Khirurgiya最新文献

{"title":"[Prognostic factors and preoperative therapy in resectable intrahepatic cholangiocarcinoma].","authors":"A N Polyakov, Yu I Patyutko, D A Granov, I S Bazin, I O Rutkin, A V Korshak, A S Turlak, D V Podluzhny","doi":"10.17116/hirurgia20250115","DOIUrl":"https://doi.org/10.17116/hirurgia20250115","url":null,"abstract":"<p><strong>Objective: </strong>To identify prognostic factors and role of preoperative therapy for resectable intrahepatic cholangiocarcinoma (IHCC).</p><p><strong>Material and methods: </strong>We analyzed the results of surgical and combined treatment of IHCC between 1999 and 2023. Immediate and long-term outcomes were evaluated depending on negative prognostic factors and additional therapy.</p><p><strong>Results: </strong>The study included 195 patients. Postoperative complications grade ≥III were observed in 35 (17.9%) case. Mortality rate was 3.1% (<i>n</i>=6). Thirty-eight patients (19.5%) underwent treatment before surgery, 109 (55.9%) ones - after surgery. The median overall survival was 31 months, 5-year overall survival - 32.0%. The following factors worsened overall survival: node size ≥8 cm (HR 1.45; 95% CI 0.97-2.17), invasion (HR 1.63; 95% CI 1.07-2.47), multiple lesion (HR 1.51; 95% CI 1.00-2.28). R1 resection worsened disease-free survival (HR 1.88; 95% CI 1.14-3.10). Lymph node metastases decreased overall (HR 1.96; 95% CI 1.27- 3.04) and disease-free survival (HR 2.37; 95% CI 1.63-3.44). Two and more negative factors worsened overall (<i>p</i>=0.0013) and disease-free survival (<i>p</i>=0.0005). Absence of adjuvant therapy worsened overall (HR 2.12; 95% CI 1.41-3.20) and disease-free survival (HR 1.42; 95% CI 0.99-2.04). There was a trend towards higher overall (<i>p</i>=0.088) and progression-free survival (<i>p</i>=0.029) in case of preoperative therapy (<i>n</i>=195). In unfavorable prognosis group, preoperative therapy (<i>n</i>=33) was superior to standard treatment (resection+capecitabine after surgery, <i>n</i>=26). There was a trend towards higher overall survival (<i>p</i>=0.066) and significantly better progression-free survival (17 vs 13 months, <i>p</i>=0.018).</p><p><strong>Conclusion: </strong>Negative prognostic factors for resectable IHCC are lesion size ≥8 cm, intrahepatic and regional metastases, invasion into neighboring structures, R1 resection. Combination of negative factors worsened prognosis. Adjuvant therapy improved postoperative outcomes. Preoperative therapy may be advisable in case of negative factors and high risk of R1 resection.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"5-13"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123673","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":"[Universal intestinal suture in rehabilitation of patients with single-layer anastomoses after elective upper gastrointestinal tract surgery].","authors":"S R Bashirov, S S Klokov, V A Korepanov, D V Krinitsky, N S Rudaya, M B Arzhanik","doi":"10.17116/hirurgia202501137","DOIUrl":"https://doi.org/10.17116/hirurgia202501137","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate universal intestinal suture in rehabilitation of patients with single-row anastomoses after elective upper gastrointestinal tract surgery.</p><p><strong>Material and methods: </strong>A single-center study included 142 patients over 8-year period. There were 72 (50.7%) pancreaticoduodenectomies and 70 (49.3%) gastric resections and gastrectomies. The rehabilitation program included single-layer anastomoses using universal intestinal suture, intestinal drainage for decompression and enteral nutrition, therapeutic and diagnostic endoscopy to stimulate motor evacuation function, patency of anastomoses and assessment of anastomositis.</p><p><strong>Results: </strong>Intestinal drainage for decompression and enteral nutrition was used for 6 (4; 7) days after surgery. Intraluminal endoscopy was performed after 9 (7; 11) days. In patients with anastomositis grade 0 (26.5%) and 1 (62.4%), we observed minimal inflammation along intestinal suture line (mean hospital-stay 16 (13; 20) days). In patients with anastomositis grade 2 (8.5%) and 3 (2.6%), we observed surface erosions and ulcers in the anastomosis zone (mean postoperative hospital-stay 20 (16; 27) days). Postoperative complications unrelated to anastomoses were diagnosed in 17.6% of cases; 12% of patients underwent redo surgery. Mortality rate was 2.8%.</p><p><strong>Conclusion: </strong>Universal intestinal suture in rehabilitation of patients with single-layer anastomoses contributed to uncomplicated healing of anastomoses in 88.9% of patients with anastomositis grade 0-1 and reduced the incidence of anastomositis grade 2-3 to 11.1%, as well as hospital-stay after elective upper gastrointestinal tract surgery.