Aim. To define the prognostic factors for puncture drain interventions efficiency and of an optimal time point for the open surgeries. Methods. Surgical treatment results in 56 patients with acute pancreatic necrosis are described. The first group (28 patients) included the patients treated only by. The second group (28 patients) included the patients who underwent puncture drain interventions with further open surgery. Puncture drain surgery efficiency was evaluated using laboratory data and results of instrumental examinations. Results. Body temperature, leukocytosis and a «left shift» on a white blood cell count performed not later than 7 days after the surgery were the key factors for assessing the puncture drain surgery efficiency. During the first 7 days after surgery the body temperature has come to normal in 100% of patients from the first group and in 30% of patients from the second group (c2=15,83, р 0,0005), in other 70% of patients from the second group the body temperature has come to normal later than 7 days after surgery. White blood cell count has come to normal during the first 7 days after surgery in 75% of patients from the first group and in 0% of patients from the second group (c2=11,14, р 0,0016), in 25% of patients from the first group and in all patients from the second group it has only came to normal range at least 7 days after surgery. A marked «left shift» during the first 7 days after surgery was registered in 50% of patients from the first group and in 0% of patients from the second group (c2=6,12, р 0,05), in 50% of patients from the first group and in all patients from the second group it has only came to normal range at least 7 days after surgery. A conservative approach should be preferred if these parameters improve over time and no significant changes in pancreas are seen on computed tomography, otherwise, especially when there are the signs of incomplete debridement on the computed tomography, an open-access surgery should be performed. Conclusions. Puncture drain intervention may be an independent and final method of surgical treatment or may become the first stage of combined surgical treatment in patients with acute pancreatic necrosis. Indications for an open-access surgery should be assessed 7-8 days after the puncture drain surgery was performed if no positive change of laboratory data is seen.

Introduction. Mortality in generalized peritonitis (GP) reaches 30%, and with the development of multiple organ failure, the lethal outcome is observed in 80-90% of cases. Enteral insufficiency syndrome (EIS) plays a leading role in the progression of generalized peritonitis. The aim of the study was to develop a differentiated approach of enteral insufficiency syndrome correction in patients with generalized peritonitis. Material and methods. This research was a retrospective prospective study. The study included 50 patients with GP, who received treatment at the Surgery Department of the Samara Regional Clinical Hospital in the period from 2017 to 2019. Depending on the chosen treatment tactics, the patients were divided into two clinical groups. Group I included 29 patients, admitted in the period from 2017 to 2018, who had received the standard GP treatment. A long-term endogenous intoxication in patients of this group associated with the progressive enteric failure led to the repeated surgeries; at the same time, a high frequency of postoperative complications was preserved. The analysis of the results in patients of Group I necessitated development of the therapeutic and diagnostic algorithm aimed at early diagnostics and timely correction of EIS. Group II included 21 patients with GP, admitted in the period from 2018 to 2019, who was treated using the new algorithm. Results. The objective criteria for the relief of EIS in GP in patients of the study groups were a decrease in the level of serum albumin and C-reactive protein, a significant decrease in the amount and qualitative change in the intestinal discharge via an intestinal tube, a decrease in the recovery time of the functions of the small intestine and start of defecation. On the 6th postoperative day, in patients of Group II there was no significant albumin level reduction in comparison with the 1st day of monitoring (28.310.77 g/l vs 37.334.69 g/l). Whereas in Group I the albumin level was significantly lower (19.30.51 g/l) than the same parameter in Group II, and in comparison with the 1st day of monitoring (19.30.51 g/l vs 39.56.05 g/l; р = 0.00001). On the 6th postoperative day, the C-reactive protein level differed significantly between the groups as well: Group I 104.7613.49 mg/l, Group II - 58.0029.05 mg/l, p = 0.003. The control of GP in patients of the Group I was reached after 4.52.5 repeated abdominal interventions, while in patients of Group II generalized peritonitis was arrested after 2.30.9 surgical interventions (p = 0.000171), which is 1.9 times less. Conclusions. The proposed algorithm of EIS control is based on the individual approach to the treatment of patients with GP. The developed EIS rating scale allows determining not only the degree and dynamics of the pathological process, but also monitoring the effectiveness of treatment options applied in a particular patient.

