Aim. To improve the results of treatment for patients with complicated portal hypertension of cirrhotic genesis using the transjugular intahepatic portosystemic shunt with endovascular obliteration of the inflow pathways to the esophageal-gastric varicose veins.Material and methods. Transjugular intahepatic portosystemic shunt was performed in 172 patients with gastroesophageal variceal bleeding. The patients were divided into 3 clinical groups. The shunting procedure was applied to 62 patients. Another 110 patients underwent transjugular intahepatic portosystemic shunt and selective obliteration of the esophageal-gastric vein inflow pathways. The short-term and long-term results (up to 140 months), the incidence of thrombosis, recurrent bleeding and mortality, as well as their relationship with the established risk factors for complications were traced.Results. All patients achieved an effective reduction in the portosystemic pressure gradient and a reduction in the manifestations of portal hypertension. Recurrence of bleeding caused by shunt thrombosis occurred in 23 (13.3%) patients. In clinical group I (n = 62), this complication was noted in 9 (14.5%) patients, in II (n = 54) – 11 (20.4%) cases, in III (n = 56) – only in 3 (5.4%) cases. Bleeding-free survival decreased from 1.0 to 0.82 in 83.9 months, then plateaued. A sharp decrease in the Kaplan–Meier curve from 1.0 to 0.88 was observed within 24.5 months after the intervention. The largest number of deaths was in group I (30.6%), the smallest in group III (7.1%).Conclusion. Transjugular intahepatic portosystemic shunt supplemented by obliteration the inflows of the esophagealgastric varicose veins provides complete eradication of varicose veins, helps to reduce the frequency of recurrent bleeding and death.

Цель: улучшить результаты портосистемных шунтирующих вмешательств при осложненной портальной гипертензии применением на этапе предоперационной подготовки адаптирующей медикаментозной портальной декомпрессии. Материал и методы: проанализированы результаты операции TIPS/ТИПС у 113 больных, у 60 из которых на дооперационном этапе применена методика адаптирующей портальной декомпрессии селективным вазоконстриктором октреотидом в сочетании с неселективными бета-адреноблокаторами. Результаты: установлено более гладкое течение послеоперационного периода и восстановление клинико-лабораторных показателей в группе пациентов, у которых операции TIPS/ТИПС предшествовало проведение адаптирующей портальной декомпрессии. Заключение: для профилактики усугубления печеночной недостаточности у больных с осложненной портальной гипертензией, подвергающихся портосистемным шунтирующим пособиям, целесообразно проведение дооперационной адаптирующей портальной декомпрессии Ключевые слова: портальная гипертензия, операция TIPS/ТИПС, печеночная недостаточность, селективные вазоконстрикторы.

Introduction. Pelvic ring fracture with complex bone fragments displacement is associated with the urethral distraction injury in about 10% of cases. Emergency care for these patients includes the provision of trauma management and urinary diversion followed by delayed urethroplasty.Purpose of the study. To determine the effect of extramedullary osteosynthesis in a pelvic ring fracture on the outcome of treatment in patients with post-traumatic urethral strictures.Materials and methods. The study included 17 patients with post-traumatic urethral strictures associated with pelvic ring fractures (Types B, C). The average age of the patients was 35.8 ± 10.2 (19 - 61) yrs. All patients underwent submerged osteosynthesis and cystostomy drainage as an emergency. Localization of strictures: 10 (58.8%) - membranous, 7 (41.2%) - bulbo-membranous. Length of strictures: 1.47 ± 0.5 (0.5 - 2.5) cm. Post-traumatic period: 6.6 ± 1.3 (4 - 10) mo.Results. All patients underwent anastomotic urethroplasty. No early postoperative complications were identified. Spontaneous urination was restored by 14 - 15 days in all patients. Early urethral stricture relapses were revealed in 9 (52.9%) patients during 3-mo follow-up. These patients underwent removal of the metal structures fixing the pelvic bones. Repeated urethroplasty was performed a month later. Subsequent relapses of urethral stricture were not detected in any of 17 cases with a median follow-up of 28 (12 - 128) mo.Conclusion. Surgical treatment of urethral strictures associated with a pelvic ring fracture and osteosynthesis is advisable after removal of the metal structures fixing the pelvic bones. This is since the excessed retropubic screws protrusion (> 0.2 - 0.3 mm) is associated with a large area of periurethral fibrous inflammation and causes high relapse risks of stricture disease (52.9%) in the case of urethral surgery preceding the removal of metal structures.