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"37-46"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123684","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":"[Endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy after previous gastrectomy, Billroth II procedure or pancreatoduodenectomy].","authors":"K V Sementsov, D K Savchenkov, A V Medvedeva, T E Koshelev, E A Gavrikova","doi":"10.17116/hirurgia202502137","DOIUrl":"10.17116/hirurgia202502137","url":null,"abstract":"<p><strong>Objective: </strong>To research the features of endoscopic treatment of choledocholithiasis and biliary strictures in patients with surgically altered anatomy of the upper gastrointestinal tract.</p><p><strong>Material and methods: </strong>A single-center retrospective study included 19 consecutive patients. Early outcomes including: the success of intubation of the afferent limb, the success of selective cannulation of the biliary ducts, the effectiveness of the performed operations; the frequency of complications; factors related to these indicators.</p><p><strong>Results: </strong>3 (15.7%) patients failed intubation of the afferent limb. In 16 (84.2%) patients, endoscopic treatment was an effective final treatment method - regression of obstructive jaundice was achieved and cholangitis was stopped. 9 (69.2%) of 13 patients with choledocholithiasis, complete one-stage stone extraction was performed; 4 (30.8%) patients staged treatment was performed, during which 3 patients underwent cholangioscopy procedure with lithotripsy (laser and electrohydraulic). 3 patients with benign strictures underwent staged endoscopic treatment - multiple procedures to upsize and number of stents. In 1 (6.3%) 85-year-old patient with choledocholithiasis complicated by cholangitis and abscesses, surgery and complex therapy did not avoid a fatal outcome. There were no other complications.</p><p><strong>Conclusion: </strong>Endoscopic treatment of choledocholithiasis and biliary strictures in patients with surgically altered anatomy is a more difficult task. In a significant proportion of patients endoscopic treatment is effective. The success of the endoscopic treatment is due to the equipment of the hospital and the skills of physicians. It may be advisable to concentrate this technique in a centres with skill and expertise.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"37-43"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366112","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":"[Robotic and thoracoscopic surgeries for anterior mediastinal neoplasms].","authors":"Z A Bagatelia, V D Parshin, D N Grekov, E M Glotov, V N Yakomaskin, S S Lebedev, A K Chekini, E A Chetverikova","doi":"10.17116/hirurgia20250216","DOIUrl":"10.17116/hirurgia20250216","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy and safety of robot-assisted (RATS) and video-assisted thoracoscopic (VTS) minimally invasive surgeries for anterior mediastinal neoplasms.</p><p><strong>Material and methods: </strong>The study involved 74 patients who underwent surgeries for anterior mediastinal neoplasms between 2020 and 2023. Patients were divided into two groups: group 1 (RATS, 33 patients) and group 2 (VTS, 41 patients). The following parameters were evaluated: surgery time, incidence of postoperative complications, pain syndrome and recovery time.</p><p><strong>Results: </strong>Duration of RATS was significantly shorter (mean 120 min) compared to VTS (140 min) (<i>p</i>< 0.05). Postoperative pain was also lower in the RATS group (4.5 vs. 6.0 points) (<i>p</i>< 0.05). The incidence of complications was lower in the same group that contributed to earlier recovery.</p><p><strong>Conclusion: </strong>Robot-assisted surgeries are preferable for anterior mediastinal tumors. The advantages of RATS include shorter surgery time, lower pain and complication rate. Thus, this approach is more advisable in high-risk patients.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"6-12"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366159","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":"[Laparoscopic interventions in urgent surgery (literature review)].","authors":"E K Salakhov, A P Vlasov, O V Markin, N S Sheiranov, A A Alagulov, K M Dukhovnova","doi":"10.17116/hirurgia202502194","DOIUrl":"10.17116/hirurgia202502194","url":null,"abstract":"<p><p>Laparoscopy is increasingly used in emergency surgery, demonstrating several advantages over open interventions.</p><p><strong>Material and methods: </strong>A systematic literature review for 2018-2023 was performed, searching PubMed, MEDLINE, RSCI, CyberLeninka databases. 33 studies on the use of laparoscopy in acute surgical abdominal diseases were selected.