issn 19955464 АННАЛЫ annals of surgical...

2014. Том 19, № 2

Подписной индекс по каталогу “Роспечати” 47434

РЕДАКЦИОННАЯ КОЛЛЕГИЯ:

2014. V. 19. N 2

EDITORIAL BOARD:Ахаладзе Г.Г. (Москва, Россия)Ахмедов С.М. (Душанбе, Таджикистан)Баймаханов Б.Б. (Алматы, Казахстан)Буриев И.М. (Москва, Россия)Бъёрн Эдвин (Осло, Норвегия)Ветшев П.С. (Москва, Россия) Ветшев С.П. (Москва, Россия) (научный редактор)Готье С.В. (Москва, Россия)Емельянов С.И. (Москва, Россия)Журавлев В.А. (Киров, Россия)Кармазановский Г.Г. (Москва, Россия)

(зам. главного редактора – распорядительный директор)

Котовский А.Е. (Москва, Россия)Кубышкин В.А. (Москва, Россия)Мамакеев М.М. (Бишкек, Киргизия)Манукян Г.В. (Москва, Россия)Наги Хабиб (Лондон, Великобритания)Назыров Ф.Г. (Ташкент, Узбекистан)Ничитайло М.Е. (Киев, Украина)Панченков Д.Н. (Москва, Россия)Патютко Ю.И. (Москва, Россия)Третьяк С.И. (Минск, Беларусь)Тулин А.И. (Рига, Латвия)Цвиркун В.В. (Москва, Россия)Шаповальянц С.Г. (Москва, Россия)Шулутко А.М. (Москва, Россия)

Akhaladze G.G. (Moscow, Russia)Akhmedov S.M. (Dushanbe, Tajikistan)Baymakhanov B.B. (Almaty, Kazakhstan)Bjorn Edwin (Oslo, Norway)Buriev I.M. (Moscow, Russia)Vetshev P.S. (Moscow, Russia) Vetshev S.P. (Moscow, Russia) (scientific editor)Gautier S.V. (Moscow, Russia)Emelianov S.I. (Moscow, Russia)Zhuravlev V.A. (Kirov, Russia)Karmazanovsky G.G. (Moscow, Russia)

(Associate Editor – Chief Executive)Kotovskiy A.E. (Moscow, Russia)Kubishkin V.A. (Moscow, Russia)Mamakeev M.M. (Bishkek, Kirgizia)Manukyan G.V. (Moscow, Russia)Nagy Habib (London, Great Britain)Nazirov F.G. (Tashkent, Uzbekistan)Nichitaylo M.E. (Kiev, Ukraine)Panchenkov D.N. (Moscow, Russia)Patyutko Yu.I. (Moscow, Russia)Tretyak S.I. (Minsk, Belarus)Tulin A.I. (Riga, Latvia)Tsvirkoun V.V. (Moscow, Russia)Shapovalyants S.G. (Moscow, Russia)Shulutko A.M. (Moscow, Russia)

Главный редактор Э.И. Гальперин (Москва, Россия)Зам. главного редактора В.А. Вишневский

(Москва, Россия)

Зам. главного редактора М.В. Данилов (Москва, Россия)Отв. секретарь Т.Г. Дюжева (Москва, Россия)

Editor/in/Chief E.I. Galperin (Moscow, Russia)Associate Editor V.А. Vishnevsky (Moscow, Russia)Associate Editor М.V. Danilov (Moscow, Russia)Secretary Editor Т.G. Dyuzheva (Moscow, Russia)

РЕДАКЦИОННЫЙ СОВЕТ: BOARD OF CONSULTANTS:

Адрес для корреспонденции:115446, Москва, Коломенский проезд, 4,

Клиническая больница № 7. Проф. Гальперину Э.И.Тел./факс (499) 782/34/68. E/mail: [email protected]

http://www.hepatoassociation.ru/journalООО “Видар” 109028, Москва, а/я 16.

Контакты (495) 768/04/34, (495) 589/86/60,http://www.vidar.ru

Address for Correspondence:Prof. Galperin E.I.,Hospital #7, Kolomensky pr. 4, Moscow, 115446 Russia.Tel/Fax + 7 (499) 782/34/68. E/mail: [email protected]://www. hepatoassociation.ru/journalVidar Ltd. 109028 Moscow, p/b 16.Contacts + 7 (495) 768/04/34, + 7 (495) 589/86/60,http://www.vidar.ru

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Регистр. № ПИ № ФС77/19824

Scientific and Practical JOURNALEst. 1996

Reg. № ПИ № ФС77/19824

Альперович Б.И. (Томск, Россия), Багненко С.Ф. (Санкт/Петербург, Россия), Бебезов Б.Х. (Бишкек, Киргизия),Бебуришвили А.Г. (Волгоград, Россия), Вафин А.З.(Ставрополь, Россия), Винник Ю.С. (Красноярск, Россия),Власов А.П. (Саранск, Россия), Гранов А.М. (Санкт/Петербург, Россия), Гришин И.Н. (Минск, Беларусь),Заривчацкий М.Ф. (Пермь, Россия), Каримов Ш.И.(Ташкент, Узбекистан), Красильников Д.М. (Казань, Россия),Лупальцев В.И. (Харьков, Украина), Полуэктов В.Л.(Омск, Россия), Прудков М.И. (Екатеринбург, Россия),Сейсембаев М.А. (Алматы, Казахстан), Совцов С.А.(Челябинск, Россия), Тимербулатов В.М. (Уфа, Россия),Чугунов А.Н. (Казань, Россия), Штофин С.Г.(Новосибирск, Россия)

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Al'perovich B.I. (Tomsk, Russia), Bagnenko S.F.(St./Petersburg, Russia), Bebezov B.Kh. (Bishkek, Kirgizia),Beburishvili A.G. (Volgograd, Russia), Vafin A.Z. (Stavropol,Russia), Vinnik Yu.S. (Krasnoyarsk, Russia), Vlasov A.P.(Saransk, Russia), Granov A.M. (St./Petersburg, Russia),Grishin I.N. (Minsk, Belarus), Zarivchatski M.F.(Perm, Russia), Karimov Sh.I. (Tashkent, Uzbekistan),Krasilnikov D.M. (Kazan, Russia), Lupaltcev V.I. (Kharkov,Ukraine), Poluectov V.L. (Omsk, Russia), Prudkov M.I.(Ekaterinburg, Russia), Seysembayev M.A. (Almaty,Kazakhstan), Sovtsov S.A. (Chelyabinsk, Russia),Timerbulatov V.M. (Ufa, Russia), Chugunov A.N. (Kazan,Russia), Shtofin S.G. (Novosibirsk, Russia)

Chief of office Platonova L.V.

Журнал включен ВАК РФ в перечень ведущих рецензируемыхнаучных журналов и изданий, в которых должны быть опубли!кованы основные научные результаты диссертации на соисканиеученой степени доктора и кандидата наук.

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АННАЛЫХИРУРГИЧЕСКОЙ

ГЕПАТОЛОГИИ

ANNALS OF SURGICALHEPATOLOGYANNALY KHIRURGICHESKOY GEPATOLOGII

© МЕЖДУНАРОДНАЯ ОБЩЕСТВЕННАЯ ОРГАНИЗАЦИЯ

“АССОЦИАЦИЯ ХИРУРГОВ!ГЕПАТОЛОГОВ”

© INTERNATIONAL PUBLIC ORGANIZATION

“ASSOCIATION OF SURGICAL HEPATOLOGISTS”

ISSN 1995�5464

CONTENTSPublication Requirements . . . . . . . . . . . . . . . . . . . . 4

XXI International Congress of Association of Surgical Hepatologists of SIS Countries10–12 September 2014, Perm’ . . . . . . . . . . . . . . . . 7

Extirpation of Pancreatic Stump and TotalDuodenopancreatectomy for Prevention and Treatment of Complications after Pancreatic Surgery

Egorov V.I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

End�to�loop Pancreatoenteroanastomosis During Pancreatoduodenectomy

Rogal M.L., Yartsev P.A., Vodyasov A.V. . . . . . . . 14

Urgent Extirpation of Pancreatic Stump Lyadov K.V., Egiev V.N., Lyadov V.K., Kovalenko Z.A., Kozirin I.A. . . . . . . . . . . . . . . . . . 19

Conclusion of the Issue . . . . . . . . . . . . . . . . . . . . . 23

Anatomical Classification of Arterial Blood Supply to the Liver for Radio�Endovascular Procedures: Analysis of 3756 Hepatic Angiographies

Balakhnin P.V., Tarazov P.G. . . . . . . . . . . . . . . . . 24

Evaluation of Morphological and Functional Changes of Hepatobiliary System with Gadoxetic Acid (Primovist)

Shimanovsky N.L. . . . . . . . . . . . . . . . . . . . . . . . . . 42

Hepatic Resection in Liver EchinococcosisAkhmedov S.M., Ibrohimov N.K., Safarov B.D., Rasulov N.A., Tabarov Z.V. . . . . . . 49

Criteria for the Choice of Construction of Endoprosthesis for Endoscopic Biliary Stenting

Glebov K.G., Kotovskiy A.E., Dyuzheva T.G. . . . . 55

Complications and Mortality Rates in MiniinvasiveProcedures for Acute Necrotizing Pancreatitis

Mizgirev D.V., Duberman B.L., Epshtein A.M.,Kremlev V.V., Bobovnik S.V., Pozdeev V.N.,Prudieva E.V. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

Miniinvasive Procedures for Management of Pancreonecrosis

Mikhaylusov S.V., Moiseenkova E.V., Tronin R.Y. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

PANCREAS

BILE DUCTS

LIVER

“TROUBLE” PANCREAS STUMPIS THE MAIN PROBLEM OF PANCREATODUODENECTOMY(CONTINUATION, BEGINNING 2013, V.18, N 3)

INFORMATION

Correlation between Melatonin Receptor Expression and Severity of Acute Pancreatitis

Shapkina L.G., Semenov D.Yu., Osmanov Z.Kh. . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

The Potential of Structural�resonance Therapy in Combined Treatment of Acute Pancreatitis

Dyatchina G.V., Ivanov Yu.V., Panchenkov D.N., Alekhnovich A.V. . . . . . . . . . . . 83

Chronic Calculous Pancreatitis: a Review of Approaches to Surgical Management

Parhisenko Yu.A., Zhdanov A.I., Parhisenko V.Yu., Kalashnik R.S. . . . . . . . . . . . . 91

Gallbladder Agenesis and the Normal GallbladderDevelopment (review)

Borodach A.V. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

Phosphorus Magnetic Resonance Hepatic Spectroscopy (review)

Bagnenko S.S. . . . . . . . . . . . . . . . . . . . . . . . . . . . 111

Tight Suturing (Capitonnage) of PostnecroticPurulent Pancreatic Pseudocyst

Galperin E.I., Chevokin A.Yu., Ignatyuk V.G., Semenenko I.A. . . . . . . . . . . . . . . 117

Two�stage "in situ split" ExtendedRight Hepatectomy in Patient with Cholangiocellular Carcinoma

Novruzbekov M.S., Olisov O.D., Lutsik K.N.,Donova L.V., Driaev V.T., Magomedov K.M.,Muslimov R.Sh., Dzioev S.H.. . . . . . . . . . . . . . . . 120

Guidelines Management of NonresectableHepatocellular Carcinoma (based on "RSOC recommendations for hepatocellular carcinoma diagnosis and treatment. Version 1.2012.")

