AIM To identify the multidetector computed tomography (MDCT) features of pancreatic neuroendocrine tumours (pNETs), which correlate with tumour histology and enable preoperative grading. MATERIALS AND METHODS Thirty-nine patients with histologically confirmed pNET who underwent preoperative contrast-enhanced MDCT were included in this study. Nineteen tumours were classified as Grade 1 (G1) and 20 as Grade 2 (G2). Histopathology slides were reviewed to assess the intratumoural microvascular density (MVD) and the amount of tumour stroma. Computed tomography (CT) image analysis included tumour size, margin delineation, calcifications, homogeneity, contrast enhancement (CE) pattern, tumour absolute and relative enhancement, presence of cystic changes, pancreatic duct dilatation, regional and distant metastases. The diagnostic ability to predict tumour grade was measured for each MDCT finding and their combinations. RESULTS The mean arterial enhancement ratio had a mean±standard deviation of 1.53±0.45 in G1 and 1.01±0.33 in G2 pNETs (p=0.0003) and correlated with intratumoural microvascular density (MVD; r=0.55, p=0.0002). Tissue stroma percentage did not correlate with imaging findings. Late CE of the tumour (the peak attenuation observed in the venous phase) was significantly associated with G2. Tumour size ≥20 mm, arterial enhancement ratio <1.1, and late CE showed 74.4%, 79.5%, and 74.4% accuracy, respectively, in diagnosing G2 tumours, while the accuracy of at least two of these criteria used in combination was 82%. Based on these results, a diagnostic algorithm was proposed, which showed high interobserver agreement (k=0.82) in the prediction of tumour grade. CONCLUSION Contrast-enhanced MDCT features correlate with histological findings and enable the differentiation between G1 and G2 pNETs during preoperative examination.

Comprehensive survey allowed to define the cause of OH. Minimally invasive organ-sparing surgery has satisfactory immediate and remote results in these patients.

Введение. Кистозные опухоли печени (КОП)-это редкое заболевание, составляющее менее 5% всех кистозных новообразований органов брюшной полости. Материал и методы. Представлен анализ результатов обследования и лечения 46 пациентов с кистозными опухолями печени. Результаты и обсуждение. использование в диагностике уЗи брюшной полости с допплерографией (37 пациентов), СКт органов брюшной полости с внутривенным болюсным контрастированием (44 пациента) и МРт органов брюшной полости с МР-холангиографией (24 больных) позволило определить лучевую семиотику кистозных заболеваний печени. наиболее важными признаками кистозных опухолей следует рассматривать наличие перегородок в просвете опухоли с наличием в них кровотока (82% пациентов), солидного компонента (6,8%) и дочерних кист (11,3%), а также билиарной гипертензии (39,2% пациентов). исследование уровня онкомаркеров РЭА, СА 19-9, АФП в плазме крови у 40 пациентов показало повышение уровня СА 19-9-только при цистаденокарциномах и внутрипротоковой папиллярной муцинозной опухоли билиарного типа. Оценка уровня онкомаркеров содержимого доброкачественных и злокачественных кистозных опухолей показала превышение референсных значений во всех случаях. Хирургическое лечение мы применяли у 42 пациентов. из них большие резекции печени выполнены у 10 (23,8%) пациентов, атипичные и анатомические резекции (удаление или резекции печени менее 3 сегментов) выполняли у 31 (73,8%) больного. в одном случае при локализации цистаденомы в 1 сегменте печени была выполнена криодеструкция опухоли, в связи с распространением опухоли на стенку нижней полой вены и гепатодуоденальную связку. в 2 случаях операции проводились лапароскопическим способом, а у 3 пациентов применялись робот-ассистированные хирургические вмешательства. По результатам иммуногистохимического исследования, проведенного у 22 пациентов, наиболее выраженная экспрессия антител ck7, Сk19, Muc1, S100p, СDХ2, p53 отмечена эпителием, выстилающим опухоль, что в группе цистаденом нами выявлено не было. При доброкачественных КОП отмечена экспрессия антител eR, PR и р53 стромальным компонентом, а ck7, Сk19, cDX2, Muc1, S100p-эпителиальным компонентом. Заключение. Существуют значительные трудности дифференциальной диагностики кистозных опухолей печени. Поэтому с целью наиболее точного подтверждения диагноза на периоперационном этапе необходимо применять единый алгоритм лечебно-диагностических мероприятий. При выявлении у женщин солитарного кистозного образования в iv сегменте печени с большей долей вероятности следует предполагать кистозную опухоль. При подозрении или подтверждении диагноза необходимо выполнять анатомическую резекцию печени с полным удалением опухоли для предупреждения рецидива заболевания. Ключевые слова: цистаденома печени, билиарная цистаденома, цистаденокарцинома, муцинозная кистозная опухоль, лучевая диагностика, хирургическое лечение, иммуногистохимическая диагностика. Mucinous cystic liver tumors-diagnosis and surgical treatment P.v. uSyAky, v.A. kubySHkin, v.A. viSHnevSky, yu.A. kovAlenko, n.A. kARel'SkAyA, D.v. kAli...

