The thoracoscopic use of the CO2 laser in the combined treatment of pleural empyema]

A new method for treating acute pneumothorax with a bronchopleural fistula was experimentally developed and clinically tested. It is based on thoracoscopic use of CO2 laser radiation. The laser beam energy is employed for evaporation of necrotic tissues in the area of pulmonary destruction, "welding" of the bronchopulmonary fistulae, and general irradiation of the empyema cavity with a defocused beam. Nineteen patients with various disease duration were treated. In 16 patients the bronchial fistulae and the empyema cavity were eliminated and the lung re-expanded. The purulent inflammation in the pleural cavity was acute in these cases.     

Selective-occlusive method of drug administration in the treatment of experimental liver tumors

263 experimental studies on 184 rats were carried out. Hepatic tumors were provoked by intraparenchymatous implantation of 0.1 ml 20% tumoral suspension of mucous cancer (RS-I). Treatment was realized on 10-12 day after vaccination. Photodynamic therapy with "Photosense" (PS) and laser irradiation (670 nm, 50-100 Dj, 4-13 mm), and also catalytic therapy (CT) with "Teraftal" (TF) and ascorbic acid (AA) were used. FS and TF were administered by developed selective-occilisive method (SOM). Rapid accumulation of drugs in occluded lobe of liver was revealed in SOM, that permitted to decrease administered dose of TF in 16.5 times. There was no growth of tumor after FDT unlike control group. Same results were obtained after CT with SOM, but there was further growth of tumor after systemic administration of drugs. Developed SOM of drugs administration in FDT and CT lead to good results in treatment of experimental hepatic tumors.     

Diagnosis and treatment of different types of high scar strictures of the hepatic ducts

Results of treatment of 224 patients with scar strictures of the hepatic ducts (BSDH) are presented. Based on Bismuth's classification of BSDH E.I. Galperin (2002) proposed own one. According to this classification there were 17 (7,6%) patients with type "+2" (stump of common hepatic duct - CHD more than 2 cm), 26 (11,6%) - with type "+1" (stump of CHD 1 - 2 cm), 72 (32,2%) - with "0" type (stump of CHD less than 1 cm), 54 (24,1%) - with "-1" type (upper fornix of CHD confluence is not affected), 35 (17,4%) - with "-2" type (CHD confluence is destroyed), 20 (8,9%) - with "-3" type (strictures of segmental ducts). There were greater number of previous surgeries in the patients with "-1" and "-2" types (p<0,05). Jaundice and secondary biliary liver cirrhosis were seen more frequently in types "0" - "-3". Hepaticojejunostomy was the surgery of choice. For approach to unaltered wall of hepatic ducts (HD) section of lobar ducts in types "+1", "0", excision of portal plate and partial resection of IV hepatic segment (31 patients) in "-1" - "-3" types were used. Exchangeable transhepatic drainage (ETD) was applied in 31 patients due to impossibility to excise scar tissues completely. In early postoperative period 9 (4%) patients died due to purulent cholangitis (7 patients) and insufficiency of anastomosis (2 patients). Long-term results were evaluated in 180 (80,4%) patients from 1 to 14 (6,6+/-3,9) years of follow-up. Thirteen surgeries were performed for repeated strictures. The main cause of restrictures was inadequate resection of scar tissues and unreasonable refusal of ETD (7 patients). Developed surgical technique in different types of strictures permits to reduce postoperative lethality and the rate of restrictures.     

Characteristics of surgical treatment of benign bifurcation strictures of the hepatic ducts

Experience in the treatment of 195 patients with benign bifurcation stricture of the hepatic ducts is discussed. This group was made up of patients with the cicatricial process involving the region of the bifurcation or continuing to one or both lobar hepatic ducts. Two basic methods of bile--diverting operations were used: with carcass drainage (mono- and bilateral) of the anastomosis and hepatic ducts (n-155) and without a carcass drainage with the formation of a widecholecysto- intestinal anastomosis (through inclusion of the left lobar hepatic duct) by means of interrupted sutures without grasping the mucous membranes of the hepatic ducts and intestine (h-36). A combined method was used in 4 patients with an isolated stenosis of the right hepatic duct and an intact left hepatic duct. Intubation of both lobar hepatic ducts is considered necessary in patients with a bifurcation stricture in the existence of indications for carcass drainage of the bile-diverting anastomosis. Analysis of the immediate and late--term results showed that the postoperative period was more favourable in patients with bilateral carcass drainage of the bile-diverting anastomosis and in those with a precision anastomosis that in patients with monolateral drainage (complications occurred, respectively, in 16.3% and 46.6% of patients, and a good late-term results was encountered, respectively, in 78.5% and 55% of patients). The stricture did not recur in patients with a precision anastomosis and in those with bilateral carcass drainage.