Khirurgiya最新文献

{"title":"[Signs of high embolic risk in iliocaval floating thrombi].","authors":"A V Bocharov, K A Savostyanov, A K Tsagaeva, L V Popov, I V Olisaev, S V Alborov, F A Tuaev","doi":"10.17116/hirurgia202503156","DOIUrl":"10.17116/hirurgia202503156","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the ultrasound characteristics of iliocaval floating thrombi in patients with deep vein thrombosis regarding embolic risk.</p><p><strong>Material and methods: </strong>The study included 221 patients with deep vein thrombosis and iliocaval floating component. According to indications, all patients underwent implantation of infrarenal vena cava filter and received adequate anticoagulation. We analyzed the following parameters: length of floating clot, clot neck-to-stem ratio (minimum diameter of floating thrombus and diameter of clot attachment to occlusive thrombus), ratio of diameter of the clot neck to the widest part of the floating thrombus, as well as presence of large lateral inflow (internal iliac vein) near floating thrombus. Vena cava filter area was assessed regarding emboli. Ultrasound examinations were performed daily until primary endpoint (floating clot detachment or attachment to venous wall). The embolism group included 23 patients with clot detachment and cava filter embolism. The fixation group included 198 patients without cava filter embolism and floating thrombus attached to venous wall.</p><p><strong>Results: </strong>The risk of floating thrombus detachment increases by 2.49 times in patients with floating clot 70-79 mm [odds ratio (OR) 2.49; 95% confidence interval (CI) (1.2; 5.16); <i>p</i>=0.02] and 4.8 times in case of length >80 mm [OR 4.8; 95% CI (1.34; 17.19); <i>p</i>=0.03]. Minimum diameter of floating clot divided into diameter of clot attachment <30% increases the risk of detachment by 2.81 times [OR 2.81; 95% CI (1.44; 5.48); <i>p</i>=0.01]. Large lateral tributary near the neck of the floating thrombus increases the risk of detachment by 1.99 times [OR 1.99; 95% CI (1.1; 3.71); <i>p</i>=0.04].</p><p><strong>Conclusion: </strong>There are certain risk factors in patients with deep vein thrombosis, iliocaval floating thrombus and no contraindications to anticoagulation (clot length >70 mm, minimum diameter of floating clot divided into diameter of clot attachment <30% and large lateral tributary near the neck of the thrombus). These ones should probably be classified as a group with extremely high risk of fatal pulmonary embolism and need for endovascular prophylaxis of venous thromboembolic complications (cava filter implantation) in addition to anticoagulation.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"56-62"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Immediate results of laparoscopic spleen-preserving distal pancreatectomy: Kimura vs Warshaw procedure].","authors":"I V Vervekin, A A Trushin, R V Kursenko, L I Gainullina, A A Zakharenko","doi":"10.17116/hirurgia202501122","DOIUrl":"10.17116/hirurgia202501122","url":null,"abstract":"<p><strong>Objective: </strong>To study the immediate results of spleen-preserving distal pancreatectomy and to compare the outcomes after Kimura and Warshaw procedures.</p><p><strong>Material and methods: </strong>A retrospective non-randomized study included 27 patients with benign tumors of pancreatic tail and body who underwent spleen preserving distal pancreatectomy between 2020 and 2024. All patients were divided into 2 groups: 1 - Kimura procedure (<i>n</i>=16), 2 - Warshaw procedure (<i>n</i>=16). We excluded patients who underwent enucleations, central resections, and other interventions instead of distal pancreatectomy.</p><p><strong>Results: </strong>Mean surgery time was 269.06±70.95 (95% CI 227.74 - 319. 95) and 197.27±42.09 min (95% CI 184.36 - 240.64), respectively (<i>p</i>=0.006). Blood loss, length of hospital day, incidence of laparotomy, splenectomy, splenic infarction, and redo surgeries were similar. Clinically significant postoperative fistula B-C was more common in 1^st group (10 (62.4%) vs. 5 (45.5%) cases, <i>p</i>=0.028). There were no significant between-group differences in the incidence of postoperative complications Clavien-Dindo grade >III and mortality.</p><p><strong>Conclusion: </strong>Laparoscopic spleen preserving distal pancreatectomy is the «gold» standard for benign tumors of pancreatic body and tail. The Warshaw and Kimura techniques are safe and effective surgical approaches with similar results. The Warshaw procedure may be more advantageous regarding less surgical resources without deterioration of immediate postoperative results.