</p><p><strong>Results: </strong>The most convincing data have been obtained regarding laparoscopic treatment of acute appendicitis, cholecystitis, and gynecological pathology. There is a growing number of studies confirming the effectiveness of laparoscopy in intestinal obstruction, perforated ulcers, and abdominal trauma. Numerous publications indicate a reduction in the complication rate, decreased pain, shortened treatment and rehabilitation time after laparoscopic surgeries compared to open ones. At the same time, insufficient integration of the method into practice, lack of clear patient selection criteria, and the need for further standardization are noted.</p><p><strong>Conclusion: </strong>Laparoscopy should be considered as the method of choice in many urgent surgical conditions; however, further study and development of uniform protocols are required for wider implementation into the routine practice of emergency surgery.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"94-101"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366147","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":"[Rotational atherectomy for acute and chronic lower limb ischemia].","authors":"A A Shchegolev, A E Markarov, S A Papoyan, D S Amirkhanyan","doi":"10.17116/hirurgia2025021102","DOIUrl":"10.17116/hirurgia2025021102","url":null,"abstract":"<p><p>As the standard of living improves, the incidence of diabetes, atherosclerosis and hypertension increases, which causes an increase in ischemic lesions of the arteries of the lower extremities. Clinical manifestations depend on the cause and the presence of the patient's underlying peripheral arterial disease. Treatment of lower extremity ischemia remains a challenge for vascular surgeons. For many years, the mainstay of treatment was surgical or catheter-based thrombectomy and bypass surgery. Later, thrombolytic therapy and percutaneous transluminal angioplasty became treatment options for some patient groups. Despite these advances in treatment, lower extremity ischemia is still associated with high rates of morbidity, mortality, and limb loss. Therefore, regardless of which treatment method is used, early diagnosis and prompt surgical intervention based on individual symptoms is essential, with the goal always being to reduce pain and improve blood flow to ultimately save the limb. When choosing a treatment option for lower extremity ischemia, the risks of a particular intervention relative to the patient's clinical condition must be weighed against the urgency and severity of the threat to the limb and the expected improvement in the patient's clinical condition. One of the modern technologies for endovascular surgical treatment of peripheral vascular disease is rotational atherectomy. Quite a large number of studies devoted to this technology have been conducted, but the results obtained confirming or questioning the effectiveness of innovative systems of rotational atherectomy at the present stage of vascular surgery development are still insufficiently generalized.</p><p><strong>Objective: </strong>To summarize the review of modern studies, clarifying the obtained results of the effectiveness of innovative systems of rotational atherectomy in acute and chronic ischemia of the lower limbs.</p><p><p>It was clarified that Rotarex and Jetstream rotational atherectomy systems allow to effectively restore blood circulation in chronic thrombosis, including atherosclerotic and diabetic arterial lesions, which allows us to recommend them for further use in patients taking into account the indications and individual features of the course of ischemic limb lesions. Although various studies have proven the safety and efficacy of rotational atherectomy, there are limitations, so careful patient selection is required and further large-scale studies are needed.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"102-110"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366161","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 children with blunt spleen injury throughout 25-year period in Sevastopol and the Republic of Crimea].","authors":"V V Ignatiev, A V Oleynik, A V Muraviev, T A Garapov, I I Dankova, M Yu Tishukov","doi":"10.17116/hirurgia202502167","DOIUrl":"10.17116/hirurgia202502167","url":null,"abstract":"<p><strong>Objective: </strong>This study examines methods of treatment of pediatric patients with blunt splenic injury (BSI) in medical institutions in the city of Sevastopol and the Republic of Crimea. The effectiveness of non-operative management (NOM) in patients with BSI of varying AAST injury grade was assessed and risk factors which could predict the need for operative management (OM) were identified.</p><p><strong>Material and methods: </strong>A two-center retrospective cohort study was performed, in which reviewed the medical records of children diagnosed with BSI between 1996 and 2023. A cohort of patients hospitalized since the start of the active use of NOM of BSI was identified to determine risk factors.