Dolgushin B.I., Patutko Y.I., Gorbunova V.А., Breder V.V., Kosyrev V.Y., Virshke E.R., Chuchuev E.S. . . . . . . . . . . . . . . . . 127

Abstracts of Current Foreign PublicationsAkhaladze G.G., Akhaladze D.G. . . . . . . . . . . . . 132

Aleksandr Sergeevich Ermolov To the 80�th anniversary . . . . . . . . . . . . . . . . . . . . 137

Valeri Alekseevich KubishkinTo the 70�th anniversary . . . . . . . . . . . . . . . . . . . . 139

Viktor Viktorovich TsvirkounTo the 65�th anniversary . . . . . . . . . . . . . . . . . . . . 141

Ilya Mikhaylovich Buriev To the 60�th anniversary . . . . . . . . . . . . . . . . . . . . 143

JUBILEES

ABSTRACTS

PRACTICAL GUIDELINES

CASE REPORTS

REVIEW

2

ANNALS OF SURGICAL HEPATOLOGY 2014. V. 19. N 2

3


Extirpation of Pancreatic Stump and Total DuodenopancreatectomyExtirpation of Pancreatic Stump and Total Duodenopancreatectomyfor Prevention and Treatment of Complications after Pancreaticfor Prevention and Treatment of Complications after PancreaticSurgerySurgery

Egorov V.I.1, 2

1 V.G. Korolenko Municipal Clinical Hospital No 14, Department of Health, Moscow; 7, Stromynka str.,

Moscow, Russian Federation2 I.M. Sechenov First Moscow State Medical University; 8, Trubetskaya str., Moscow, 119992, Russian Federation

Egorov Viacheslav Ivanovich – Doct. of Med. Sci., Head of Surgical Oncology Department of V.G. Korolenko Municipal

Clinical Hospital No 14, professor of Chair of Surgery, Institute of Postgraduate Education, I.M. Sechenov First Moscow State

Medical University.

For correspondence: Egorov Viacheslav Ivanovich – 7, Stromynka Str., 107014 Moscow, Russia. Phone: +7�926�735�95�11.

E�mail: [email protected]

“TROUBLE” PANCREAS STUMP IS THE MAIN PROBLEM OF PANCREATODUODENECTOMY

Prevention and management of postoperative pancreatic fistula or pancreatico�digestive anastomosis failure still remains

a major problem. There is an ongoing dispute in relation to the choice of treatment. This review article discusses advis�

ability and effectiveness of pancreatic stump extirpation and total duodenopancreatectomy in prevention and manage�

ment of postoperative complications after pancreatic resection.

Key words: pancreatic resection, pancreatodoudenectomy, total duodenopancreatectomy, pancreatic stump extirpation, pan�

creatic fistula, pancreatico�digestive anastomosis failure.

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5


End�to�loop Pancreatoenteroanastomosis End�to�loop Pancreatoenteroanastomosis During PancreatoduodenectomyDuring Pancreatoduodenectomy

Rogal M.L., Yartsev P.A., Vodyasov A.V.N.V. Sklifosovsky Research Institute for Emergency Medicine; 3, bld 5, B. Sukharevskaya sq, Moscow, 129090,

Russian Federation

Aim. To analyze the immediate results of pancreatoduodenectomy with end�loop pancreaticoenterostomy.

Materials and Methods. 29 cases of pancreatoduodenal resection were analyzed. The surgery was performed in patients

with pancreatic head cancer (6 cases, 20.7%), chronic pancreatitis (14 cases, 48.3%), pancreatic carcinoid (2 cases,

6.8%), gastrointestinal stromal tumor (1 case, 3.4%), common bile duct tumors (3 cases, 10.4%), and major duodenal

papilla cancer (3 cases, 10.4%).

Results. Failures of pancreaticoenteroanastomosis and hepaticoenteroanastomosis occurred in 2 (6.8%) and 1 (3.4%)

cases respectively. There were no lethal outcomes and no repeated surgery was performed. Intra�abdominal abscesses

were treated by ultrasound�guided drainage, fistulae closure was obtained with conservative therapy.

Conclusion. End�loop pancreaticoenterostomy allows for improved immediate results of pancreatoduodenectomy by

preventing anastomotic failure, lowering pyoinflammatory and destructive complication rates as well as hospital�level

mortality.

Key words: end�loop pancreaticoenterostomosis, pancreatoduodenectomy, anastomotic failure, pancreatic head cancer,

chronic pancreatitis, common bile duct cancer.

Rogal Mikhail Leonidovich – Doct. of Med. Sci., Professor, Head of the Scientific Department of Acute Liver and Pancreas

Diseases, N.V. Sklifosofsky Research Institute of Emergency Care. Yartsev Petr Andreevich – Doct. of Med. Sci., Head of

Scientific Department of Emergency Surgical Gastroenterology, the same Institute. Vodyasov Anton Vyacheslavovich –

Researcher, Laboratory of Transfusion, Preservation of Tissues and Artificial Feeding, the same Institute.

For correspondence: Rogal Mikhail Leonidovich – 15, Bol'shaja Perejaslavskaja Str., Apt. 76, Moscow, 129110, Russia. Phone:

+7�903�617�74�13. E�mail: [email protected]

References1. Cattell R.B. Resection of the pancreas, discussion of special problems. Surg. Clin. North Am. 1943; 23: 753–766.

2. Howard J.M. Historical aspects and the future of pancreatoduodenectomy. J. Hepatobiliary Pancreat. Surg. 1996; 3 (2): 149–153.

3. Carrabetta S., De Cian F., Mondini G., Bocchio M.M., D’Ambra L., Spirito C., Lazzari I., Griffanti Bartoli F., Civalleri D. Pancreatic can�

cer. Analysis of 149 cases in our 17�year experience. Chir. Ital. 1998; 19 (6–7): 265–270.

4. Chew D.K., Attiyeh F.F. Experience with the Whipple procedure (pancreaticoduodenectomy) in a university�affiliated community hospi�

tal. Am. J. Surg. 1997; 174 (3): 312–315.

5. Cullen J.J., Sarr M.G., Ilstrup D.M. Pancreatic anastomotic leak after pancreaticoduodenectomy: incidence, significance, and manage�

ment. Am. J. Surg. 1994; 168 (4): 295–298.

6. Howard J.M. Pancreatojejunostomy: leakage is a preventable complication of the Whipple resection. J. Am. Coll. Surg. 1997; 184 (5):

454–457.

7. Yeo C.J., Cameron J.L., Sohn T.A., Lilemoe K.D., Pitt H.A., Talamimi M.A., Hruban R.H., Ord S.E., Sauter P.K., Coleman J., Zahurak

M.L., Grochow L.B., Abrams R.A. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and

outcomes. Ann. Surg. 1997; 226 (3): 248–257.

8. Schmidt C.M., Powell E.S., Yiannoutsos C.T., Howard T.J., Wiebke E.A., Wiesenauer C.A., Baugardner J.A., Cummings O.W., Jacobson

L.E., Brodie T.A., Canal D.F., Goulet R.J. Jr, Curie E.A., Cardenes H., Watkins J.M., Loehrer P.J., Lillemoe K.D., Madura J.A.

Pancreaticoduodenectomy: a 20�year experience in 516 patients. Arch. Surg. 2004; 139 (7): 718–727.

9. Kim J.H., Yoo B.M., Kim J.H., Kim W.H. Which method should we select for pancreatic anastomosis after pancreaticoduodenectomy?

World J. Surg. 2009; 33 (2): 326–332.

10. Kleespies A., Albertsmeier M., Obeidat F., Seeliger H., Jauch K.W., Bruns C.J. The challenge of pancreatic anastomosis. Langenbecks

Arch. Surg. 2008; 393 (4): 459–471.

11. Allema J.H., Reinders M.E., van Gulik T.M., Koelemay M.J., van Leeuwen D.J., de Wit L.T., Gouma D.J., Obertop H. Prognostic fac�

tors for survival after pancreaticoduodenectomy for patients with carcinoma of the pancreatic head region. Cancer. 1995; 75 (8):

2069–2076.

12. Cameron J.L., Pitt H.A., Yeo C.J., Lillemoe K.D., Kaufman H.S., Coleman J. One hundred and forty�five consecutive pancreaticoduo�

denectomies without mortality. Ann. Surg. 1993; 217 (5): 430–435.


6


13. Miedema B.W., Sarr M.G., van Heerden J.A., Nagorney D.M., McIlrath D.C., Ilstrup D. Complications following pancreaticoduo�

denectomy: current management. Arch. Surg. 1992; 127 (8): 945–949.

14. Fern�andez�del Castillo C., Rattner D.W., Warshaw A.L. Standards for pancreatic resection in the 1990s. Arch. Surg. 1995; 130 (3):

295–300.

15. Trede M., Schwall G., Saeger H.D. Survival after pancreatoduodenectomy. 118 consecutive resections without an operative mortality. Ann.

Surg. 1990; 211 (4): 447–458.

16. Kakita A., Yoshida M., Takahashi T. History of pancreaticojejunostomy in pancreaticoduodenectomy: development of more reliable anas�

tomosis technique. J. Hepatobiliary Pancreat. Surg. 2001; 8 (3): 230–237.

17. Yeo C.J., Barry M.K., Sauter P.K., Sostre S., Lillemoe K.D., Pitt H.A., Cameron J.A. Erythromycin accelerates gastric emptying after pan�

creaticoduodenectomy. A prospective, randomized, placebo�controlled trial. Ann. Surg. 1993; 218 (3): 229–238.

18. Sakorafas G.H., Friess H., Balsiger B.M., Buchler M.W., Sarr M.G. Problems of reconstruction during pancreatoduodenectomy. Dig. Surg.

2011; 18 (5): 363–369.

19. Onopriev V.I., Manujlov A.M., Rogal M.L., Voskanjan S.E. The immediate results of pancreatoduodenectomy with using of end�to�loop

pancreatoenteroanastomosis. Khirurgia. 2003; 3: 24–30. (In Russian)

20. Onopriev V.I., Manuilov A.M., Voskanyan S.E. Experience with end�to�loop pancreaticoenteroanastomosis in pancreatoduodenectomy.

Hepato�Gastroenterology. 2003; 50 (53): 1650–1654.

7


Urgent Extirpation of Pancreatic Stump Urgent Extirpation of Pancreatic Stump

Lyadov K.V., Egiev V.N., Lyadov V.K., Kovalenko Z.A., Kozirin I.A.NFederal Medical Rehabilitation Center, Ministry of Health; 3, Ivan'kovskoye shosse, Moscow, 125367,

Russian Federation

Aim. To develop the optimal surgery in complicated postoperative pancreatic fistula.

Materials and Methods. Between 2008 and 2013 a total of 8 patients underwent urgent pancreatic stump extirpation in

our clinic. Preceding surgery was performed to treat benign and malignant pancreatic head and periampullary tumors

and also a penetrating ulcer of the duodenal bulbus. Indications for pancreatic stump extirpation were development of

massive abdominal hemorrhage (in 5 cases), septic complications related to pancreaticoenteric anastomosis failure

(in 2 cases) and necrosis of pancreatic stump (in 1 case).

Results. The average operative time and the average intraoperative blood loss were 167 ± 53 min and 657 ± 400 mL

respectively. Postoperative death occurred in 4 patients (50%) as a result of intra�abdominal sepsis leading to progressive

multiorgan dysfunction. Compensation for carbohydrate metabolism disorder was achieved in all survived patients over

a follow�up period from 7 to 64 months, with the average daily insulin demand of 28 ± 10 IU. Pancreatic exocrine insuf�

ficiency was treated with Creon (the average daily dose of 240 ± 60 kU).

Conclusion. Pancreatic stump extirpation is a radical surgical treatment for pancreaticodigestive anastomosis failure

complicated with abdominal hemorrhage or intra�abdominal sepsis. The major advantages of this method are that it

ensures complete removal of the intra�abdominal septic focus and reduce the risk of recurrent abdominal hemorrhage.

Key words: pancreaticoduodenectomy, completion pancreatectomy, postoperative pancreatic fistula, arrosive bleeding, abdom�

inal sepsis.

References1. Danilov M.V., Fedorov V.D. Khirurgiya podzheludochnoy zhelezy [Surgery of the pancreas]. Moscow: Meditsina, 1995. 506 р. (In Russian)

2. Kubishkin V.A., Vishnevskij V.A. Rak podzheludochnoy zhelezy [Pancreatic cancer]. Moscow: Medpraktika�M, 2003. 375 р. (In Russian)

3. Patyutko Ju.I., Kotel'nikov A.G. Khirurgiya raka organov biliopankreatoduodenal'noy zony [Surgery of the biliopancreatoduodenal malig�

nancy]. Moscow: Meditsina, 2007. 446 р. (In Russian)

4. Bassi C., Dervenis C., Butturini G., Fingerhut A., Yeo C., Izbicki J., Neoptolemos J., Sarr M., Traverso W., Buchler M. International

Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery.