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"22-28"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Resection of sternum body with anterior segments of ribs II-III and bone replacement with individual titanium implant].","authors":"D A Kharagezov, E A Mirzoyan, O N Stateshny, A A Antonyan, I A Leyman, K D Iozefi","doi":"10.17116/hirurgia202501168","DOIUrl":"10.17116/hirurgia202501168","url":null,"abstract":"<p><p>Metastatic breast cancer is the most common malignancy and urgent problem due to high mortality. This fact emphasizes the need for development of innovative surgical approaches. Innovative approaches, including 3D modeling, provide unique opportunities for accurate reconstruction of the sternum. This method promises significant progress in individualized treatment with higher effectiveness and survival. We present resection of sternum body with anterior segments of ribs II-III and bone replacement with individual titanium implant in a patient with metastatic breast cancer.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"68-73"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Comparative analysis of longitudinal and transverse minilaparotomy during colon cancer surgery].","authors":"Z A Bagatelija, D N Grekov, S S Lebedev, V M Kulushev, N Ju Sokolov, G S Mikhailyants, A Yu Lukin, A A Polikarpov, M S Lebedko, A I Maksimkin, A S Sharenkova","doi":"10.17116/hirurgia202504171","DOIUrl":"https://doi.org/10.17116/hirurgia202504171","url":null,"abstract":"<p><strong>Background: </strong>The steady increase in the incidence of colorectal cancer and its early diagnosis contribute to the identification of resectable forms of this disease, which in turn increases the number of minimally invasive surgical interventions. Therefore, the question of studying the influence of risk factors for the development of hernias and the search for an \"ideal\" place on the abdominal wall, which would provide the most convenient access for safe removal of the macropreparation and subsequent extracorporeal surgical procedures, as well as a low incidence of wound complications and postoperative ventral hernias, is the most pressing issue in colon cancer surgery.</p><p><strong>Objective: </strong>To study the differences in the incidence of postoperative ventral hernias during transabdominal extraction of the specimen depending on the type of access after minimally invasive colon resections for cancer, and to evaluate the risk factors for the occurrence of postoperative hernias.</p><p><strong>Material and methods: </strong>We retrospectively analyzed the medical records of 216 patients who underwent colon resection at the Botkin Medical Scientific and Clinical Center from January 2022 to September 2023. We used a cohort study to determine the impact of the type of access after minimally invasive colon resections for cancer on the incidence of postoperative ventral hernias. The formation of postoperative hernias was detected when longitudinal minilaparotomy was used for the extracorporeal stage of the operation or extraction of the removed preparation.</p><p><strong>Results: </strong>Of the 216 patients included in the study, 3 patients dropped out according to the exclusion criteria, so 213 patients were analyzed. Median criteria for operative time and blood loss did not differ (<i>p</i>>0.05) in both groups. There were no differences depending on the technique of videoendoscopic intervention used <i>p</i>=(0.762). A strong tendency to use a longitudinal approach was also observed when performing minimally invasive right hemicolectomy (<i>p</i>=0.051), and for distal colon resections, Pfanenstiel minilaparotomy was performed significantly more often (<i>p</i>=0.047). Among patients who underwent transverse minilaparotomy for the extracorporeal stage of surgery or extraction of the removed specimen, hernias in the incision area did not develop (<i>p</i>=0.0001), and in the longitudinal minilaparotomy group, hernias in the area of the access performed were detected in 21.9% of the operated patients.</p><p><strong>Conclusion: </strong>In our study, patients who underwent minimally invasive radical surgery for colon cancer using the longitudinal minilaparotomy method had a higher risk of hernia compared with patients who underwent surgery using transverse approaches.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 4","pages":"71-78"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Endovascular aortic repair in a patient with secondary aortoenteric fistula and critical lower limb ischemia].","authors":"A A Shubin, G B Fataliev, A V Sidorova, M O Knyazev","doi":"10.17116/hirurgia2025041100","DOIUrl":"https://doi.org/10.17116/hirurgia2025041100","url":null,"abstract":"<p><p>The authors present successful treatment of a patient with aortoenteric fistula and chronic critical lower limb ischemia after previous aortobifemoral bypass grafting (ABF). Examination revealed intimate contact of inferior duodenal wall near proximal anastomosis and thrombosis of the right branch. The patient underwent hybrid surgery, i.e. unilateral endovascular repair and crossover replacement. Despite severe status upon admission and concomitant diseases, postoperative period was uneventful. The authors reviewed literature data regarding pathogenesis and diagnosis of secondary aortoenteric fistulas, immediate and long-term results of open and endovascular treatment, advantages and limitations of various surgical tactics and materials.