Khirurgiya最新文献

{"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":"[3D printing for airway stenting in patients with complex benign tracheobronchial stenosis].","authors":"M A Rusakov, V D Parshin, M S Simonova, V G Duvidzon, A V Parshin","doi":"10.17116/hirurgia202507187","DOIUrl":"10.17116/hirurgia202507187","url":null,"abstract":"<p><p>Tracheal bifurcation stenting for cicatricial stenosis is a complex problem due to individual anatomical features in each patient. Unlike malignant stenosis with acceptable metal self-expanding stents, tracheal bifurcation stenting with standard linear silicone stents for cicatricial stenosis is a technically complex task. In such cases, 3D printing is perspective for manufacturing of personalized endoprostheses. The article presents treatment of a patient using individual silicone bifurcation endoprosthesis manufactured with 3D printing technologies. Safe implantation, improvement of breathing quality and service life of such stents are demonstrated. Long-term results confirmed their effectiveness and safety.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 7","pages":"87-93"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545117","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":"[Incidence of regional lymph node metastases in patients with early prognostically unfavorable molecular biological breast cancer].","authors":"L P Kazaryan, A D Zikiryakhodzhaev, M V Moshurova, G G Khakimova, V O Timoshkin","doi":"10.17116/hirurgia202507111","DOIUrl":"https://doi.org/10.17116/hirurgia202507111","url":null,"abstract":"<p><strong>Objective: </strong>To study the incidence and risk factors of regional lymph node metastases in patients with early primary operable prognostically unfavorable breast cancer.</p><p><strong>Material and methods: </strong>The study included 200 patients with early (stage I and IIA) prognostically unfavorable molecular biological type of breast cancer between 2015 and 2019. Patients were divided equally into two groups: group 1 - oncoplastic breast resection or mastectomy with regional lymph node dissection at the first stage; group 2 - sentinel lymph node biopsy with urgent cytological examination was performed instead of regional lymph node dissection, and lymph node dissection was performed only in case of verified metastasis.</p><p><strong>Results: </strong>There were regional lymph node metastases in 15 (7.5%) patients. Of these, 10 (66.7%) ones had luminal B, Her2/neu-positive type of breast cancer, 3 (20%) and 2 (13.3%) patients - triple negative and Her2/neu-positive breast cancer, respectively. Metastatic regional lymph node lesion was common in luminal B, Her2/neu-positive type (14.7%), in Her2/neu-positive type - 3.6%, in triple negative type - 3.8%. Analysis of relationship between the incidence of regional lymph node lesion on primary tumor dimension, malignancy grade, <i>BRCA1</i>, <i>BRCA2</i> and <i>CHEK2</i> gene mutations, as well as lymphovascular invasion in tumor found no significant differences.</p><p><strong>Conclusion: </strong>Luminal B, Her2/neu-positive breast cancer has the highest aggressiveness regarding regional metastasis (14.7%) among prognostically unfavorable types of breast cancer in stage I-IIA patients.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 7","pages":"11-15"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545123","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":"[Resuscitative endovascular balloon occlusion of the aorta (REBOA) in a multi-field center for a patient with severe combined abdominal trauma].","authors":"Z A Bagateliya, D N Grekov, A A Kolotilshchikov, M V Petrishin, A A Ageeva","doi":"10.17116/hirurgia2025081117","DOIUrl":"10.17116/hirurgia2025081117","url":null,"abstract":"<p><strong>Objective: </strong>To improve the treatment strategy in patients with severe combined abdominal trauma using minimally invasive technique (REBOA).</p><p><strong>Material and methods: </strong>We present a patient with severe combined abdominal trauma (traffic accident) who underwent REBOA.</p><p><strong>Results: </strong>The patient admitted to the intensive care unit in 65 min after traffic accident. Examination including eFAST and CT was performed within 25 min. The REBOA took 7 minutes. After that, the patient was transferred to the operating theatre under ongoing intensive therapy. The patient underwent emergency surgery: angiography, embolization of splenic arteries, fixation of anterior semicircle of the pelvis and right iliac wing with external fixation device, surgical treatment of wounds of the right shoulder and left forearm, open fractures of the patellae on both sides, plaster immobilization, external fixation of the right humerus and left forearm using the Ilizarov apparatus A prerequisite for successful treatment is «Damage-control» tactics (total surgery time was 102 min). After that, further treatment was continued in the intensive care unit. Intraoperative and early postoperative transfusion therapy was performed (packed red blood cells 1268 ml, fresh frozen plasma 1475 ml, platelets 420 ml). ICU-stay was 16 days, hospital-stay - 32 days.</p><p><strong>Conclusion: </strong>Minimally invasive REBOA technology is important in the treatment of patients with severe combined abdominal trauma. Further accumulation of experience with subsequent analysis and evaluation of results is necessary.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 8","pages":"117-124"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817730","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}