2005; 138 (1): 8–13.

5. Farley D.R., Schwall G., Trede M. Completion pancreatectomy for surgical complications after pancreaticoduodenectomy. Br. J. Surg.

1996; 83 (2): 176–179.

6. Smith C.D., Sarr M.G., van Heerden J.A. Completion pancreatectomy following pancreaticoduodenectomy: clinical experience. World J.

Surg. 1992; 16 (3): 521–524.

7. Tamijmarane A., Ahmed I., Bhati C.S., Mirza D.F., Mayer A.D., Buckels J.A., Bramhall S.R. Role of completion pancreatectomy as a

damage control option for post�pancreatic surgical complications. Dig. Surg. 2006; 23 (4): 229–234.

8. Gueroult S., Parc Y., Duron F., Paye F., Parc R. Completion pancreatectomy for postoperative peritonitis after pancreaticoduodenectomy:

early and late outcome. Arch. Surg. 2004; 139 (1): 16–19.

9. Aranha G.V., Aaron J.M., Shoup M., Pickleman J. Current management of pancreatic fistula after pancreaticoduodenectomy. Surgery.

2006; 140 (4): 561–568; discussion 568–569.

10. Lee H.G., Heo J.S., Choi S.H., Choi D.W. Management of bleeding from pseudoaneurysms following pancreaticoduodenectomy. World

J. Gastroenterol. 2010; 16 (10): 1239–1244.

11. Kent T.S., Callery M.P., Vollmer C.M. Jr. The bridge stent technique for salvage of pancreaticojejunal anastomotic dehiscence. HPB

(Oxford). 2010; 12 (8): 577–582.

12. Ribero D., Amisano M., Zimmitti G., Giraldi F., Ferrero A., Capussotti L. External tube pancreatostomy reduces the risk of mortality asso�

ciated with completion pancreatectomy for symptomatic fistulas complicating pancreaticoduodenectomy. J. Gastrointest. Surg. 2013; 17 (2):

332–338.

13. Kazanjian K.K., Hines O.J., Eibl G., Reber H.A. Management of pancreatic fistulas after pancreaticoduodenectomy: results in 437 con�

secutive patients. Arch. Surg. 2005; 140 (9): 849–854.


Lyadov Konstantin Viktorovich – Doct. of Med. Sci., Professor, Corresponding Member of RAMSci, Director of Federal Medical

Rehabilitation Center. Egiev Valeriy Nikolaevich – Doct. of Med. Sci., Professor, Chief Surgeon of the same Center. Lyadov VladimirKonstantinovich – Cand. of Med. Sci., Head of Department of Surgical Oncology in the same Center. Kovalenko Zakhar Andreevich– Surgeon of the same Department. Kozirin Ivan Aleksandrovich – Cand. of Med. Sci., Surgeon of the same Department.

For correspondence: Kovalenko Zakhar Andreevich – 3, Ivan'kovskoye Shosse, Moscow, 125367, Russia.

Phone: +7�495�942�52�00. E�mail: [email protected]

8


14. Bachellier P., Oussoultzoglou E., Rosso E., Scurtu R., Lucescu I., Oshita A., Jaeck D. Pancreatogastrostomy as a salvage procedure to treat

severe postoperative pancreatic fistula after pancreatoduodenectomy. Arch. Surg. 2008; 143 (10): 966–970.

15. Govil S. Salvage pancreaticogastrostomy for pancreatic fistulae after pancreaticoduodenectomy. Indian J. Gastroenterol. 2012; 31 (5):

263–266.

16. Muller M.W., Friess H., Kleeff J., Dahmen R., Wagner M., Hinz U., Breisch�Girbig D., Ceyhan G.O., Buchler M.W. Is there still a role for

total pancreatectomy? Ann. Surg. 2007; 246 (6): 966–974.

17. Janot M.S., Belyaev O., Kersting S., Chromik A.M., Seelig M.H., Sulberg D., Mittelkotter U., Uhl W.H. Indications and early outcomes

for total pancreatectomy at a high�volume pancreas center. Clinical Study. HPB Surgery. 2010; 10 (10): 2–8.

9


LIVER

Anatomical Classification of Arterial Blood Supply Anatomical Classification of Arterial Blood Supply to the Liver for Radio�Endovascular Procedures: to the Liver for Radio�Endovascular Procedures: Analysis of 3756 Hepatic AngiographiesAnalysis of 3756 Hepatic Angiographies

Balakhnin P.V.1, Tarazov P.G.

2

1 Department of Endovascular Diagnostic and Treatment Methods, St. Petersburg Clinical and Scientific

Oncological Center; 68а, Leningradskaya str. (Pesochny), St. Petersburg, 197758, Russian Federation2 Department of Angiography and Interventional Radiology, Russian Scientific Center of Radiology

and Surgical Technologies, Ministry of Health of Russian Federation; 70, Leningradskaya str. (Pesochny),

St. Petersburg, 197758, Russian Federation

Aim. To study patterns of arterial blood supply to the liver based on angiography findings and systematize them for facil�

itation and optimization of radio�endovascular procedures.

Materials and Methods. Angiograms of 3756 patients were analyzed. 5 types of arterial blood supply were distinguished

based on “degree of centralization” of hepatic circulation. Within each type numerous identified patterns were arranged

into few groups based on the number of arteries, supplying right (segments V�VIII) and left (segmentsI�IV) functional

liver lobes (Rx/Lx).

Results. 114 blood supply patterns were identified. Central (common hepatic) type was documented in 68% of patients,

including 6 groups: group 1 (50,8%) comprised 10 blood supply patterns, group 2 (16.5%) – 5 patterns, group 3 (0.6%) –

7 patterns, group 4 (<0.1%) – 2 patterns, group 5 (<0.1%) – 2 patterns, group 6 (<0.1%) – 1 pattern of blood supply.

Celiac type was identified in 14,3% cases, divided into 7 groups: group 1 (7.5%) – 10 patterns of blood supply, group 2

(4.3%) – 7 patterns, group 3 (1.3%) – 3 patterns, group 4 (0.9%) – 5 patterns, group 5 (0.2%) – 6 patterns, group 6

(<0.1%) – 1 pattern, group 7 (<0.1%) – also 1 pattern. Celiac�mesenterial type was observed in 14.6% cases, compris�

ing 5 groups: group 1 (8%) – 5 patterns of arterial blood supply, group 2 (3.6%) – 8 patterns, group 3 (1.8%) – 4 pat�

terns, group 4 (1.1%) – 7 patterns, group 5 (<0.1%) – 2 patterns of blood supply. Mesenterial type was identified in 2,1%

cases, divided into 3 groups: group 1 (1.4%) – 5 patterns of arterial blood supply, group 2 (0.7%) – 3 patterns, group 3

(<0.1%) – 1 pattern of blood supply. Aortal type was found in 1% of cases, comprising 4 groups: group 1 (0.6%) – 5 pat�

terns of blood supply, group 2 (0,3%) – 9 patterns, group 3 (<0.1%) – 3 patterns, group 4 (<0.1%) – 2 patterns.

Conclusion. In 2/3 of all patients examined arterial blood supply to the liver is completely provided from common hepat�

ic artery system, in 4/5 – is limited to celiac artery system. Degree of arterial supply decentralization directly correlates

with the number of potential blood supply patterns and inversely correlates with the probability of their identification.

Key words: arterial blood supply to the liver, endovascular techniques, chemoembolization, intra�arterial systems, liver sur�

gery, angiography.

Balakhnin Pavel Vasil'evich – Cand. of Med. Sci., Head of Department of Endovascular Diagnostic and Treatment Methods, St.

Petersburg Clinical and Scientific Oncological Center. Tarazov Pavel Gadel'garaevich – Doc. of Med. Sci., Professor, Head of

Department of Angiography and Interventional Radiology, Russian Scientific Center of Radiology and Surgical Technologies.

For correspondence: Balakhnin Pavel Vasil'evich – 68A, Leningradskaya str., Pesochny, St. Petersburg, 197758, Russia.


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10


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12


LIVER

Evaluation of Morphological and Functional Changes Evaluation of Morphological and Functional Changes of Hepatobiliary System with Gadoxetic Acid (Primovist)of Hepatobiliary System with Gadoxetic Acid (Primovist)

Shimanovsky N.L.

Department of Molecular Pharmacology and Radiobiology of Academic P.V. Sergeev of Pirogov Russian National

Research Medical University; 9a, Bolshaya Pirogovskaya str., Moscow, 119071, Russian Federation

The article considers information on improvements in MRI diagnosis of focal liver lesions and liver function evaluation

with the use of gadoxetic acid (Primovist), which are of clinical significance in preoperative planning. It also presents the

results of clinical trials proving the advantages of Primovist�enchanced MRI, compared to extracellular contrast medi�

um MRI and contrast�enhanced CT in diagnosis of focal liver lesions.

Key words: gadoxetic acid (Primovist), focal liver lesions, liver function, hepatic surgery.

Shimanovsky Nikolay Lvovich – Doct. of Med. Sci., Professor, Member�corr. of RAMS, Head of Department of Molecular

Pharmacology and Radiobiology of Academic P.V. Sergeev of Pirogov Russian National Research Medical University.

For correspondence: Shimanovsky Nikolay Lvovich – 9a, Bolshaya Pirogovskaya str., Moscow, 119071, Russian Federation.


References1. Karmazanovsky G.G., Shimanovsky N.L. Diagnostic efficacy of new magnetic�resonance contrast agent Primovist (gadoxetic acid) for

detection of primary and secondary liver tumors. Meditsinskaya vizualizatsiya. 2007; 6: 135–143. (In Russian)

2. Karmazanovsky G.G., Shimanovsky N.L. New technology of hepatobiliary tract visualization by hepatocyte tropic contrast agent gadox�

etate dinatrium. Annaly khirurgicheskoy gepatologii. 2007; 12 (4): 69–72. (In Russian)

3. Karmazanovsky G.G., Shimanovsky N.L. Gadoxetic acid (Primovist) use for diagnostic of focal liver lesions: Efficacy evidences and pos�

sibilities for further improvement of protocol optimization of comprehensive evaluation of the liver by MRI. Meditsinskaya vizualizatsiya.

2011; 5: 133–142. (In Russian)

4. Haimerl M., Wächtler M., Platzek I., Muller�Wille R., Niessen C., Hoffstetter P., Schreyer A.G., Stroszczynski C., Wiggermann P. Added

value of Gd�EOB�DTPA�enhanced Hepatobiliary phase MR imaging in evaluation of focal solid hepatic lesions. BMC Med. Imaging. 2013;

1 (13): 13– 41.

5. Choi J.W., Lee J.M., Kim S.J., Yoon J.H., Baek J.H., Han J.K., Choi B.I. Hepatocellular carcinoma: imaging patterns on gadoxetic acid�

enhanced MR Images and their value as an imaging biomarker. Radiology. 2013; 267 (3): 776–786.

6. Park M.J., Kim Y.K., Lee M.W., Lee W.J., Kim Y.S., Kim S.H., Choi D., Rhim H. Small hepatocellular carcinomas: improved sensitivity by

combining gadoxetic acid�enhanced and diffusion�weighted MR imaging patterns. Radiology. 2012; 264 (3): 761–770.

7. Kim H.S., Choi D., Kim S.H., Lee M.W., Lee W.J., Kim Y.K., Jang K.M., Park M.J., Park C.K. Changes in the signal� and contrast�to�

noise ratios of hepatocellular carcinomas on gadoxetic acid�enhanced dynamic MR imaging. Eur. J. Radiol. 2013; 82 (1): 62–68.