</p><p><strong>Results: </strong>The study included 112 patients. The mean age was 9.9±3.6 years, with a predominantly male (72%) population. In 64% of cases, the injury mechanism of BSI was a fall from a height. 26% of patients were hemodynamically unstable. Among the cohort of patients hospitalized since the start of the active use of NOM of BSI, NOM was effective in 94% of patients with low or moderate AAST injury grade, and in 56% of patients with high AAST injury grade. According to the study results, the risk factors that determine the indications for OM in this cohort of patients are BSI of high AAST injury grade (OR 20.0; 95% CI 2.7-53; <i>p</i><0.01), hemoperitoneum volume >500 ml according to ultrasound and/or CT (OR 15.0; 95% CI 2.3-98; <i>p</i>< 0.01), Hb <92.5 g/l (OR 20.0; 95% CI 1.9-219; <i>p</i>=0.01), hemodynamic instability (OR 5.4; 95% CI 1.4-21; <i>p</i>=0.02).</p><p><strong>Conclusion: </strong>NOM is an effective treatment for BSI of any AAST injury grade. The decision about OM should be based on haemodynamic instability.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"67-76"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366165","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 external intestinal fistulas and widespread peritoneal adhesions].","authors":"E Yu Levchik, K V Atamanov","doi":"10.17116/hirurgia202502144","DOIUrl":"10.17116/hirurgia202502144","url":null,"abstract":"<p><strong>Objective: </strong>To substantiate the safe timing and volume of enterolysis during operative treatment of patients with external small intestinal fistulas against the background of widespread peritoneal adhesive process.</p><p><strong>Material and methods: </strong>Comparative results of treatment of 315 adult patients, divided into 3 groups (60, 74 and 181 patients), depending on the graduation of peritoneal adhesive process, timing of operations and volumes of enterolysis are presented.</p><p><strong>Results: </strong>The highest postoperative mortality (17 (6.7%) out of 255) and the frequency of complications were characterized by operations performed within 1 month, against the background of widespread adhesive process. After 30 days, more favorable outcomes were observed in patients after complete distal enterolysis. The lowest mortality rate of patients (3 (2.4%) of 127) was observed more than 3 months after the onset of fistulas, after complete distal enterolysis.</p><p><strong>Conclusion: </strong>The presence of widespread peritoneal adhesions worsens the outcomes in patients with external small intestinal fistulas; performing reconstructive operations within more than 3 months from the formation of fistulas and complete distal enterolysis improves treatment results.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"44-49"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366169","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":"[Liver abscesses: modern approaches to diagnosis and treatment].","authors":"D G Amarantov, V N Pavlova, A S Barinova","doi":"10.17116/hirurgia202501193","DOIUrl":"10.17116/hirurgia202501193","url":null,"abstract":"<p><p>The review is devoted to global trends in diagnosis and treatment of liver abscesses. The definition of disease, etiology, epidemiology, clinical picture and diagnosis of pyogenic liver abscesses are covered in detail. The advantages and disadvantages of various treatments are analyzed. The authors estimated various opinions regarding the indications for percutaneous drainage and puncture aspiration depending on etiology, size and location of liver abscess.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"93-99"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123549","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":"[Blood transfusion at the stages of evacuation of the wounded in military conflicts of the XIX century].","authors":"M S Sergeeva, N N Krylov","doi":"10.17116/hirurgia2025021130","DOIUrl":"10.17116/hirurgia2025021130","url":null,"abstract":"<p><p>During the 19th century, the scope of blood transfusion was significantly expanded. Along with obstetric practice, hemotransfusion has been actively used in the fight against acute blood loss in combat and traumatic injuries. New broad opportunities for the development of the method were obtained during numerous military campaigns of the XIX century, accompanied by an increase in the destructive power of firearms and the number of wounded who died from acute massive bleeding on the battlefield. The article examines how high hopes for the introduction of blood transfusion among the means of helping the wounded were replaced by a complete rejection of its use outside inpatient medical institutions.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"130-136"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366045","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}