{"title":"[Treatment of patients with obstructive jaundice in the flagship center].","authors":"S S Petrikov, E A Kiselev, P A Yartsev, S V Novikov, M L Rogal, A M Shadiev, Yu S Teterin","doi":"10.17116/hirurgia20250515","DOIUrl":"https://doi.org/10.17116/hirurgia20250515","url":null,"abstract":"<p><strong>Objective: </strong>To improve treatment outcomes in patients with obstructive jaundice at the flagship center through distributing patient flows and applying optimal tactics.</p><p><strong>Material and methods: </strong>A retrospective study included patients with obstructive jaundice between January 2022 and April 2024. Patients were divided into 2 groups: the main group - patients hospitalized between March 2023 and April 2024 (the first year of work of the flagship center); the control group - patients hospitalized between January 2022 and February 2023 (one year before the commissioning of the flagship center). In both groups, we analyzed gender- and age-adjusted distribution of patients, channels of hospitalization, severity of obstructive jaundice and its etiology, nature and number of surgical interventions, postoperative morbidity and mortality. Mean time to diagnosis, waiting time for surgery, postoperative and overall hospital-stay were compared.</p><p><strong>Results: </strong>There was significantly lower postoperative morbidity in the main group (<i>p</i><0.05). Moreover, the same group was characterized by significantly shorter time for diagnosis (3.4 versus 12.1 hours; <i>p</i><0.0001), earlier surgical treatment (6.8 versus 17.4 hours; <i>p</i><0.0001), postoperative (2.8 versus 5.7 days) and overall hospital-stay (3.6 versus 6.4 days).</p><p><strong>Conclusion: </strong>The capabilities of the flagship center make it possible to provide specialized high-tech medical care within the first hours after admission, significantly reduce the time for correct diagnosis and period until surgery. Original algorithm for patient distribution and optimal tactics based on minimally invasive technologies significantly improved treatment outcomes in patients with obstructive jaundice.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 5","pages":"5-12"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040118","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":"[Personalized prediction of acute pancreatitis after endoscopic transpapillary interventions].","authors":"Yu I Vedenin, M I Turovets, V V Mandrikov, G V Mikhailichenko","doi":"10.17116/hirurgia202501129","DOIUrl":"10.17116/hirurgia202501129","url":null,"abstract":"<p><strong>Objective: </strong>To develop the personalized model for predicting the risk of acute pancreatitis after endoscopic transpapillary interventions.</p><p><strong>Material and methods: </strong>A retrospective analysis of treatment outcomes included 366 patients with benign and malignant pancreaticobiliary diseases who underwent endoscopic transpapillary interventions. Risk factors associated with patients, underlying diseases and interventions were analyzed. Logistic regression analysis was used to present the personalized model for predicting the risk of acute pancreatitis.</p><p><strong>Results: </strong>Female gender (<i>p</i>=0.028), age <40 years (<i>p</i>=0.001-0.018), calculous cholecystitis (<i>p</i>=0.010) and stenosis of the major duodenal papilla (<i>p</i>=0.008) are patient-associated risk factors of acute postoperative pancreatitis. Stenting of the main pancreatic duct and thoracic epidural analgesia reduced this risk by 6.5 and 4.6 times, respectively. We developed significant (<i>p</i><0.001) regression model to determine the likelihood of acute post-manipulation pancreatitis.</p><p><strong>Conclusion: </strong>Original prediction model is valuable to determine the risk of acute pancreatitis after endoscopic transpapillary interventions. This model justifies various methods to prevent this complication.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"29-36"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123607","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":"[Pulmonary distress syndrome in urgent surgery: A concept, pathogenesis, and fundamentals of treatment].","authors":"A P Vlasov, V A Trofimov, T I Vlasova, N A Myshkina, T A Muratova, N Y Leshchankina, K M Dukhovnova","doi":"10.17116/hirurgia202502177","DOIUrl":"10.17116/hirurgia202502177","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To study several non-respiratory lung functions in conjunction with the respiratory component in acute abdominal diseases with different natures of the inflammatory process; to identify the key mechanisms of organ damage; and, based on the data, establish a new syndrome in urgent surgery-pulmonary distress syndrome-and evaluate the effectiveness of Remaxol in its treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Material and methods: &lt;/strong&gt;Chronic experiments have been done on dogs. Under anesthesia, progressive acute peritonitis was simulated in the first group (24) (the first subgroup (12) received infusion therapy, the second subgroup (12) received Remaxol (20 mL/kg)), in the second group (8) acute destructive pancreatitis, in the third group (8) acute obstructive ileus. The treatment outcomes of 78 patients with acute surgical pathology of the abdomen were analyzed: 38 patients with acute peritonitis caused by destructive appendicitis, hollow viscus perforation (the first subgroup (16) received standard of care, in the second (22) Remaxol was added to the standard of care); 18 with acute severe pancreatitis complicated by enzymatic peritonitis, 22 with acute intestinal obstruction. Surgeries were performed on all the patients. The extension and type of the surgeries depended on the condition. In the early postoperative period (up to 5 days), several indicators of respiratory lung function were evaluated in the experiment and patients, and non-respiratory function was assessed using several indicators of arterial and venous blood. In the experiment, the state of lipid metabolism and the hemostasis system was assessed in lung tissues.