8. Bluemke D.A., Sahani D., Amendola M. Efficacy and safety of MR imaging with liver specific contrast agent: U.S. multicenter phase III

study. Radiology. 2005; 237 (1): 89–98.

9. Kolblinger C., Ssalamah A., Langle F. Gd�EOB�DTPA enhanced MR imaging versus triphasic CT: detection and classification of focal

liver lesions. Eur. Radiol. 2006; Suppl. 1; 16: 195.

10. Yagudina R.I., Kulikov I.Yu., Zinchuk A.Yu., Kotlyarov P.М., Sergeev N.I., Andrianov М.М., Gvozdev А.А., Solodky V.A.

Pharmacoeconomic study of liver lesions diagnostics by different contrast media. Meditsinskaya vizualizatsiya. 2010; 3: 118–128. (In

Russian)

11. Hwang J., Kim S.H., Kim Y.S., Lee M.W., Woo J.Y., Lee W.J., Lim H.K. Gadoxetic acid�enhanced MRI versus multiphase multidetector

row computed tomography for evaluating the viable tumor of hepatocellular carcinomas treated with image�guided tumor therapy. J. Magn.

Reson. Imaging. 2010; 32 (3): 629–638.

12. Di Martino M., Marin D., Guerrisi A., Baski M., Galati F., Rossi M., Brozzetti S., Masciangelo R., Passariello R., Catalano C.

Intraindividual comparison of gadoxetate disodium�enhanced MR imaging and 64�section multidetector CT in the detection of hepato�

cellular carcinoma in patients with cirrhosis. Radiology. 2010; 256 (3): 806–816.

13. Hwang J., Kim S.H., Lee M.W., Lee J.Y. Small (</= 2 cm) hepatocellular carcinoma in patients with chronic liver disease: comparison of

gadoxetic acid�enhanced 3.0 T MRI and multiphasic 64�multirow detector CT. Br. J. Radiol. 2012; 85 (1015): e314–e322.

14. Sun H.Y., Lee J.M., Shin C.I., Lee D.H., Moon S.K., Kim K.W., Han J.K., Choi B.I. Gadoxetic acid�enhanced magnetic resonance imag�

ing for differentiating small hepatocellular carcinomas (< or =2 cm in diameter) from arterial enhancing pseudolesions: special emphasis

on hepatobiliary phase imaging. Invest. Radiol. 2010; 45 (2): 96–103.

15. Akai H., Matsuda I., Kiryu S., Tajima T., Takao H., Watanabe Y., Imamura H., Kokudo N., Akahane M., Ohtomo K. Fate of hypointense

lesions on Gd�EOB�DTPA�enhanced magnetic resonance imaging. Eur. J. Radiol. 2012; 81 (11): 2973–2977.

13


16. Grazioli L., Bondioni M.P., Haradome H., Motosugi U., Tinti R., Frittoli B., Gambarini S., Donato F., Colagrande S. Hepatocellular ade�

noma and focal nodular hyperplasia: value of gadoxetic acid�enhanced MR imaging in differential diagnosis. Radiology. 2012; 262 (2):

520–529.

17. Toyota N., Nakamura Y., Hieda M., Akiyama N., Terada H., Matsuura N., Nishiki M., Kono H., Kohno H., Irei T., Yoshikawa Y.,

Kuraoka K., Taniyama K., Awai K. Diagnostic capability of gadoxetate disodium�enhanced liver MRI for diagnosis of hepatocellular car�

cinoma: comparison with multi�detector CT. Hiroshima J. Med. Sci. 2013; 62 (3): 55–61.

18. Koh D.M., Collins D.J., Wallace T., Chau I., Riddell A.M. Combining diffusion�weighted MRI with Gd�EOB�DTPA�enhanced MRI

improves the detection of colorectal liver metastases. Br. J. Radiol. 2012; 85 (1015): 980–989.

19. Scharitzer M., Ba�Ssalamah A., Ringl H., Kölblinger C., Grünberger T., Weber M., Schima W. Preoperative evaluation of colorectal liver metas�

tases: comparison between gadoxetic acid�enhanced 3.0�T MRI and contrast�enhanced MDCT with histopathological correlation. Eur. Radiol.

2013; 23 (8): 2187–2196.

20. Kim Y.K., Park G., Kim C.S., Yu H.C., Han Y.M. Diagnostic efficacy of gadoxetic acid�enhanced MRI for the detection and characteri�

sation of liver metastases: comparison with multidetector�row CT. Br. J. Radiol. 2012; 85 (1013): 539–547.

21. Jeong H.T., Kim M.J., Chung Y.E., Choi J.Y., Park Y.N., Kim K.W. Gadoxetate disodium�enhanced MRI of mass�forming intrahepatic

cholangiocarcinomas: imaging�histologic correlation. Am. J. Roentgenol. 2013; 201 (4): W603–W611.

14


LIVER

Hepatic Resection in Liver EchinococcosisHepatic Resection in Liver Echinococcosis

Akhmedov S.M.1, Ibrohimov N.K.

2, Safarov B.D.

1, Rasulov N.A.

3, Tabarov Z.V.

1

1 The Institute of Gastroenterology of the Academy of Medical Sciences of Health Ministry Republic of Tajikistan;

2, Mayakovskogo str., Dushanbe, 734064, Tajikistan 2 City Clinical Emergency Hospital, Dushanbe; 52, str. Dehlavi, Dushanbe, 734020, Tajikistan

3 The Institute of Postgraduate Education of the Medical Staff Republic of Tajikistan; 59, str. Somoni,

Dushanbe, 73402659, Tajikistan

Aim. To improve the results of surgical treatment in liver echinococcosis.

Materials and Methods. The results of 130 hepatic resections in patients with echinococcosis were analyzed. Major

hepatic resection were performed in 59 (45.3%) patients, including 12 cases of right and 6 cases of left anatomical hepat�

ectomy. 71 (54.6%) patients underwent minor hepatic resection; in most of these cases an atypical (non�anatomical)

resection was performed with resection margins within 1.5–2 cm from the cyst wall.

Results. Specific postoperative complications were observed in 23 (17.6%) patients. 6 patients developed bilio�cutaneous

fistulae, supra� and subhepatic fluid collections occurred in 7 patients. Relaparotomy was performed in 7 cases; indications

were bleeding from the liver stump (n = 4), and subphrenic abscess formation (n = 3). There were 2 (1.5%) lethal outcomes.

Conclusion. The results of this study allowed further specification for indications and contraindications to liver resection in

echinococcosis, and made it possible to recommend implementation of this approach in specialized surgical departments.

Key words: echinococcosis, echinococcectomy, liver resection, hemihepatectomy, postoperative complications.

Akhmedov Saidilhom Mukhtorovich – Doct. of Med. Sci., Professor, Head of Department of Liver and Pancreatic Surgery of the

Institute of Gastroenterology of the Academy of Medical Sciences of Health Ministry Republic of Tajikistan, Dushanbe.

Ibrohimov Nuridin Kendzhaevich – Cand. of Med. Sci., Surgeon of the Liver, Bile Ducts and Pancreatic Surgery Department of

the City Clinical Emergency Hospital. Safarov Bakhrom Dzhumaevich – Cand. of Med. Sci., Surgeon of the Department Liver

and Pancreatic Surgery of the Institute of Gastroenterology of the Academy of Medical Sciences of Health Ministry Republic of

Tajikistan, Dushanbe. Rasulov Nazir Aminovich – Cand. of Med. Sci., Docent, Head of Surgery Faculty of the Institute

Postgraduate Education of Medical Staff Republic of Tajikistan. Tabarov Zafar Valievich – Surgeon of the Department Liver and

Pancreatic Surgery of the Institute of Gastroenterology of the Academy of Medical Sciences of Health Ministry Republic of

Tajikistan, Dushanbe.

For correspondence: Akhmedov Saidilhom Mukhtorovich – 2, Mayakovskogo str., Dushanbe, 734064, Tajikistan.

Phone: 992�236�01�83. E�mail: [email protected]

References1. Akhmedov S.M., Latifov M.D., Rasulov N.A. Reshenie problem gemostaza pri operacijah na pecheni. Materialy nauchno�prakticheskoj kon�

ferencii hirurgov Hatlonskoj oblasti. [Resolution of hemostasis problems during operations on the liver. Materials Surgeon’s scientific�prac�

tical conference in Khatlon region]. Kurgan�Tube, 2007. P. 24–25. (In Russian)

2. Ibrohimov N.K. Improvement of techniques resection for liver echinococcosis. Zdravookhranenie Tajikistana. 2005; 5: 45–47. (In Russian)

3. Chernyshev V.N., Ivanov S.A. Khirurgija jehinokokkoza pecheni. [Surgery of the liver echinococcosis]. Samara, 2005. 196 р. (In Russian)

4. Belli L., Favero E., Marni A., Romani F. Resection versus pericystectomy in the treatment of hydatidosis of the liver. Am. J. Surg. 2006; 145 (2):

239–242.

5. Wagholikar D., Sikora S.S., Kumar A. Surgical management of complicated hydatid cyst of the liver. Trop. Gastroentrol. 2010; 23 (1): 35–37.

6. Akhmedov S.M. Prophylaxis of purulent postoperative complication in liver surgery. Khirurgia. 1991; 2: 17–21. (In Russian)

7. Akhmedov S.M., Ibrohimov N.K., Rasulov N.A., Nazarov A.F. Resection of focal liver disease. Materials of the scientific�practical con�

ference “The current strategy of diagnosis and treatment in gastroenterology”. Problemi gastroenterologii. 2008; 4: 219–221. (In Russian)

8. Rudakov V.A., Okhotina G.N., Rudakova O.V. Some of the contentious questions in the surgical treatment of hepatic echinococcosis.

Annaly khirurgicheskoy gepatologii. 2005; 10 (2): 123. (In Russian)

9. Rothlin M., Schlumpf R., Bornman P., Krige J., Largiader F. Intraoperative ultrasonography of the liver. Swiss. Surg. 2009; 3: 105–111.

10. Zhuravlev V.A., Cheremisinov O.V. Traditional, new and controversial in surgery of the liver echinococcosis. Annaly khirurgicheskoy gepa�

tologii. 2005; 10 (2): 109. (In Russian)

11. Harns S.S., Lotov A.N., Musoev G.H. Ultrasonic semiotics of hydatid cysts of the liver. Annaly khirurgicheskoy gepatologii. 2005; 10 (2):

133. (In Russian)

12. Akhmedom S.M., Ibrohimov N.K., Kaharov M.A., Kamilov G.T. Liver resection in case of echinococcosis. Annaly khirurgicheskoy gepa�

tologii. 2008; 13 (3): 23. (In Russian)

13. Veronsky G.I., Demin S.A., Ershov K.G. Radical operations in liver echinococcoses. Annaly khirurgicheskoy gepatologii. 2005; 10 (2): 55.

(In Russian)

14. Vishnevsky V.A., Ikramov R.Z., Kaharov M.A. Radical surgical treatment of liver echinococcosis. Annaly khirurgicheskoy gepatologii. 2002;

7 (1): 315–316. (In Russian)

15


BILE DUCTS

Criteria for the Choice of Construction Criteria for the Choice of Construction of Endoprosthesis for Endoscopic Biliary Stentingof Endoprosthesis for Endoscopic Biliary Stenting

Glebov K.G.1, 4

, Kotovskiy A.E.2, 3

, Dyuzheva T.G.1

1 Department of Hepatopancreatobiliary and Regenerative Surgery, Scientific Research Institute of Molecular

Medicine, I.M. Sechenov First Moscow State Medical University; 8, Trubetskaya str., Moscow, 119992,

Russian Federation2 Chair of Hospital Surgery No 2, I.M. Sechenov First Moscow State Medical University; 8, Trubetskaya str.,

Moscow, 119992, Russian Federation3 Moscow Clinical Hospital No 7, Department of Health of Moscow; 4, Kolomenskiy passage, Moscow, 115446,

Russian Federation4 Moscow Clinical Hospital No 15, Department of Health of Moscow; 23, Veshnyakovskaya str., Moscow, 111539,

Russian Federation

Aim. To define and substantiate the criteria for the choice of construction of endoprosthesis for endoscopic biliary stenting.