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 4","pages":"100-106"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Relationship between intestinal insufficiency syndrome and risk of external intestinal fistulas in patients with severe acute pancreatitis].","authors":"V V Kiselev, M S Zhigalova, P A Yartsev, S V Novikov, A M Kuzmin, D T Tkeshelashvili","doi":"10.17116/hirurgia202504179","DOIUrl":"https://doi.org/10.17116/hirurgia202504179","url":null,"abstract":"<p><strong>Objective: </strong>To identify the risk factors of external intestinal fistulas in patients with severe acute pancreatitis (SAP) and pancreatic necrosis.</p><p><strong>Material and methods: </strong>A retrospective and prospective study included 537 patients (354 (65.9%) men and 183 (34.1%) women) with SAP. Mean age was 51.2±18.5 years. To assess the effectiveness of intensive therapy, patients were divided into 2 groups. The control group (<i>n</i>=207) included patients who underwent examination and treatment according to the national guidelines «Acute pancreatitis», 2020). In the main group (<i>n</i>=330), examination and treatment were supplemented with original protocol.</p><p><strong>Results. p: </strong>Atients with intestinal failure score< 5 had no purulent-septic complications and multiple organ failure. Among patients with 6-9 scores, purulent-septic complications were observed in 11.7% of cases, multiple organ failure - 14.8% of cases. Among patients with 10-12 scores, the incidence of purulent-septic complications was 24.6%, multiple organ failure - 30% of cases. Thus, intestinal failure score > 10 is an important prognostic criterion of purulent-septic complications and multiple organ failure. In addition, external intestinal fistulas occurred in 8.5% of patients with intestinal failure score > 10.</p><p><strong>Conclusion. p: </strong>Rogression of intestinal failure correlates with purulent-septic complications and external intestinal fistulas in patients with SAP and pancreatic necrosis. Original diagnostic algorithm is valuable for early detection of functional gastrointestinal disorders, severity and localization of these changes. Original scoring system makes it possible to predict the risk of purulent-septic complications and multiple organ failure on the first day after admission. Moreover, timely therapy improves treatment outcomes in patients with SAP. In our study, the incidence of purulent-septic complications including external intestinal fistulas decreased from 10% to 7% in the main group.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 4","pages":"79-85"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Preliminary results of fluorescent lymphography in patients with biliary cancer undergoing liver resection].","authors":"A N Polyakov, A V Korshak, A G Kotelnikov, I V Sagaidak, N E Kudashkin, M V Batalova, A Sh Umirzokov, D V Podluzhny","doi":"10.17116/hirurgia202502127","DOIUrl":"10.17116/hirurgia202502127","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the diagnostic capability of intraoperative fluorescence lymphography (FLG) in detecting of sentinel lymph nodes (SLN) and lymph outflow pathways in patients with biliary cancer (BC).</p><p><strong>Material and methods: </strong>From April 2023 till March 2024, ten liver resections for BC were performed using FLG. We carried out the standard lymph node dissection with additional removal of lymph nodes (LN) that have accumulated indocyanine green (ICG). The lymphatic outflow pathways in all patients and frequency of SLN invasion were evaluated.</p><p><strong>Results: </strong>Ten patients were included: five patients had been diagnosed with intrahepatic cholangiocarcinoma (IHCC), two - with perichilar tumor (PT), the last three ones had gallbladder cancer (GBC). SLN No. 1 were detected in eight patients, the accumulation of ICG was detected in the following groups of LN: No. 8 (<i>n</i>=2), No. 13 (<i>n</i>=1), No. 12b (<i>n</i>=2), cystic lymph node (<i>n</i>=2), and No. 7 (<i>n</i>=1). SLN No. 2 was detected in seven patients. In three cases LN No. 13 were stained, in one - LN No. 12a, in another - LN No. 8. In two patients, staining of vesicular LN was noted. The combined morphological assessment of SLN No. 1 and SLN No. 2 made it possible to predict the presence of LN metastases in all patients (100%, <i>n</i>=3). Fluorescence of third-order LN was detected in four patients. In one case, the staining of LN No. 13 was noted. Another patient revealed accumulation of ICG in LN No. 3. In two cases, at the third stage, fluorescence of LN No. 7 was noted, while metastatic invasion of LN No. 7 was detected in one patient with IHCC.