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;It was established that in acute abdominal diseases, lung damage occurs regardless of the nature of the inflammatory process. It manifested not only with changes in the homeostasis indicators due to modifications of the respiratory component but also non-respiratory functions of the organ. It was shown that the signs of the non-respiratory dysfunction of the lungs, as indicated by the parameters of blood inflowing to the lungs and outflowing from the lungs, included a deterioration in their detoxification and lipid-modifying ability and changes in the blood coagulation system. The key and unifying feature of respiratory and non-respiratory lung damage in various types of inflammatory processes are disorders of the lipid metabolism of lung cells. In the pathogenesis of membrane destabilization, the peroxidation of membrane lipids and the high activity of phospholipases play a decisive role. In the pathological process, a certain role is assigned to the tissue (pulmonary) coagulation-lytic system. The inclusion of Remaxol in the treatment of acute peritonitis increased lung tolerance to trigger pathogenetic agents, as indicated by improved laboratory and clinical parameters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Experimental and clinical evidence was obtained for establishing th","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"77-85"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366155","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":"[Improvement of surgical strategy for acute biliary pancreatitis].","authors":"B M Belik, Z A Abduragimov, R Sh Tenchurin, A V Rodakov, S Yu Efanov","doi":"10.17116/hirurgia202503140","DOIUrl":"10.17116/hirurgia202503140","url":null,"abstract":"<p><strong>Objective: </strong>To improve surgical tactics for acute biliary pancreatitis.</p><p><strong>Material and methods: </strong>Treatment outcomes were analyzed in 502 patients with acute biliary pancreatitis. Patients were divided into two groups depending on surgical tactics: control group (<i>n</i>=293) - standard diagnosis and treatment of biliary pancreatitis, main group (<i>n</i>=209) - treatment of biliary pancreatitis based on original algorithm. In these patients, therapeutic and diagnostic program included functional state of biliary tract and stratification of patients depending on severity of acute pancreatitis (APACHE II and Imrie/Glasgow scale) in addition to standard procedures.</p><p><strong>Results: </strong>There are 2 fundamentally different clinical variants of ductal hypertension and biliary pancreatitis: with acute blockade of pancreatobiliary tract (obstructive variant) and without this blockade (non-obstructive variant). Each variant included various clinical forms of acute biliary pancreatitis etiologically associated with specific biliary disease. In the 2^nd group, a differentiated surgical approach was applied taking into account clinical variant of biliary pancreatitis. The first stage implied correction of pancreatobiliary ductal hypertension through minimally invasive methods. At the second stage, radical surgical debridement of biliary tract was performed with elimination of etiological factor of biliary pancreatitis within the same hospitalization in patients with mild-to-moderate disease. In patients with severe biliary pancreatitis, the second stage of treatment was carried out 3 months after discharge. This treatment strategy reduced the number of infectious and inflammatory complications from 26.6% to 11.5%, mortality from 7.5% to 3.3% and avoid recurrent biliary pancreatitis.</p><p><strong>Conclusion: </strong>Original therapeutic and diagnostic algorithm optimizes surgical strategy and improves the effectiveness of treatment of acute biliary pancreatitis.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"40-47"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658835","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":"[Surgical access for thoracic and intrathoracic goiter].","authors":"L P Kotelnikova, S A Plaksin","doi":"10.17116/hirurgia202501154","DOIUrl":"10.17116/hirurgia202501154","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness of surgical approach for resection of retrosternal and intrathoracic goiter.</p><p><strong>Material and methods: </strong>There were 33 patients who underwent surgery for retrosternal (31) and intrathoracic goiter (2) through various surgical approaches. For retrosternal goiter, a Farabeuf hook was used to remove a large retrosternal component of tumor.</p><p><strong>Results: </strong>In 28 cases (84.8%), substernal goiter was resected through cervical collar incision. In 4 cases, a Farabeuf hook was used to extract retrosternal part of the goiter to the neck and avoid sternotomy. In one case, a combined approach was used (thoracoscopy and cervical collar incision). Sternotomy was performed in only one patient for suspected thyroid malignancy. In two patients with tumors of posterior mediastinum, intrathoracic goiter was removed through thoracoscopic access.</p><p><strong>Conclusion: </strong>Cervical collar incision allows resection of retrosternal goiter in 84.4% of cases. Retrosternal part can be effectively displaced to the neck wound using a Farabeuf hook. Thoracoscopy is preferable for removal of intrathoracic goiter and can be used to mobilize a large node in mediastinum as an alternative to sternotomy.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"54-61"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123679","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}