Materials and Methods. Endoscopic transpapillary stenting was performed in 374 patients with obstructive jaundice.

In 195 patient the symptoms were caused by malignant and in 179 patients by benign diseases of hepatopancreatoduo�

denal zone. Different types of plastic stents were used in 298 patients (134 with malignant and 164 with benign diseases).

Self�expanding Nitinol stents were used in 76 patients (61 cases with obstructive jaundice related to tumor formation).

Results. 13 out of 298 patients with plastic stents had developed early complications. In 12 cases stent migration into the

small bowel was observed within 1–3 days after placing (re�stenting was performed); in 1 case duodenal perforation was

caused by the distal end of the stent (perforation was closed by suturing). The average duration of patency for plastic

stents was 6 ± 2 months, after this period stent blockage was observed in 25 patients, stent migration into common bile

(hepatic) duct or bowel had occurred in 6 patients. Nitinol stent failure was observed in 3 patients with corrosive bile duct

stricture (hepaticojejunal anastomosis was formed). Out of 61 patients with malignant diseases, in 9 patients stent block�

age with tumoral or sludge masses was observed, the stent lumen was mechanically cleaned.

Conclusion. Stenting high efficacy and minimal postoperative complication rate has been proved for patients with

obstructive jaundice. Indications for using biliary stents of different construction types have been clearly defined. The

criteria for the choice of construction of endoprosthesis for endoscopic biliary stenting consistent with disease pattern

and prognosis have been established.

Key words: obstructive jaundice, transpapillary stenting, bile ducts, pancreas.

Glebov Konstantin Glebovich – Cand. of Med. Sci., Senior Research Fellow, Department of Hepatopancreatobiliary and

Regenerative Surgery, Scientific Research Institute of Molecular Medicine, I.M. Sechenov First Moscow State Medical

University; Head of Endoscopy Department, Moscow Clinical Hospital No 15. Kotovskiy Andrey Evgenievich – Doct. of Med.

Sci., Professor of Chair of Hospital Surgery No 2, I.M. Sechenov First Moscow State Medical University. Dyuzheva TatyanaGennadievna – Doct. of Med. Sci., Professor, Head of Department of Hepatopancreatobiliary and Regenerative Surgery,

Scientific Research Institute of Molecular Medicine, I.M. Sechenov First Moscow State Medical University.

For correspondence: Glebov Konstantin Glebovich – 23, Veshnyakovskaya Str., Moscow, 111539, Russian Federation.

Phone: 8�926�498�44�09. E�mail: [email protected]

References1. Balalykin A.S. Endoskopicheskaja abdominal'naja khirurgija [Endoscopic abdominal surgery]. Moscow: IMA�press, 1996. P. 30–50. (In

Russian)

2. Galperin E.I., Kotovski A.E., Ahaladze G.G., Chevokin A.Yu., Graschenko S.A. Lechenie bol'nyh zhelchekamennoj bolezn'ju, oslozhnennoj

mehanicheskoj zheltuhoj i holangitom [Treatment of patients with cholelithiasis complicated by obstructive jaundice and cholangitis]. Materials

of the Plenum of the Association of Endoscopic Surgeons. Sant�Petersburg, 2003. P. 56–60. (In Russian)

3. Kotovski A.E., Glebov K.G., Urzhumtseva G.A., Petrova N.A. Endoscopic technologies in hepatopancreatobiliary zone diseases. Annaly

khirurgicheskoy gepatologii. 2010; 15 (1): 9–18. (In Russian)

4. Artifon E.L.A., Sakai P., Ishioka S. Marques S.B., Lino A.S., Cunha J.E., Jukemura J., Cecconello I., Carrilho F.J., Opitz E., Kumar A.

Endoscopic sphincterotomy before deployment of covered metal stent is associated with greater complication rate: a prospective random�

ized control trial. J. Clin. Gastroenterol. 2008; 42 (7): 815–819.

5. Banerjee N., Hilden K., Baron T.H., Douglas G.A. Endoscopic biliary sphincterotomy is not required for transpapillary SEMS placement for bil�

iary obstruction. Dig. Dis. Sci. 2011; 56 (2): 591–595.

16


6. Glebov K.G., Dyuzheva T.G., Petrova N.A., Bekbauov S.A., Kotovski A.E. Endoscopic transpapillary biliary stenting by means of self�

expanding metallic endoprosthesis. Annaly khirurgicheskoy gepatologii. 2012; 17 (3): 65–74. (In Russian)

7. Weston B.R., Ross W.A., Wolff R.A., Evans D., Lee J.E., Wang X., Xiao L.C., Lee J.H. Rate of bilirubin regression after stenting in malignant

biliary obstruction for the initiation of chemotherapy: how soon should we repeat endoscopic retrograde cholangiopancreatography? Cancer.

2008; 112 (11): 2417–2423.

8. Van Berkel A.�M., Huibregtse I.L., Bergman J., Rauws E.A., Bruno M.J., Huibregtse K. A prospective randomized trial of Tannenbaum�

type Teflon�coated stents versus polyethylene stents for distal malignant biliary obstruction. Eur. J. Gastroenterol. Hepatol. 2004; 16 (2):

213–217.

9. Yoon W., Ryu J., Yang K., Paik W.H., Lee J.K., Woo S.M., Park J.K., Yong T.K., Yong B.Y. A comparison of metal and plastic stents for

the lief of jaundice in unresectable malignant biliary obstruction in cost. Gastrointest. Endosc. 2009; 70 (2): 284–289.

10. England R.E., Martin D.F., Morris J., Sheridan M.B., Frost R., Freeman A., Lawrie B., Deakin M., Fraser I., Smith K. A prospective ran�

domised multicentre trial comparing 10 Fr Teflon Tannenbaum stents with 10 Fr polyethylene Cotton�Leung stents in patients with malig�

nant common duct strictures. Gut. 2000; 46 (3): 395–400.

11. Kotovski A.E., Glebov K.G. Bile duct endoscopic transpapillary stenting. Annaly khirurgicheskoy gepatologii. 2008; 13 (1): 66–72. (In

Russian)

12. Ornellas L.C., Stefanidis G., Chuttani R., Gelrud A., Kelleher T.B., Pleskow D.K. Covered Wallstents for palliation of malignant biliary

obstruction: primary stent placement versus reintervention. Gastrointest. Endosc. 2009; 70 (4): 676–683.

13. Tringali A., Mutignani M., Perri V., Zuccala G., Cipolletta L., Bianco M.A. A prospective, randomized multicenter trial comparing

DoubleLayer and polyethylene stents for malignant distal ommon bile duct strictures. Endoscopy. 2003; 35 (11): 992–997.

14. Kaassis M., Boyer J., Dumas R., Ponchon T., Coumaros D. Plastic or metal stents for malignant stricture of the common bile duct? Results

of a randomized prospective study. Gastrointest. Endosc. 2003; 57 (2): 178–182.

15. Gallinger Yu.I., Khrustalyova Yu.V. Endoskopicheskie metody lechenija neopuholevyh stenozov vnepechenochnyh zhelchnyh protokov

[Endoscopic treatment of non�neoplastic stenosis of the extrahepatic bile ducts]. Abstracts of the 7th

International Congress of Endoscopic

Surgery. Moscow, April 14–16. 2003. Р. 434–435. (In Russian)

16. Glebov K.G., Kotovski A.E. Endoscopic management of the papillary stenosis. Annaly khirurgicheskoy gepatologii. 2010; 15 (1): 34–36. (In

Russian)

17. Kullman E., Frozanpor F., Soderlund C., Linder S. Covered versus uncovered self�expandable nitinol stents in the palliative treatment of

malignant distal biliary obstruction: results from a randomized, multicenter study. Gastrointest. Endosc. 2010; 72 (5): 915–923.

18. Lawrence C., Romagnuolo J., Payne K.M., Hawes R.H., Cotton P.B. Low symptomatic premature stent occlusion of multiple plastic stents

for benign biliary strictures: comparing standard and prolonged stent change intervals. Gastrointest. Endosc. 2010; 72 (3): 558–563.

19. Shah R.J., Howell D.A., Desilets D.J., Sheth S.G., Parsons W.G., Okolo P. Multicenter randomized trial of the spiral Z�stent compared with

the Wallstent for malignant biliary obstruction. Gastrointest. Endosc. 2003; 57 (7): 830–836.

20. Catalano M.F., Geenen J.E., Lehman G.A., Siegel J.H., Jacob L., McKinley M.J., Raijman I., Meier P., Jacobson I., Kozarek R.

“Tannenbaum” Teflon stents versus traditional polyethylene stents for treatment of malignant biliary stricture. Gastrointest. Endosc. 2002;

55 (3): 354–358.

21. Dumonceau J.�M., Tringali A., Blero D., Deviere J., Laugiers R., Heresbach D., Costamagna G. Biliary stenting: Indications, choice of

stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2012; 44 (3): 277–298.

22. Moss A.C., Morris E., Mac Mathuna P. Palliative biliary stents for obstructing pancreatic carcinoma. Cochrane Database Syst. Reviews.

2006: 02 CD004200. Updated March 2009.

23. Chen V.K., Arguedas M.R., Baron T.H. Expandable metal biliary stents before pancreaticoduodenectomy for pancreatic cancer: a Monte�

Carlo decision analysis. Clin. Gastroenterol. Hepatol. 2005; 3 (12): 1229–1237.

24. Cho J.H., Jeon T.J., Park J.Y., Kim H.M., Kim Y.J., Park S.W., Chung J.B., Song S.Y., Bang S. Comparison of outcomes among second�

ary covered metallic, uncovered metallic, and plastic biliary stents in treating occluded primary metallic stents in malignant distal biliary

obstruction. Surg. Endosc. 2011; 25 (2): 475–482.

25. Arhan M., Odemis B., Parlak E., Ertugrul I., Basar O. Migration of biliary plastic stents: experience of a tertiary center. Surg. Endosc. 2009;

23 (4): 769–775.

26. Dumonceau J.�M., Rigaux J., Kahaleh M., Gomez C.M., Vandermeeren A., Deviere J. Prophylaxis of post�ERCP pancreatitis: a practice

survey. Gastrointest. Endosc. 2010; 71 (5): 934–939.

17


PANCREAS

Complications and Mortality Rates in Miniinvasive Procedures Complications and Mortality Rates in Miniinvasive Procedures for Acute Necrotizing Pancreatitisfor Acute Necrotizing Pancreatitis

Mizgirev D.V.1, Duberman B.L.

1, Epshtein A.M.

2, Kremlev V.V.

2,

Bobovnik S.V.1, Pozdeev V.N.

2, Prudieva E.V.

1

1 Chair of Surgery of Northern State Medical University; 51, Troitsky prosp., Arkhangelsk, 163000, Russian Federation

2 First Clinical City Hospital after E.E. Volosevich; 1, Suvorov str., Arkhangelsk, 163001, Russian Federation

Aim. To assess complications and mortality rates after mini�invasive procedures for acute necrotizing pancreatitis using

Dindo�Clavien classification of surgical complications.

Materials and Methods. It was a one�center retrospective study of a prospective group of patients. Inclusion criteria: Use

of MIS�procedures for management of pancreonecrosis during the period 2008–2012 y. All outcomes and complications

of pancreonecrosis, requiring MIS, were grouped into 3 arms: pancreatogenic abscess (n = 32), pancreatic pseudocyst

(n = 73), retroperitoneal fat cellulitis (n = 62).

Results. Totally 1124 MIS procedures were performed during the 5�year period. The total number of complications dur�

ing percutaneous draining of pancreatogenic abscesses was 7 (21.9%), including I grade complication – in 1 patient,

IIIа – in 2, and IIIb – in 4 patients. In the group of post�necrotizing pseudocysts the total number of complications was

19 (26%), including I grade complication – in 2 patients, IIIа – in 3, and IIIb – in 11, IVb – in 2, and V – in 1 patient.

