http://ir.librarynmu.com/handle/123456789/18688 2026-04-10T01:16:56Z 2026-04-10T01:16:56Z http://ir.librarynmu.com/handle/123456789/18729 2026-03-19T16:24:25Z 2024-01-01T00:00:00Z

Название: General Surgery №3 (10) 2024

2024-01-01T00:00:00Z Volkovetskii, V. Pererva, L. Maksymenko, M. Puzyr, N. http://ir.librarynmu.com/handle/123456789/18728 2026-03-19T16:22:46Z 2024-01-01T00:00:00Z

Название: Difficult choledocholithiasis. Literature review Авторы: Volkovetskii, V.; Pererva, L.; Maksymenko, M.; Puzyr, N. Краткий осмотр (реферат): The incidence of stones in the common bile duct in patients with symptomatic gallstone disease varies significantly and depends on age, ranging from 5 % to 33 %. In 85 — 90 % of cases, choledocholithiasis is effectively treated with endoscopic papillotomy (EPT) and lithoextraction, which is currently considered the standard method for managing this pathology. However, in 10 — 15 % of cases, choledocholithiasis is technically challenging for endoscopic treatment, requiring alternative methods and specialized equipment. This research examines the epidemiological aspects related to the increasing detection rate of choledocholithiasis, which is attributed to advancements in modern diagnostic techniques. Particular emphasis is placed on etiological factors such as genetics, obesity, and dietary habits that enhance bile lithogenicity. The pathogenesis section elucidates the mechanisms underlying primary and secondary stone formation in the bile ducts and their physiological impacts, including such complications as acute cholangitis, biliary sepsis, cholestatic hepatitis, and biliary cirrhosis of the liver. Distinct focus is placed on the criteria for difficult choledocholithiasis, encompassing stone characteristics, location, altered biliary anatomy, and the patient’s general condition. Diagnostic techniques include laboratory and instrumental investigations, particularly ultrasound, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasound. The treatment section emphasizes the importance of timely stone removal to prevent complications. Modern treatment options are discussed, including both conservative and surgical methods such as endoscopic procedures and laparoscopic surgeries. The significance of an interdisciplinary approach to the diagnosis and treatment of choledocholithiasis and its many manifestations is emphasized. Difficult choledocholithiasis remains a relevant issue in hepatobiliary surgery, and its effective treatment requires an individualized and multidisciplinary approach, involving endoscopic and laparoscopic technologies.

2024-01-01T00:00:00Z Dibrova, Y. Kryvopustov, M. http://ir.librarynmu.com/handle/123456789/18727 2026-03-19T16:18:56Z 2024-01-01T00:00:00Z

Название: Evolution of the doctrine of Zollinger–Ellison syndrome. Literature review Авторы: Dibrova, Y.; Kryvopustov, M. Краткий осмотр (реферат): Zollinger–Ellison syndrome (ZES) is a rare pathology that does not have specific clinical manifestations and is not always diagnosed in time. This is attributed to doctors’ insufficient awareness of this pathology and the limited availability of the necessary examination methods. Foreign literary sources on this problem are analysed. Historical data regarding the discovery of this pathology and the origin of the syndrome’s name are provided. The epidemiology of the disease is highlighted. The most characteristic clinical manifestations and possible complications of ZES are described in detail. The characteristic changes in gastric acid production associated with this pathology and their diagnostic value (sensitivity and specificity) are presented. At the same time, indicators of both basal and maximal stimulated gastric acid production are significantly increased. The most important stage in the examination of patients with suspected ZES is the determination of blood gastrin levels. At the same time, it is shown that it is not always possible to make definitive judgements in support of ZES based on gastrin indicators. An absolute criterion in favor of ZES is fasting gastrin values of 1000 pg/ml or more. When gastrin levels are less than this indicator, tests using secretin or calcium gluconate have significant diagnostic value. In these circumstances, tests with secretin or calcium gluconate are mandatory. The information on the possible localization of gastrin, the incidence of malignant transformation, and the mechanism of metastasis is given. Methods of determining gastrin localization, sensitivity, and specificity are described in detail. Based on the findings, a differentiated treatment strategy for patients with ZES is provided. Indications and contraindications for surgical and medical treatment of patients with ZES are given. The prospects of a new treatment direction - the use of targeted radiotherapy - are shown. These patients require constant monitoring by a gastroenterologist and a surgeon and periodically undergo the necessary examinations.

2024-01-01T00:00:00Z Puzyr, N. Tkachenko, N. Maksymenko, M. Pererva, L. Volkovetskii, V. Susak, Y. http://ir.librarynmu.com/handle/123456789/18726 2026-03-19T16:16:21Z 2024-01-01T00:00:00Z

Название: Endoscopic transluminal necrosectomy in the complex treatment of a patient with acute infected necrotizing pancreatitis. Clinical case Авторы: Puzyr, N.; Tkachenko, N.; Maksymenko, M.; Pererva, L.; Volkovetskii, V.; Susak, Y. Краткий осмотр (реферат): This study presents a clinical case of acute pancreatitis treatment, which manifested as infected walled-off necrosis in a 49-year-old obese woman. Diagnosis and treatment were provided by a multidisciplinary team comprising surgeons, anesthesiologists, interventional radiologists, and endoscopists. The treatment strategy followed a «step-up approach,» a modern technique involving gradual progression from less to more invasive methods, thereby reducing the physiological stress on the patient. This approach has demonstrated efficacy in numerous studies. In Western countries, endoscopic transluminal necrosectomy is gaining popularity, and our clinic has been implementing it successfully since 2021. Despite its effectiveness, clinicians still encounter challenges when opting for endoscopic transluminal interventions over other minimally invasive methods. Key issues include determining the timing and frequency of interventions, choosing debridement techniques and antiseptics for walled-off necrosis, and establishing criteria for transitioning to more invasive procedures. Today, researchers handle these nuances on a case-by-case basis, relying on the expertise and proficiency of a specific specialized department, which necessitates further research. In this case the patient achieved complete debridement of a localized fluid/necrosis collection through a stepwise approach. Initial management involved ultrasound-guided percutaneous drainage and lavage, followed by four sessions of endoscopic transluminal necrosectomy as the final minimally invasive intervention. We assess the unfavorable long-term outcomes, 2.5 years post-treatment, as negligible.

2024-01-01T00:00:00Z