 -with Patsiora's operation, 2 -with application of selective porto-caval shunt between the low mesenteric vein and the left vein of an ovary. 84 patients died during observation. The duration of observation was from 0.5 to 3.5 years. All patients underwent fibrogastroscopy every 3-4 month. Hemodynamics was assessed on the base of repeated ultrasound of abdominal cavity. There were assessed diameter of hepatic and splenic vessels; qualitative and quantitative characteristics of blood flow in hepatic and splenic arteries, portal and splenic veins. Results of research. Changes of hemodynamics in patients after splenectomy as opposed to non-operative patients are characterized with the decrease of diameter of portal vein at almost stable speed of the linear blood flow in it.The result is some decrease of the volume of portal blood and index of portal blood congestion that indirectly indicates the decrease of portal pressure after splenectomy. At the same time arterial hepatic blood flow stays without essential changes. At fibrogastroscopy there was noticed a decrease of esophageal varicose veins dilatation, its tension, elimination of «red signs" that is a prognostic marker of the menace of bleeding. There were noticed no one relapse of bleeding and the sign of refractory ascites during the period of observation. Conclusion. The changes of splanchnic hemodynamics after splenectomy are characterized with decrease of the volume of splanchnic blood. The result is...