In the group of retroperitoneal fat cellulitis the total number of complications was 18 (32,3%): I grade – in 6 patients,

II– in 2, IIIa – in 1, IIIb – in 9, IVb – in 1, and V grade – in 12 patients.

Conclusion. Dindo�Clavien classification of surgical complications allows objective assessment of the severity of post�

MIS complications in patients with pancreonecrosis. MIS procedures demonstrate low associated mortality rates

(8.4%). Progression of purulent�necrotic process, non�adequate drainage and arrosive hemorrhage are viewed as major

causes of post�MIS complications and deaths in patients with pancreonecrosis.

Key words: pancreas, pancreatitis, accumulation of liquid, mini�invasive treatment, percutaneous drainage, complication.

Mizgirev Denis Vladimirovich – Cand. of Med Sci., Associate Professor of Chair of Faculty Surgery, Northern State Medical

University. Duberman Boris L'vovich – Doct. of Med. Sci., Head of Chair of Surgery of the same University. Epshtein AlexeyMikhailovich – Cand. of Med. Sci., Physician�Endoscopist of 2

ndUnit of Department of Radiological Methods of Diagnosis and

Treatment, First Clinical City Hospital after E.E. Volosevich. Kremlev Valeryi Vladimirovich – Head of the Second Department

of Surgery of the same Hospital. Bobovnik Sergey Victorovich – Cand. of Med. Sci., Associate Professor of Chair of

Anesthesiology and Intensive Care, Northern State Medical University. Pozdeev Victor Nikolaevich – Cand. of Med. Sci., Chief

of Surgery, First Clinical City Hospital after E.E. Volosevich. Prudieva Elena Victorovna – Postgraduate, Chair of Surgery,

Northern State Medical University.

For correspondence: Duberman Boris L'vovich – Apt. 1, 98, Northern Dvina River Embankment str., Arkhangelsk, 163061.


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Pancreatic necrosis configuration and differentiated management of acute pancreatitis. Annaly khirurgicheskoy gepatologii. 2013; 18 (1):

92–102. (In Russian)

6. Duberman B.L., Mizgirev D.V., Ponomarev A.N., Pozdeev V.N., Epshtein A.M., Dynkov S.M. Puncture and drainage of acute pancreatic

collections in acute pancreatitis and its complications. Annaly khirurgicheskoy gepatologii. 2008; 13 (1): 87–93. (In Russian)

7. Ivshin V.G., Ivshin M.V. Creskozhnoye lechenie bol’nyh s pankreonekrosom i rasprostrnennim parapankreatitom. [Percutaneous treatment of

pancreonecrosis and distended parapancreatitis.] Tula technology. Tula: Grif and C0, 2013. 128 p. (In Russian)

8. Navalho M., Pires F., Duarte A., Goncalves A., Alexandrino P., Tavora I. Percutaneous drainage of infected pancreatic fluid collections in

critically ill patients: correlation with C�reactive protein values. Clin. Imaging. 2006; 30 (2): 114–119.

18


9. Duberman B.L., Mizgirev D.V., Tarabukin A.V., Epshtein A.M., Pozdeev V.N., Savelyev M.V., Nasonov Y.A. Organization of miniinva�

sive surgery department in multifunctional hospital. Ecologiya cheloveka. 2009; 10: 44–48. (In Russian)

10. Dindo D., Demartines N., Clavien P.A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients

and results of a survey. Ann. Surg. 2004; 240 (2): 205–213.

11. Clavien P.A., Barkun J., de Oliveira M.L., Vauthey J.N., Dindo D., Schulick R.D., de Santibanes E., Pekolj J., Slankamenac K., Bassi C.,

Graf R., Vonlanthen R., Padbury R., Cameron J.L., Makuuchi M. The Clavien�Dindo classification of surgical complications: five�year expe�

rience. Ann. Surg. 2009; 250 (2): 187–96.

12. Mizgirev D.V., Duberman B.L., Tarabukin A.V., Pozdeev V.N., Pyatigorova G.I., Nedashkovskiy E.V. Microbiological features of pancre�

atic fluid collection. Infektsii v khirurgii. 2010; 8 (2): 24–28. (In Russian)

13. Akilov F.A., Giyasov S.I., Mirkhamidov D.K., Mukhtarov S.T., Nasyrov F.R. Evaluation of complications of nephrolithiasis endoscopic

surgery from positions of Clavien�Dindo classification. Experimental’naya i klinicheskaya urologiya. 2012; 3: 26–33. (In Russian)

19


Miniinvasive Procedures for Management of PancreonecrosisMiniinvasive Procedures for Management of Pancreonecrosis

Mikhaylusov S.V.1, Moiseenkova E.V.

2, Tronin R.Y.

2

1 N.I. Pirogov Russian National Research Medical University of the Ministry of Health of the RF;

1, Ostrovitianova str., Moscow, 117513, Russian Federation2 O.M. Filatov City Clinical Hospital No 15; 23, Veshnyakovskaya str., Moscow, 111539, Russian Federation

Aim. To identify the role of Miniinvasive Procedures in management of pancreonecrosis.

Materials and Methods. 860 patients with pancreonecrosis of different etiology, including 332 (38.6%) cases of infected

pancreonecrosis were evaluated during the period of 2001–2012 yy. US examinations were performed in real time and

grey scale mode. Special linear probe and Chiba 16–22 G needles were used for diagnostic and therapeutic percutaneous

fine needle puncture/aspiration (FNA) procedures, and umbrella 3–5 mm stylet�catheters were used for puncture�

drainage procedures. X�ray fistulography, US examination and CT modalities were used for evaluation of pancreatic and

retroperitoneal fat involvement, as well as for assessment of post�drainage cavities. Aspirated tissue samples were sub�

jected to cytological (microscopy) and microbiological examination, and measurement of α�amylaze activity.

Results. Puncture procedure has become the final therapeutic option in 51.8% cases of infected pancreonecrosis and in

25.6% cases – was a pre�op therapeutic intervention. Diagnostic FNA should be performed immediately after verifica�

tion of liquid accumulation irrespective of localization. Curative therapeutic FNA is possible only with homogenous

lesions less than 100 ml in volume. Successful puncture drainage is possible only with acoustically accessible liquid accu�

mulations, given that sequesters occupy less than 1/3 of total volume. Trans�fistula endoscopic procedure looks like a jus�

tified alternative to open sequestrectomy in cases where puncture drainage was not effective.

Conclusion. Use of US�guided MIS procedures in multi�step management of pancreonecrosis allowed to minimize the rate

of potentially fatal complications (such as arrosive hemorrhage, intestinal and pancreatic fistulae) and to decrease all cause

mortality.

Key words: pancreas, pancreonecrosis, minimally invasive procedure, ultrasound examination, puncture, drainage.

PANCREAS

Mikhaylusov Sergei Vladimirovich – Doct. of Med. Sci., Professor of the Hospital Surgery faculty No 1 of the N.I. Pirogov Russian

National Research Medical University. Moiseenkova Elena Valeryevna – Cand. of Med. Sci., Surgeon of the City Clinical Hospital

O.M. Filatov No 15. Tronin Rostislav Yuryevich – Cand. of Med. Sci., Doctor of the Endoscopy Department of the same Hospital.

For correspondence: Mikhaylusov Sergei Vladimirovich – 23, Veshnyakovskaya str., Moscow, 111539, Russian Federation.

Phone: 8�495�375�23�91. E�mail: [email protected]

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2. Brekhov E.I., Reshetnikov E.A., Mironov A.S., Denisov A.Yu. Diagnosis and treatment of sterile necrotizing pancreatitis. Khirurgia.

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3. Burnevich S.Z., Kulikova V.M., Sergeeva N.A., Kirsanov K.V., Morozova L.A. Diagnosis and surgical treatment of pancreatic necrosis.

Annaly khirurgicheskoy gepatologii. 2006; 11 (4): 10–14. (In Russian)

4. Gostishchev V.K., Glushko V.A. Necrotizing pancreatitis and its complications, the basic principles of surgical treatment. Khirurgia.

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5. Savelyev V.S., Kiriyenko A.I. Ostry pankreatit. Klinicheskaya khirurgiya. Nacionalnoe rukovodstvo. [Acute pancreatitis. Clinical Surgery.

National manual.] Moscow: GЕOTAR�Media, 2009. Volume II. Chapter 47. P. 196–228. (In Russian)

6. Briskin B.S., Khalidov O.Kh., Shebzukhov A.E., Dobryakova A.F.,, Landyshev A.A. Evolution of views on surgical treatment of acute

destructive pancreatitis. Vestnik Khirurgii imeni I.I. Grekova. 2008; 2 (7): 105–109. (In Russian)

7. Galperin E.I., Dyuzheva T.G., Dokuchaev K.V., Pogosyan G.S., Achaladzae G.G., Chevokin A.Yu., Shakhova T.V., Aliyev B.A. Main

issues concerning the treatment of destructive pancreatitis. Annaly khirurgicheskoy gepatologii. 2001; 6 (1): 139–142. (In Russian)

8. Dubrov E.Y., Alekseyechkina O.A. Ultrasvukovye kriterii formirovaniya parapankreaticheskih infiltratov. [Ultrasound criteria for the para�

pancreatic infiltrates formation.] Materials of the municipal seminar on “Diagnosis and treatment of pancreatic necrosis suppurative com�

plication’. Moscow, 2000. P. 38–41. (In Russian)

9. Dyuzheva T.G., Jus E.V., Ramishvili V.Sh., Shefer A.V., Platonova L.V., Galperin E.I. Early CT�indications predicting various forms of

pancreatic necrosis. Annaly khirurgicheskoy gepatologii. 2009; 14 (4): 54–63. (In Russian)

10. Balthazar E.J. Complication of acute pancreatitis clinical and CT evaluation. Radial. Clin. N. Am. 2002; 40 (6): 1211–1227.

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Russian)

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novich medicinskich technologii. 2003; 3: 64–66. (In Russian)

20


13. Luzganov Y.V. , Ostrovskaya N.E., Yagubova V.A., Shkirya K.S. The differential diagnosis and therapy principles of pancreatitis and pan�

creatic necrosis various forms. Russkiy meditsinskiy zhurnal. 2005; 13 (27): 1842–1845. (In Russian)

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pancreatitis.] Moscow: Binom�Press, 2004. 304 p. (In Russian)

15. Shapovalyanz S.G., Mylnikov A.G., Orlova S.Y., Pankov A.G., Budzinski S.A., Ardasenov T.B. Diagnosis and treatment of acute biliary

pancreatitis. Annaly khirurgicheskoy gepatologii. 2009; 1 (14): 29–33. (In Russian)

16. Blagovestnov D.A., Borisenko E.O., Nikulina V.P. Inficirovannyy pankreonekros – diagnostika i lechenie. [Infected necrotizing pancreatitis

– diagnosis and treatment.] Materials from the IV Congress of Surgeons of Moscow “Emergency and specialized surgical care”. 19–20

May, 2011. P. 190–191. (In Russian)

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Russian)

19. Kubyshkin V.A. Necrotizing pancreatitis (discussion). Annaly khirurgicheskoy gepatologii. 2000; 5 (2): 67–68. (In Russian)

21


PANCREAS

Correlation between Melatonin Receptor Expression Correlation between Melatonin Receptor Expression and Severity of Acute Pancreatitisand Severity of Acute Pancreatitis

Shapkina L.G., Semenov D.Yu., Osmanov Z.Kh.

Chair of Common Surgery, I.P. Pavlov Saint Petersburg State Medical University; 68, Str. Leo Tolstoy,

Saint Petersburg, 197022, Russian Federation

Aim. To establish correlation between melatonin receptor expression and severity of pancreatic damage after acute pan�

creatitis.

Materials and Methods. A retrospective analysis of medical records of 41 male patients with acute pancreatitis of vary�

ing severity was carried out. Measurements of melatonin membrane receptors expressed on lymphocytes were available

in all records. Saveliev V.S. scale was used to measure the severity of pancreatic tissue destruction.