Obvious advantage of robot-assisted operation was precision of great vessels and lymphatic nodes dissection, performing anastomoses. Robot-assisted pancreatoduodenectomy corresponds to all requirements inherent to radical cancer surgery.

Aim. To improve quality and duration of life in patients with locally advanced pancreatic cancer. Material and methods. Cryosurgery through laparotomy has been performed in 36 patients with locally advanced pancreatic cancer since 2012. There were 14 (38.9%) men and 22 (61.1%) women (mean age 58 ± 6.8 years). Dimensions of pancreatic tumors were from 4 to 10 cm. Domestic devices “CRYO-MT”, “CRYO-01”, “ELAMED” and cryoapplicators with a diameter 2–5 cm were applied. Target temperature was about 186 °С, time of exposure – 3–5 min. There were 1–5 sessions of cryoablation (mean 2.4) and their number depended on tumor dimensions. Local cryodestruction was supplemented by bypass anastomoses in 18 patients (50%). All patients subsequently underwent adjuvant chemotherapy with additional regional chemoembolization in 10 of them. Results. There were no lethal outcomes during cryodestruction and in postoperative period. Early postoperative complications occurred in 14 (38.8%) patients, severe complications – in 13.6%. Cryodestruction was followed by complete regression (39.2%) or significant improvement (41.6%) of pain syndrome. 6-, 12-, 24- and 36-month survival was 92%, 84%, 48% and 14%, respectively. Median survival was 18.2 months. Conclusion. Cryodestruction is able to improve patients’ quality of life due to reduced pain syndrome in case of locally advanced pancreatic cancer. Certain increase of survival was observed in additional chemotherapy.

Background: Сombined treatment for patients with metastatic liver damage offers better long-term outcome, and laser ablation can increase the indications for liver resection for somatically burdened patients. Methods: The Results of treatment of 28 patients with metastatic liver damage and using laser ablation technique for the period from March 2017 to 2018, women 17, men 11, average age was 61 AE 2.7 years. All patients in the preoperative stage performed removal of the primary focus in the volume of R0 and lymphadenectomy D1, D2 and are at different stages of chemotherapy. Laser ablation of liver formations was performed percutaneously transhepatic, under the control of ultrasonic scanning in real time. For laser ablation, ECHO LASER, manufactured in Italy, was used, a 4-channel multiple source with a complex ultrasound system, using laser radiation with a wavelength of 1064 nm. Control of the effectiveness of the effect was carried out by ultrasound, MRI and CT with intravenous bolus enhancement in dynamics. Result: In the early postoperative period pain syndrome was noted, within 3 days, stopped with the use of analgesics, biochemical analyzes (ALT, AST, AP) were observed for 10 days. In the early postoperative period, formation under the capsular hematoma, in the area of "h"hthe light guide, was not required, which did not require surgical intervention. In 4 patients, at 6 months, progression of the disease was noted, followed by liver resection. Morphological examination of the ablation zone shows pathomorphosis of the fourth degree (according to Lushnikov). The average bed-day was 4 days. Conclusion:The use of laser ablation allows several nodes to act simultaneously. Due to low traumatism and

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Background: Сombined treatment for patients with metastatic liver damage offers better long-term outcome, and laser ablation can increase the indications for liver resection for somatically burdened patients. Methods: The Results of treatment of 28 patients with metastatic liver damage and using laser ablation technique for the period from March 2017 to 2018, women 17, men 11, average age was 61 AE 2.7 years. All patients in the preoperative stage performed removal of the primary focus in the volume of R0 and lymphadenectomy D1, D2 and are at different stages of chemotherapy. Laser ablation of liver formations was performed percutaneously transhepatic, under the control of ultrasonic scanning in real time. For laser ablation, ECHO LASER, manufactured in Italy, was used, a 4-channel multiple source with a complex ultrasound system, using laser radiation with a wavelength of 1064 nm. Control of the effectiveness of the effect was carried out by ultrasound, MRI and CT with intravenous bolus enhancement in dynamics. Result: In the early postoperative period pain syndrome was noted, within 3 days, stopped with the use of analgesics, biochemical analyzes (ALT, AST, AP) were observed for 10 days. In the early postoperative period, formation under the capsular hematoma, in the area of "h"hthe light guide, was not required, which did not require surgical intervention. In 4 patients, at 6 months, progression of the disease was noted, followed by liver resection. Morphological examination of the ablation zone shows pathomorphosis of the fourth degree (according to Lushnikov). The average bed-day was 4 days. Conclusion:The use of laser ablation allows several nodes to act simultaneously. Due to low traumatism and minimally invasive, it is possible to perform surgical intervention in somatically burdened patients who can not perform liver resection, as well as possible use in the presence of a pacemaker.