</p><p><strong>Conclusion: </strong>Using FLG, it was possible to determine an alternative lymph flow outpath to LN No. 7 in three patients. The method allowed to identify and remove metastatic LN No. 7 in one case. 100% sensitivity was shown in the determination of SLN in BC in a small group of patients. It is advisable to study the sensitivity of the method in large-scale studies.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"27-36"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Ascending aorta and aortic arch replacement without circulatory arrest].","authors":"S Yu Boldyrev, P K Tyutyunikov, S B Abidzakh, V A Sapunov, S A Raff, V Yu Ivashchuk, I V Tolstykh, K O Barbukhatti","doi":"10.17116/hirurgia2025021119","DOIUrl":"10.17116/hirurgia2025021119","url":null,"abstract":"<p><p>Circulatory arrest is the main method used in surgical interventions for prosthetics of the proximal aorta. However, recently, facts have been discovered that prove the benefits of avoiding circulatory arrest during planned and emergency surgical interventions. We present a clinical case of planned prosthetics of the ascending section and the aortic arch with a Intergard Woven 28 mm multibranch prosthesis without circulatory arrest in conditions of mild hypothermia. The patient was extubated 5 hours after the operation, and was discharged home in satisfactory condition on the 7th day. The rejection of circulatory arrest made it possible to reduce the duration of surgery, the duration of hospitalization and complications associated with hypoperfusion of organs and tissues that occur during cooling of patients.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"119-122"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Redo surgical treatment of a patient with hypertrophic cardiomyopathy and recurrent left ventricular outflow tract obstruction].","authors":"A V Lysenko, G I Salagaev, Yu S Gilevskaya, A I Malmina, Yu V Belov","doi":"10.17116/hirurgia2025021123","DOIUrl":"10.17116/hirurgia2025021123","url":null,"abstract":"<p><p>Septal myectomy is the gold standard for patients with obstructive hypertrophic cardiomyopathy. Nevertheless, some patients develop postoperative recurrence of left ventricular outflow tract obstruction and clinical symptoms of heart failure. Such ones require redo surgery if optimal medical therapy is ineffective.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"123-127"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Remodeling of muscular layer of abdominal wall in patients with postoperative ventral hernia].","authors":"L B Kanakhina, A V Protasov, O I Mazurova","doi":"10.17116/hirurgia202504146","DOIUrl":"https://doi.org/10.17116/hirurgia202504146","url":null,"abstract":"<p><strong>Objective: </strong>To compare the musculature of anterior abdominal wall in healthy people and patients with large or gigantic ventral hernia.</p><p><strong>Material and methods: </strong>A retrospective study included 200 patients between January 2020 and September 2024. Two groups were formed for subsequent analysis. The first group consisted of 100 participants without postoperative ventral hernia who underwent examination and treatment. The second group consisted of 100 patients diagnosed with large or giant ventral hernias. All participants underwent computed tomography (CT) of the abdomen, retroperitoneal space and pelvic region. Analysis of anterior abdominal wall muscles was based on CT findings. Thickness, length, area, density, symmetry, structural integrity, volume and circumference were measured.</p><p><strong>Results: </strong>There were significant differences in muscle length along the inner and outer contours on the right side and area of anterior abdominal wall muscles on both sides. These findings suggest potential changes of these parameters in the 2^nd group. Thickness of anterior abdominal muscles differed significantly (<i>p</i>-value ~0.017).</p><p><strong>Conclusion: </strong>There are significant structural differences in anterior abdominal wall musculature between healthy individuals and people with large and giant ventral hernias. This information can improve preoperative management and surgical techniques aimed at restoring the integrity and function of abdominal wall.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 4","pages":"46-52"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}