Results. Decreased expression of melatonin receptors after acute pancreatitis was established in all cases. Reduced expres�

sion of МТ2�receptors turned out to be an unfavorable prognostic marker. Stage E destructive acute pancreatitis by Saveliev

scale was associated with 38% reduction of МТ2/МТ1 value as compared with B stage. There’s an evident trend towards

reduction of lymphocyte МТ2�receptors expression with increasing severity of acute pancreatitis (rs = −0.37; p < 0.05).

Conclusion. The value of measured cell markers МТ2/МТ1 ratio in lymphocytes (rs = −0.64; p < 0.001) demonstrates

statistically significant inverse correlation with Saveliev scoring system values. Established correlation between

МТ2/МТ1 ratio and clinical course/severity of acute pancreatitis makes it possible to use this indicator for risk assess�

ment, when destructive course of recurring disease can be anticipated.

Key words: pancreas, acute pancreatitis, melatonin, melatonin receptor expression.

Shapkina Lyubov Gennad'evna – Postgraduate, Chair of Common Surgery, I.P. Pavlov Saint Petersburg State Medical University.

Semenov Dmitriy Yur'evich – Doct. of Med. Sci., Professor, Head of Chair of Common Surgery, the same University. OsmanovZeynur Khuddusovich – Cand. of Med. Sci., Docent of the same Chair.

For correspondence: Shapkina Lyubov Gennad'evna – 52, Volodarskogo Str., Apt. 5, Saint Petersburg, Sestroreck, 197706.

Phone: 8�905�225�81�92. E�mail: lyuba�[email protected]

References1. Mayerle J., Hlouschek V., Lerch M.M. Current management of acute pancreatitis. Nat. Clin. Pract. Gastroenterol. Hepatol. 2005; 2 (10):

473–483.

2. Vinnik Yu.S., Miller S.V., Teplyakova O.V. Improvement of differential diagnosis and prognosis of destructive forms of acute pancreatitis.

Vestnik khirurgii imeni I.I. Grekova. 2009; 6: 16–20. (In Russian)

3. Yadav D., Lowenfels A. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology. 2013; 144 (6): 1252–1261.

4. Dubocovich M.L. Melatonin receptors: are there multiple subtypes? Trends Pharmacol. Sci. 1995; 16 (2): 50–56.

5. Slominski R.M., Reiter R.J., Schlabritz�Loutsevitch N., Ostrom R.S., Slominski A.T. Melatonin membrane receptors in peripheral tissues:

distribution and functions. Mol. Cell Endocrinol. 2012; 351 (2): 152–166.

6. Jaworek J., Konturek J.S., Leja�Szpak A., Nawrot K., Bonior J., Tomaszewska R., Stachura J., Pawlik W.W. Role of endogenous melatonin

and its MT2 receptor in the modulation of caerulin�induced pancreatitis in the rat. J. Physiol. Pharmacol. 2002; 53 (4, Pt. 2): 791–804.

7. Aust S., Jager W., Kirschner H. Pancreatic stellate/myofibroblast cells express G�protein�coupled melatonin receptor 1. Wien Med.

Wochenschr. 2008; 158 (19–20): 575–578.

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[Prediction of acute pancreatitis on the basis of the expression of receptors of melatonin in the blood mononuclear cells: avtoref. … cand.

of med. sci.]. Saint Petersburg, 2009. Р. 11–13. (In Russian)

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ferentiated therapeutic and diagnostic tactics]. Moscow: Litterra, 2010. P. 10–11.] (In Russian)

10. Masana M.I., Soares J.M. Jr., Dubocovich M.L. 17 Beta�estradiol modulates hMT1 melatonin receptor function. Neuroendocrinology.

2005; 81 (2): 87–95.

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Novyj Khirurgicheskij Arhiv. 2002; 1 (5): 45–46. (In Russian)

12. Roit A., Brostoff D., Mail D. Immunologija: Uchebnik. [Immunology: Textbook]. Moscow: Mir, 2000. 582 р. (In Russian)


PANCREAS

The Potential of Structural�resonance Therapy The Potential of Structural�resonance Therapy in Combined Treatment of Acute Pancreatitisin Combined Treatment of Acute Pancreatitis

Dyatchina G.V.1, Ivanov Yu.V.

1, 2,Panchenkov D.N.

2, Alekhnovich A.V.

1, 2

1 FSBO Federal Scientific�Clinical Center of Specialized Medical Care and Medical Technologies FMBA of

Russia; 28, Orekhovy boulevard, Moscow, 115682, Russian Federation2 SBOU VPO Moscow State University of Medicine and Dentistry them. A.I. Evdokimov Ministry of Health;

1, 20, Delegatskaya str., Moscow, 127473, Russian Federation

Aim. To assess the feasibility and efficiency of the new method of structural�resonance therapy in combined treatment of

acute pancreatitis.

Materials and Methods. 144 patients with acute pancreatitis were included in a comparative prospective randomized

placebo�controlled study. 84 of these patients were included in the main group in which the structural�resonance thera�

py was used for the first time in combined treatment of the disease.

Results. Patients included in the main group demonstrated earlier resolution of the following symptoms commonly associ�

ated with acute pancreatitis: abdominal pain, nausea/vomiting, gastrointestinal paralysis, hyperthermia, and abdominal

rigidity. They also showed significantly faster decrease in C�reactive protein and amylase levels in comparison with patients

from the placebo group (p < 0.05). No side effects of structural�resonance therapy were reported. The improved outcomes

from adding structural�resonance therapy to the combined treatment of acute pancreatitis can be attributed to biorhythms

normalization and restoration of the normal function of the sphincter of Oddi, as well as anti�inflammatory, anti�edema�

tous effects, microcirculatory improvement, better synchronization between sympathetic and parasympathetic systems.

Conclusion. Adding structural�resonance therapy to combined treatment of patients with acute pancreatitis can improve

the efficiency of conservative therapy by earlier resolution of the main clinical and laboratory manifestations of the dis�

ease, thus allowing shorter recovery period.

Key words: acute pancreatitis, structural�resonance therapy, pancreas, spontaneous biopotential activity, pain syndrome.

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2. Pugaev A.V., Achkasov E.E. Ostryj pankreatit. [Acute pancreatitis]. Moscow: PROFIL, 2007. 336 р. (In Russian)

3. Savel'ev V.S., Filimonov M.I., Burnevich S.Z. Pankreonekrozy. [Pancreatonecrosis]. Moscow: MIA, 2008. 259 р. (In Russian)

4. Sleinberg W., Tenner S. Acute pancreatitis. Engl. J. Med. 1994; 330 (17): 1198–1210.

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pancreatitis]. Moscow: BINOM, 2004. 304 р. (In Russian)

6. Cruickhank A.H. Non�infective acute pancreatitis. Pathology of Pancreas. 1995; 162 (4): 12.

7. Mayerle J., Simon P., Lerch M., Mayumi T. Medical treatment of acute pancreatitis. Gastroenterol. Clin. N. Am. 2004; 33 (4): 855–869.

8. Le Mee J., Paye F., Sauvanet A., Takada T., Kawarada Y. Incidence and reversibility of organ failure in the course of sterile or infected

necrotizing pancreatitis. Arch. Surg. 2001; 136 (12): 1386–1390.

9. Gubareva V.V., Kuzovlev O.P., Kotenko K.V., Laktionova L.V. Application of structural resonance therapy for hypomenstrual syndrome in

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i jelektromagnitnaja) terapija: Posobie dlja vrachej. [Structurally resonance (electric and magnetic) therapy: The manual for doctors].

Moscow, 2004. 243 р. (In Russian)

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15. Hendeles L., Dorf A., Stecenko A., Weinberger M. Treatment failures after substitution of generic pancrelipase capsules: correlation with

in vitro lipase activity. JAMA. 1990; 263 (18): 2459–2461.

Dyatchina Galina Vladimirovna – Cand. of Med. Sci., Chair Physiotherapy Department FSBO FNKC FMBA of Russia. IvanovYuri Viktorovich – Doct. of Med. Sci., Professor, Chair Department of Surgery FSBO FNKC FMBA of Russia, Professor of the

Department of Surgery FPDO, MSMSU them. A.I. Evdokimov. Panchenkov Dmitry Nikolaevich – Doct. of Med. Sci., Professor,

Head Department of Surgery of same University. Alekhnovich Alexey Vladimirovich – Cand. of Med. Sci., Senior Research

Institute of Clinical Surgery FSBO FNKC FMBA of Russia, Candidate Department of Surgery of same University.

For correspondence: Ivanov Yuri Viktorovich – 28, Orekhovy boulevard, Moscow, 115682. Phone: +7�916�162�05�21.


23


REVIEW

Chronic Calculous Pancreatitis: Chronic Calculous Pancreatitis: a Review of Approaches to Surgical Managementa Review of Approaches to Surgical Management

Parhisenko Yu.A., Zhdanov A.I., Parhisenko V.Yu., Kalashnik R.S.

Chair of Hospital Surgery of Voronezh N.N. Burdenko State Medical Academy Ministry of Health

of the Russian Federation; 10, Studencheskaja str., Voronezh, 394036, Russian Federation

Surgical treatment of chronic calculous pancreatitis still remains one of the unresolved problems in modern day’s pan�

creatology due to lack of consensus on specific operative procedures and techniques. The article highlights the relevance

of this issue and provides a review of the surgical approaches to management of chronic calculous pancreatitis.

Key words: chronic calculous pancreatitis, pancreatic resection, pancreaticoenterostomy.

Parhisenko Yuri Alexandrovich – Doct. of Med. Sci., Professor of Chair of Hospital Surgery of Voronezh N.N. Burdenko State

Medical Academy. Zhdanov Alexander Ivanovich – Doct. of Med. Sci., Professor, Head of Chair of Hospital Surgery of the same

Academy. Parhisenko Vadim Yurievich – Assistant of Chair of Hospital Surgery of the same Academy. Kalashnik RomanSergeyevich – a 6

thyear Student of Medical Department of the same Academy.

For correspondence: Kalashnik Roman Sergeyevich – Apt. 53, 4A, Mendeleeva str., Voronezh, 394014. Phone: +7�951�541�97�90.


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Russian)

24


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25


REVIEW

Gallbladder Agenesis and the Normal Gallbladder Development Gallbladder Agenesis and the Normal Gallbladder Development (review)(review)

Borodach A.V.

Novosibirsk State Medical University; 52, Krasny prospekt, Novosibirsk, 630091, Russian Federation

Gallbladder agenesis is a rare congenital anomaly occurring in 4 to 6 per 10,000 births and in 1 per 190–250 cholecys�

tectomies. Out of 126 case reports published from 1967 to 2012 choledocholithiasis was found in 20% of patients, coex�

isting congenital anomalies in 8%, malignant neoplasms in 2.4%, and pancreonecrosis in 2% of patients. Decrease of

bile cholato�cholesterol ratio was observed in all the patients tested. There are case reports of gallbladder agenesis asso�

ciated with congenital anomalies related to cholesterol and its derivatives metabolism disorders. Gallbladder agenesis can

mimic chronic cholecystitis, its clinical presentation can be consistent with biliary colic, chronic pancreatitis, cholangi�

tis, or bile reflux esophagitis. Studies reveal the development of isolated gallbladder agenesis in Lgr4�hypomorphic mice.

Prenatal ultrasonography facilitates diagnosis, treatment, and follow�up for gallbladder agenesis. Additional studies are

needed for further clarification of the pathogenesis of symptomatic gallbladder agenesis.

Key words: gallbladder, agenesis, aplasia, congenital anomalies, choledocholithiasis, cholecystectomy complications, embryo�

genesis, Lgr4.

Borodach Andrey Viacheslavovich – Doct. of Med. Sci., Professor, Chair of Surgical Diseases, Novosibirsk State Medical

University.

For correspondence: Borodach Andrey Viacheslavovich – 21, Polzunova str., Novosibirsk, 630051, Russian Federation.

