Surgical interventions for benign lesions of the extrahepatic bile ducts in 15-25% of cases end with the creation of bypass biliodigestive anastomoses. After pancreaticoduodenal resection, every 6 patients have failure of biliodigestive anastomoses and the formation of an external biliary fistula. During the same operation, failure of the pancreatodigestive anastomosis develops in about 15-40%, leading to high mortality. The use of traditional technologies in the surgical treatment of pancreatic pseudocysts is accompanied by the development of early complications and leads to relapses. In connection with this, interest arose in the use, for the treatment and prevention of these complications accompanying operations on the bile ducts and pancreas, of a new generation of implant materials with shape memory. From 1990 to 2021, we performed 183 stenting operations for pancreato- and biliodigestive anastomoses with titanium nickelide stents. In the comparison group of 56 patients with cicatricial lesions of the extrahepatic biliary tract, who used STPD and precision suture, good results were achieved in 58.5%, satisfactory in 22%, unsatisfactory in 19.5%. In the second comparison group of patients with this pathology, who underwent X-ray endobiliary stenitization with nitinol stents with a round thread section, good results were obtained in 41.8% of patients, satisfactory - in 58.2%. The average duration of stent functioning in this group of patients was 38.2±2.3 months. The results of treatment and prevention of the development of cicatricial lesions of the extrahepatic bile ducts of pancreato- and biliodigestive anastomoses using superelastic stents made of titanium nickelide with shape memory indicate the effectiveness and prospects of this direction both in open and laparoscopic operations.

хирургическая гастроэнтерология surgical gastroenterology Резюме Введение. Большинство современных классификаций хронических доброкачественных заболеваний аноректальной области базируется на оценке тяжести морфологических изменений, возникающих при этих заболеваниях. Однако, прямая зависимость между стадией заболевания и тяжестью ее клинических проявлений прослеживается далеко не всегда. Таким образом, существует необходимость в разработке инструмента оценки тяжести течения заболевания в качестве дополнения к текущей морфологической классификации.

In the literature devoted to the problems of liver transplantation, there is no clearly indicated attitude of the authors to intraoperative epidural blocks, although theoretically the benefits of a sympathetic block are considered. Some sources recommend prophylactic sodium bicarbonate infusion to alleviate post-reperfusion syndrome, but its effectiveness is questionable.Purpose: to present the physiological, biochemical and hematological characteristics of recipients at the stages of orthotopic liver transplantation with an assessment of the feasibility of using sodium bicarbonate for the prevention of reperfusion complications.Materials and methods. An observational study, contains an analysis of data from 39 participants operated on in 2020 in the volume of: hepatectomy, an orthotopic liver transplantation, with an initial assessment on the Child- Turcott- Pugh scale of 11 points. All participants were operated on under general inhalation anesthesia with sevoflurane and thoracic epidural three- component anesthesia according to the Breivik- Niemi method. There are 3 stages of data registration: the beginning of the anhepatic stage; the beginning of the neohepatic stage; the end of the operation.Results and discussion. Significant fluctuations in hemodynamics, violations of the acid-base state and energy metabolism were not revealed; a decrease in hepatic protein synthesis, a shift of the P50 point to the left, and moderate metabolic acidosis did not exceed the levels described in the literature. The dynamics of acidosis, РСО2 and natremia did not depend on the infusion of soda. There was no close correlation between arterial blood pH and lactate concentration.Conclusion. The benefits and safety of epidural anesthesia in orthotopic liver transplants are obvious and make it possible to recommend this component as a routine element of anesthesia during these operations. The indications for sodium bicarbonate infusion should be narrowed and consensus is needed to determine the critical pH value for sodium bicarbonate infusion.

The category of newborns with congenital malformations is considered the most difficult to treat. The influence of “stress”factors on the body in a short period of time triggers a pathogenetically determined chain reaction that leads to the development of multiple organ failure syndrome. The forecasting methodology determines the timeliness and directions of intensive care to approach and achieve positive results in this group of patients.The aim of the study: is to show the diagnostic and practical value of metabolic markers and functional indicators of homeokinesis in newborns with congenital malformations of the gastrointestinal tract.Materials and methods. An observational study of 81 patients in the neonatal period. The prognostic assessment of functional parameters and biochemical markers was performed by ROC analysis.Results. In newborns with malformations of the gastrointestinal tract, the course of the pre-and early postoperative period is associated with cardiopulmonary maladaptation, which requires the protection of vital functions. By the end of the first week, priority is given to therapy aimed at restoring the motility of the gastrointestinal tract. The prognostic value of the adverse outcome was determined: stress index greater than 3503 Sp = 98.36% (95%CI 86.3–99.2) and Se = 99.2% (95%CI 87.3–100), lactatemia level greater than 3.3 mmol/L Sp = 73.7% (95% CI 59.6–84.7) and Se = 93.6% (95% CI 78.9–100). The control of the infectious process and the selection of antibacterial therapy is important, since the risks of developing septic shock are high. Prolonged epidural analgesia is the optimal method of analgesia and is indicated in suspected cases of failure to achieve 75% of the volume of enteral nutrition by the week of the postoperative period Sp 85.42% (95%CI 48.2–97.7), Se 46.8% (95% CI 62.0–84.2).Conclusions. Prognostic models allow predicting the outcome of critical conditions and timely adjusting the volume of therapy.

АННОТАЦИЯ Целью исследования явилась разработка способа прогнозирования развития инсульта у мужчин, работающих в условиях воздействия общей вибрации. В обследование были включены 134 мужчины в возрасте от 30 до 65 лет, работавшие 5 и более лет по профессиям: водитель грузовой машины (БелАЗ-75, уровень общей вибрации-80-116 дБ), водитель автобуса (уровень общей вибрации-75-101 дБ). Участники исследования были разделены на две группы: первая-70 мужчин, перенесших инсульт; вторая-64 мужчины с диагнозом «Хроническая церебральная ишемия». С помощью метода последовательного включения переменных (Forward Stepwise) были установлены факторы риска развития инсульта в исследуемой группе (возраст, стаж работы, уровень общего холестерина, прием гипотензивных препаратов, наличие в анамнезе фактора курения) и предложена формула логистической регрессии, позволяющая определять вероятность развития инсульта. Значение, равное или превышающее 0.6, получаемое при расчете по этой формуле, свидетельствует о высоком риске развития инсульта. Чувствительность предлагаемого метода составила 81.4 %, специфичность-76.6 %. Предложенный метод прогнозирования развития инсульта у мужчин, работающих в условиях воздействия общей вибрации, может быть использован при проведении профилактических и периодических медицинских осмотров.