The urgency of the problem: Pancreatitis is one of the most severe complications of transpapillary interventions. It is not always possible to predict the occurrence of pancreatitis. Mortality from this complication reaches 3%. Research objective: To substantiate the prognostic significance of risk factors for the development of acute pancreatitis in patients undergoing transpapillary interventions. To establish the probability of complication development depending on a different combination of PEP risk factors. Materials and methods: 418 transpapillary interventions was performed on the base of NGHCI Railway Clinical Hospital on Samara station OAO RGHD for 2 years. Acute pancreatitis was observed in 41 (9%) cases. Patients treated during the listed period were stratified into two groups: active treatment group (retrospective) and control group (prospective). Based on the analysis of the first patients group the following PEP were identified: female sex, young age, cholelithiasis, uneven cannulation of MPD, atypical PST. It was found that patients didnt have one isolated risk factor. A combination of various risk factors was observed in all cases. Prediction of acute pancreatitis by applying the selection of patients with a high risk of complications is used in practice at the control group. The sensitivity of the PEP predictive method on the basis of identifying a risk group, on the basis of a factors combination which affect on the complication development was 96.6%. The specificity of this method is 97.1%. Results: The frequency of pancreatitis in the active treatment group and control group was 9% and 14% after ERCP performing. At the same time, the method of the determining the high risk of PEP, which was identified retrospectively, allowed predicting the complication development in most cases. Acute pancreatitis developed in 22 patients out of 27 who had a risk of developing this complication. Complex medicamentally prevention was performed for all patients with high risk of PEP. The group of patients most susceptible to the pancreatitis development which has the following combination of risk factors was selected: female sex, age from 20 to 40 years old, litoextraction with choledocholithiasis , atypical PST, cannulation of MPD. The risk of complications in a patient who has these risk factors is 88.8% according to our data. Conclusion: The identification of risk factors for the development of acute pancreatitis among patients undergoing transpapillary interventions allows to identify the group of patients most susceptible to complication. It allows starting a complex prevention of the complications development. Conservative prevention with Octreotides solution, infusion and antibacterial therapy is low-efficiency and does not reduce the risk of developing PEP. The introduction of other types of acute pancreatitis prevention, which have a more favorable effect and can prevent the pancreatitis development into clinical practice, is necessary.

The aim of the study is to illustrate the case reports of patients with catamenial pneumothorax and with consecutive discussion about the causes of late diagnosis of endometriosis and recurrence of pneumothorax.Material and methods. Three own clinical cases of middle-aged women with catamenial pneumothorax who were treated in the surgical thoracic department of the «Samara Regional Clinical Hospital named after V.D. Seredavina» in 2017 had been described.Results. In all clinical cases the pleuroperitoneal fistula was the direct cause of the development of pneumothorax due to the germination of the endometrial node. The lack of caution regarding endometriosis leads to the fact that the revision of the diaphragm during thoracoscopy is performed rarely and very superficially. The solution about the volume of diaphragm repair is simple: the suturing of the defect is indicated. The definition of gynecological tactics should go parallel to the surgical one immediately, as soon as the assumption of possible endometriosis appeared.Conclusion. It is important to remember about endometriosis of the diaphragm as a possible reason of spontaneous pneumothorax in women of reproductive age. When performing thoracoscopy, a revision of the diaphragm is necessary to identify its possible fenestration. Prevention of recurrent pneumothorax consists in the induction of pleurodesis and the subsequent treatment of endometriosis by an obstetrician-gynecologist.

Objective. To analyze minimally invasive treatment methods (puncture-draining intervention and laparoscopic) of liver echinococcosis and to develop an optimal treatment algorithm.Methods. The results of 120 clinical observations of patients with liver echinococcosis who were treated from 2002 to 2018 are presented. based on SOKB them. V.D. Seredavina (Samara). The comparison group (n = 68) consisted of patients with PDV and laparoscopic intervention in the period from 2002 to 2008, the main group (n = 52) - patients with PDV and laparoscopic intervention in the period from 2009 to 2018.Results. The starting points of the choice of treatment for echinococcosis in patients of the main group were the stage of life and the diameter of the hydatid cyst. Evaluation of the results of surgical treatment was carried out on the basis of a list of criteria that were assigned the values ​​of "good", "satisfactory", "unsatisfactory". With the right choice of surgical treatment tactics, as well as the priority of echinococcectomy in patients of the main group, 94% of clinical observations (n ​​= 52) achieved positive results.Conclusion. The proposed differential algorithm of surgical tactics of echinococcosis using minimally invasive techniques answers questions regarding the choice of access and method of surgical treatment based on the size of cysts, their number and localization, as well as the period of the parasite's vital activity.