Phone: +7�913�941�79�65. E�mail: [email protected], [email protected]

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29


REVIEW

Phosphorus Magnetic Resonance Hepatic Spectroscopy (review)Phosphorus Magnetic Resonance Hepatic Spectroscopy (review)

Bagnenko S.S.

S.M. Kirov Military Medicine Academy, St. Petersburg, Russian Federation. Department of Roentgenology and

Radiology; 6, Akademika Lebedeva str., 194044, St. Peterburg, Russian Federation

This review provides literature�based information on the development of phosphorus�31 magnetic resonance spec�

troscopy method. Current state and potential of this technique to diagnose focal and diffuse liver lesions were analyzed.

Magnetic resonance spectroscopy was shown to be highly informative for cellular�level liver metabolism research. The

review also highlights certain difficulties and technical limitations which impede the extensive use of spectroscopy

in clinical practice.

Key words: liver, MRI, 31P�MRS spectroscopy, HCC, MTS.

Bagnenko Sergei Sergeevich – Cand. of Med. Sci., Lecturer, Head of MRI Unit.

For correspondence: Bagnenko Sergei Sergeevich – 19�2�264, Varshavskaya str., St. Peterburg, 196128. Phone: +7�905�217�79�47.

E�mail: bagnenko [email protected]

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30


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31


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32


CASE REPORTS

Tight Suturing (Capitonnage) of Postnecrotic Purulent Tight Suturing (Capitonnage) of Postnecrotic Purulent Pancreatic PseudocystPancreatic Pseudocyst

Galperin E.I.1, 2

, Chevokin A.Yu.1, 2

, Ignatyuk V.G.2, Semenenko I.A.

1, 2

1 Department of Hepatopancreatobiliary and Regenerative Surgery, Scientific Research Institute

of Molecular Medicine, I.M. Sechenov First Moscow State Medical University; 8, Trubetskaya str.,

Moscow, 119992, Russian Federation2 Municipal Clinical Hospital No 7 of Health Department of Moscow; 4, Kolomenskiy passage, Moscow,

115446, Russian Federation

This article presents a case report of a 42�years�old patient who 1.5 years ago underwent laparotomy, sanitation and

drainage of abdominal cavityand retroperitoneal space for necrotic pancreatitis. The patient was admitted on May 05,

2014 with abdominal pain, a CT scan revealed two fluid collections: 4.4 × 10 cm in the area of pancreatic head and

3.8 × 4.8 cm in left mesogastric area. The patient underwent surgery on May 08, 2014, the purulent pseudocyst in left

mesogastric area was excised, and incision of pancreatic head pseudocyst was performed, with evacuation of 100 ml of

liquid purulence with sequestra, followed by sanitation and tight suturing (capitonnage) of the pseudocyst with Vicryl

sutures. There were no postoperative complications, and on May 16, 2014 the patient was discharged from the clinic.

Key words: pancreatic pseudocyst, necrotic pancreatitis, suturing of purulent pseudocyst, capitonnage.

Galperin Eduard Izrailevich – Doct. of Med. Sci., Professor, Chief Scientific Researcher, Department of Hepatopancreatobiliary

and Regenerative Surgery, I.M. Sechenov First Moscow State Medical University. Chevokin Aleksandr Yur’evich – Cand. of Med.

Sci., Docent, Head of 13th

Surgical Department, Municipal Clinical Hospital No 7. Ignatyuk Vyacheslav Grigor’evich – Cand. of

Med. Sci., Surgeon�physician of the same Department. Semenenko Ivan Al’bertovich – Cand. of Med. Sci., Senior Researcher,

Department of Hepatopancreatobiliary and Regenerative Surgery, I.M. Sechenov First Moscow State Medical University.

For correspondence: Semenenko Ivan Al’bertovich – Apt. 23, 12/1, Graivoronovskaya Str., Moscow, 109518.


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33


CASE REPORTS

Two�stage "in situ split" Extended Right Hepatectomy Two�stage "in situ split" Extended Right Hepatectomy in Patient with Cholangiocellular Carcinoma in Patient with Cholangiocellular Carcinoma

Novruzbekov M.S., Olisov O.D., Lutsik K.N., Donova L.V.,

Driaev V.T., Magomedov K.M., Muslimov R.Sh., Dzioev S.H.

N.V. Sklifosovskiy Scientific & Research Institute of Emergency; 3, B. Sukharevskaya,

Moscow, 129010, Russian Federation

The risk of postoperative liver failure is the most common reason for withholding surgery in cases of large liver tumors.

“In situ split” (ISS) liver resection is a new approach for patients with tumors that were previously considered unre�

sectable. This article presents the first successful experience of using ISS liver resection technique in Moscow

Sklifosovsky Research Institute for Emergency Medicine. The surgery was performed in a young patient with unre�

sectable cholangiocellular cancer. The first stage included the portal vein ligation and total liver parenchyma transection.

After 10 day interval the second stage (right extended hepatectomy) was performed. There were some biliary complica�

tions in postoperative period, which were successfully treated by minimally invasive procedures. The ISS liver resection

is a new and very perspective surgical method for patients with lesions previously considered unresectable.

Key words: in situ split liver resection, two�stage hepatectomy, ALPPS, liver hypertrophy.

Novruzbekov Murad Saftarovich – Cand. of Med. Sci., Chief of the Liver Surgery Department of N.V. Sklifosovskiy Scientific &

Research Institute of Emergency. Olisov Oleg Danielovich – Cand. of Med. Sci., Associate Senior Researcher of the Liver Surgery

Department of the same Institute. Lutsik Konstantin Nikolaevich – Cand. of Med. Sci., Head of the Liver Surgery Department

of the same Institute. Donova Lubov Viktorovna – Cand. of Med. Sci., Associate Senior Researcher of the Liver Surgery

Department of the same Institute. Driaev Vladimir Taimurazovich – Surgeon of the Liver Surgery Department of the same

Institute. Magomedov Kubai Magomedovich – Surgeon of the Liver Surgery Department of the same Institute. Muslimov RustamShahismailovich – Cand. of Med. Sci., Leading Researcher of the Radiology Department of the same Institute. Dzioev SoslanHadgumarovich – Postgraduate, Chair of Transplantology, Moscow State University of Medicine and Dentistry.

For correspondence: Olisov Oleg Danielovich – 3/5, B. Sukharevskaya st., Moscow, 129090. Phone: 8�495�628�35�02.


References1. Polischuk L.O., Skipenko O.G. Portal vein occlusion as a method of leftl lobe hypertrophy. Ukrainskiy Zhurnal Khirurgii. 2012; 16 (1):

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Khirurgii im. A.V. Vishnevskogo. 2008; 3 (3): 23–28. (In Russian)

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liver partition and portal vein ligation for staged hepatectomy (ALPPS): the Brazilian experience. Arq. Bras. Cir. Dig. 2013; 26 (1): 40–43.

7. Schnitzbauer A., Lang S.A., Goessmann H., Nadalin S., Baumgart J., Farkas S.A., Fichtner�Feigl S., Lorf T., Goralcyk A., Horbelt R.,

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combined with in situ splittinginduces rapid left lateral liver lobe hypertrophy enabling2�staged extended right hepatic resection in small�

for�sizesettings. Ann. Surg. 2012; 255 (3): 405–414.

8. Sala S., Ardiles V., Ulla M., Alvarez F., Pekolj J., de Santibanes E. Our initial experience with ALPPS technique: encouraging results.

Updates Surg. 2012; 64 (3): 167–172.

9. Homayounfar K., Liersch T., Schuetze G., Niessner M., Goralczyk A., Meller J., Langer C., Ghadimi B.M., Becker H., Lorf T. Two�stage

hepatectomy (R0) with portal vein ligation towards curing patients with extended bilobular colorectal liver metastases. Int. J. Colorectal.

Dis. 2009; 24 (4): 409–418.

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Ann. Surg. 2000; 232 (6): 777–785.

34


11. Ji W., Li J.S., Li L.T., Liu W.H., Ma K., Wang X., He Z., Dong J. Role of preoperative selective portal vein embolization in two�step cur�

ative hepatectomy for hepatocellular carcinoma. World J. Gastroenterol. 2003; 9 (8): 1702–1706.

12. Loos M., Friess H. Is there new hope for patients with marginally resectable liver malignancies. World J. Gastrointest. Surg. 2012; 4 (7):

163–165.

13. Broering D.C., Hillert C., Krupski G., Fischer L., Mueller L., Achilles E.G., Schulte am Esch J., Rogiers X. Portal vein embolization vs.

portal vein ligation for induction of hypertrophy of the future liver remnant. J. Gastrointest. Surg. 2002; 6 (6): 905–913.

14. Iida H., Aihara T., Ikuta S., Yoshie H., Yamanaka N. Comparison of percutaneous transhepatic portal vein embolization and unilateral

portal vein ligation. World J. Gastroenterol. 2012; 18 (19): 2371–2376.

15. Knoefel W.T., Gabor I., Rehders A., Alexander A., Kraush M., Schulte E., Furst G., Topp S.A. In situ liver transection with portal vein lig�

ation for rapid growth of the future liver remnant in two�stage liver resection. Br. J. Surg. 2013; 100 (3): 388–394.

16. Iida H., Yasui C., Aihara T., Ikuta S., Yoshie H., Yamanaka N. Simultaneous bile duct and portal venous branch ligation in two�stage hepa�

tectomy. World J. Gastroenterol. 2011; 17 (30): 3554–3559.

35


PRACTICAL GUIDELINES

Guidelines Management of Nonresectable HepatocellularGuidelines Management of Nonresectable HepatocellularCarcinoma (based on "RSOC recommendations for hepatocellularCarcinoma (based on "RSOC recommendations for hepatocellularcarcinoma diagnosis and treatment. Version 1.2012.")carcinoma diagnosis and treatment. Version 1.2012.")

Dolgushin B.I., Patutko Y.I., Gorbunova V.А.,

Breder V.V., Kosyrev V.Y., Virshke E.R., Chuchuev E.S.N.N. Blokhin Russian Cancer Research Center of RAMSci;

24, Kashirskoe shosse, Moscow, 115478, Russian Federation

Dolgushin Boris Ivanovich – Сorresponding Member of RAMSci, Deputy Director of N.N. Blokhin Russian Cancer Research

Center, Head of Diagnostic and Interventional Radiology Department of the same Сenter. Patutko Yuri Ivanovich – Doct. of

Med. Sci., Professor, Head of Liver and Pancreas Cancer Surgical Treatment Department of the same Center. Gorbunova VeraAndreevna – Doct. of Med. Sci., Professor, Head of Chemotherapy Department of the same Center. Breder Valeriy Vladimirovich –

Doct. of Med. Sci., Leading Researcher, Department of Clinical Biotechnology of the same Center. Kosyrev Vladislav Yurievich –

Doct. of Med. Sci., Leading Researcher, Laboratory of Interventional Radiology of the same Center. Virshke EduardRengol'dovich – Doct. of Med. Sci., Leading Researcher of the same Laboratory. Chuchuev Evgeniy Stanislavovich – Cand.

of Med. Sci., Senior Researcher, Liver and Pancreas Cancer Surgical Treatment Department of the same Center.

For correspondence: Dolgushin Boris Ivanovich – 24, Kashirskoe shosse, Moscow, 115478, Russia. Phone: +7�495�324�63�60.


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2. EASL–EORTC Clinical Practice Guidelines: Management of hepatocellular carcinoma. J. Hepatol. 2012; 56 (4): 908–943.

Abstracts of Current Foreign Publications Abstracts of Current Foreign Publications

Akhaladze G.G., Akhaladze D.G.

ABSTRACTS

Akhaladze Guram Germanovich – Professor, Chief Researcher of Liver Surgery Department of Sechenov First MSMU. AkhaladzeDmitriy Guramovich – Phisician of Liver Transplantation unit of V.I. Shumakov Federal Research Center of Transplantology and

Artificial Organs Ministry of Health of the Russian Federation.

For correspondence: Akhaladze Guram Germanovich – 4, Kolomenskiy proezd, Moscow, 115446, Russia.


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