Biomedical subjects
Publications and source records attributed to V M Kopchak.
The experience was summarized concerning the treatment of 5 patients with chronic pancreatitis and ductal hypertension, complicated by retropancreatic pseudocyst. One-stage internal draining of pseudocyst and the pancreatic duct, using the method elaborated in the clinic, was performed. There were no postoperative complications. Late follow-up result is good.
Ten-year experience of operative treatment of cholelithic disease using mini-access cholecystectomy (MACH) in 920 patients was summarized. There were operated on 167 patients for an acute cholecystitis, chronic calculous cholecystitis--716, gall bladder polyposis--36, gall bladder cancer--1. In 48 patients the MACH was matched with choledochus drainage, in 9--choledocholithotomy was performed, in 1--choledochoduodenostomy. In 6 observations the MACH were done simultaneously inguinal herniotomy, in 10--umbilical herniotomy, in 7--uterine extirpation, in 13--operation for ovarial cyst. The bile leakage from gall bladder bed occurred in 3 observations, the operative wound suppuration--in 4. Duration of stationary treatment was 4.1 days at average.
Experience of surgical treatment of 271 patients the extrahepatic biliary ducts tumor for the 1992-1999 yrs period is presented. Indirect signs of extrahepatic biliary ducts tumor were revealed in 84% of observations. Depending on the tumor localization the trustworthiness of the endoscopic retrograde pancreatocholangiography method had constituted from 79.8 to 96.4%. Correct diagnosis was established before the operation in 94.3% of patients. Radical operation was done in 93 (34.3%) of patients, including 22 with proximal localization of tumor, 13--with central one, 10--distal, 48--terminal. Palliative operation was performed in 178 patients, in 76 of them biliodigestive anastomosis was done. Total postoperative mortality was 14.8%.
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In 46 patients with an destructive acute pancreatitis (AP) the invasive intervention under control of ultrasonography, in 38 of them--in stage of purulent complications, was performed. It had promoted stabilization of state in 39 (89.8%) patients, normalization of clinic--laboratory indexes, that had permitted to realize radical operative intervention with minimum risk in perspective. Invasive intervention under control of ultrasonography--highly effective primary surgical manipulation in complex of treatment of the destructive AP severe forms.
For the period from 1992 to 1998 years 554 patients with complicated chronic pancreatitis were operated on. In 248 patients the longitudinal pancreatojejunostomy was performed, in 113--pancreatojejunostomy in 75--external drainage of the cyst, of them in 12--under the ultrasonic investigation control. In 21 patients pancreatoduodenal resection was conducted, pancreatic gland (PG) distal resection--in 41. In 4 patients with the PG head calcinosis the pancreatic resection according to Beger was done, in 3--the Frey operation. In the total PG calcinosis in 9 patients the modified Frey's operation was performed in conjunction with platitude PG resection along posterior wall of her duct. The indirect operation on PG were done in 40 patients. Nine (1.6%) of patients died.
The methods of formation and the surgical instruments for the biliodigestive compression anastomoses (BDA) doing were elaborated in the clinic. For the 1997-2000 years period 137 patients were operated on for the biliary ducts impassibility, in 36 of whom the compression BDA was formated. In 69% patients the rejection was noted on 7-10th day after the operation. The result of treatment was studied in 6 month-4 years term and estimated as good in 32 (94.12%) patients.
Experience of application of the somatostatin synthetic analog sandostatin ("Novartis" firm) in treatment of 212 patients, including 84--with an acute pancreatitis (AP), 41--with postoperative AP (APP), 15--with external pancreatic fistula and 72--with high risk of the APP occurrence for prophylaxis was summarized. The significant inhibiting action of preparation on endocrine pancreatic function was noted. High efficacy of sandostatin in patients with AP and its complications was determined.
The method of the compressive biliodigestive anastomosis formation, using implant and the apparatus for its performance, was elaborated. An experimental investigation on 30 rabbits was done. An optimal strength of compression while doing the tissues connection was 0.002-0.004 N/m2. Minimal traumaticity, preservation of sufficient blood flow of the tissues connected, delineation of the healing zone from the intestinal contents and bile, the absence of chronic inflammation in anastomotic tissues are the advantages of compressive biliodigestive anastomosis, promoting early restoration of the intestinal and gallbladder wall, the formation of functionally full value anastomosis, which is not stenotizes cicatricially.
The experience of surgical treatment of 517 patients with complicated forms of chronic pancreatitis (CP) was analyzed. In patients with the fibrotic CP without ductal hypertension, while involvement in the process of neighboring organs, the operations were conducted for the biliary and duodenal impassability elimination. The drainage operations of various types are indicated in fibrotic CP with ductal hypertension. In patients with fibrotic-degenerative CP the resectional methods were applied. Postoperative mortality have constituted 1.9%. Good and fair result of treatment in the late follow-up period was achieved in 75.7% of patients due to application of the proposed differentiative tactics.
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Experience of surgical treatment of 370 patients with chronic pancreatitis, complicated by pancreatic pseudocyst occurrence, was analysed. Differentiational approach to operative intervention permitted to reduce the frequency of conduction of resections by 21.5%, replacing them by enhancing the quantity of drainage operations, what permitted to lower the occurrence of postoperative complications and to improve late follow-up result of treatment.
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Among 208 patients with extrahepatic biliary ducts fistula there were 60 with internal one, and 148--external one. The correction of main biliary ducts bile outflow was the principal stage of procedure. The method of correction was selected taking into account the character, level, and extent of pathological process the bile outflow impeded. The adequate surgical tactics and pathogenetically proven treatment allowed to achieve the favourable results in 96.6% of patients.
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