Khirurgiya最新文献

{"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":"[Differentiated approach to surgical treatment of patients with large postoperative ventral hernia].","authors":"N K Tarasova, S M Dynkov, D V Mizgirev, G A Ivanov","doi":"10.17116/hirurgia202503133","DOIUrl":"https://doi.org/10.17116/hirurgia202503133","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the results of large postoperative ventral hernia repair using the Rives-Stoppa technique and posterior component separation between 2018 and 2023.</p><p><strong>Material and methods: </strong>We retrospectively analyzed 55 case histories of patients with large postoperative ventral hernias. The Rives-Stoppa technique was used in 25 (45.5%) patients, posterior component separation - in 30 (54.5%) patients.</p><p><strong>Results: </strong>The classical Rives-Stoppa technique was predominantly performed in women (mean age 67.3±1.2 years). In 20 (80%) patients, hernia defect did not exceed 14 cm. Mean wound drainage time was 3.8±0.7 days, mean postoperative in-hospital stay - 12.7±2.4 days. Posterior component separation was more common in men, whose age was significantly lower (58.4±2.0 years, <i>U</i>=160.500, <i>p</i><0.001). This technique was significantly more common for hernia > 15 cm (14 (47%) patients, c²=4.288, <i>p</i>=0.038). Mean wound drainage time was 9.7±0.8 days, mean postoperative in-hospital stay - 18.8±1.6 days (<i>p</i><0.001). In early postoperative period, 15 (27.3%) patients had wound complications. There was no significant difference in the incidence of wound complications (<i>p</i>=0.808), and no deaths were recorded.</p><p><strong>Conclusion: </strong>A differentiated approach is necessary for large hernias. Some elderly and senile patients underwent Rives-Stoppa procedure. Posterior component separation is required for anterior abdominal wall reconstruction in young and middle-aged men. Posterior component separation significantly increases the wound drainage time and hospital-stay, but does not significantly affect the incidence of wound complications.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"33-38"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658919","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":"[Surgical treatment of pulmonary tuberculosis in children and adolescents].","authors":"M A Bagirov, S S Sadovnikova, V K Aliev, A E Ergeshova, M V Chashchina, G A Asoyan","doi":"10.17116/hirurgia202503116","DOIUrl":"10.17116/hirurgia202503116","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the operable forms of pulmonary tuberculosis, structure of surgical interventions, and effectiveness of surgical treatment in children and adolescents.</p><p><strong>Material and methods: </strong>We analyzed surgical treatment of pulmonary tuberculosis in 423 children and adolescents between 2012 and 2023. Low-traumatic invasive surgical methods were a part of comprehensive treatment including antituberculous therapy.</p><p><strong>Results: </strong>Segmental (including anatomical) lung resections were performed in 39.9% of cases, resection of intrathoracic lymph nodes - 21.3%, peripheral lymph node dissection - 2.6%, large-volume resections - 19.6% (including pneumonectomy - 1.7%, lobectomy - 8.5%, combined resections - 9.5%), pleurectomies - 13.9%. Stage-by-stage surgical treatment was performed in 5.5% of patients. Postoperative complications occurred after 1.9% of surgical procedures. All complications were successfully eliminated, there were no fatal outcomes, and effectiveness of comprehensive treatment was 100%.</p><p><strong>Conclusion: </strong>Timely surgical treatment combined with antituberculous chemotherapy can enhance the effectiveness of treatment for pulmonary tuberculosis in children and adolescents.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"16-23"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658951","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":"[Prevention of recurrent laryngeal nerve injury in thyroid surgery: a systematic review and meta-analysis].","authors":"A E Tseimakh, Ya N Shoikhet, A A Pantyushin, I Saxena","doi":"10.17116/hirurgia2025031140","DOIUrl":"https://doi.org/10.17116/hirurgia2025031140","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness of modern methods for preventing damage to recurrent laryngeal nerve in thyroid surgery.</p><p><strong>Material and methods: </strong>Full-text prospective comparative studies were reviewed in the PubMed Central databases, bibliographic database of the Russian Science Citation Index and Cochrane library database. Heterogeneity was assessed using forest plots, tau² and I² statistics.</p><p><strong>Results: </strong>Meta-analysis of pooled risk of recurrent laryngeal nerve injuries revealed significantly lower pooled estimate of the incidence of recurrent laryngeal nerve injuries in groups of intraoperative neuromonitoring (z=-2.04, <i>p</i>=0.0409). Heterogeneity among studies was not significant (I²=28%, <i>p</i>=0.25). Meta-analysis of pooled risk of damage to recurrent laryngeal nerve in case of prevention by precise dissection using ultrasound and electric cauterization found no significant differences in both groups (z= -0.19, <i>p</i>=0.8806). Heterogeneity among studies was moderate (I²=60%, <i>p</i>=0.11). There were no significant publication biases.</p><p><strong>Conclusion: </strong>Intraoperative neuromonitoring and precise dissection of recurrent laryngeal nerve using ultrasound and electric cauterization reduce surgery time. Intraoperative neuromonitoring is advisable as an optional procedure for prevention of damage to recurrent laryngeal nerve.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"140-148"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658844","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":"[Early complications after surgical treatment of spontaneous pneumothorax: risk factors analysis].","authors":"G M Agafonov, A S Petrov, O V Novikova, M A Atyukov, P K Yablonsky","doi":"10.17116/hirurgia202503124","DOIUrl":"https://doi.org/10.17116/hirurgia202503124","url":null,"abstract":"<p><strong>Objective: </strong>To study the risk factors of complications after wedge resection with subsequent pleurectomy.</p><p><strong>Material and methods: </strong>There were 454 patients diagnosed with spontaneous pneumothorax between 2018 and 2023. Surgical intervention was performed in 331 (72.9%) patients according to commonly accepted indications for prevention of recurrence. Risk factors were studied using regression analysis and directed acyclic graph (DAG) method to build predictive models.</p><p><strong>Results: </strong>The complication rate was 11.5% (<i>n</i>=38). The most common complications were intrapleural bleeding and prolonged air leak (3.9% and 3.6%, respectively). One-third of cases were classified as major complications according to the Clavien-Dindo classification in thoracic surgery and required pleural cavity drainage or debridement. Significant risk factors of postoperative complications were secondary pneumothorax (HR 4.009; 95% 1.147-14.013; <i>p</i>=0.030) and severe pleural adhesions (HR 4.258; 95% 1.134-15.991; <i>p</i>=0.032).</p><p><strong>Conclusion: </strong>Secondary pneumothorax and severe pleural adhesions are independent risk factors of postoperative complications.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"24-32"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658921","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 significance of quantitative assessment of carotid artery tortuosity].","authors":"A V Gavrilenko, A V Abramyan, G F Magomedova, Zh Li, Z A Eremeeva, D A Semchenkova, P D Burkhanova, D D Donskaya","doi":"10.17116/hirurgia202503163","DOIUrl":"https://doi.org/10.17116/hirurgia202503163","url":null,"abstract":"<p><strong>Objective: </strong>To compare sensitivity and specificity of various methods for quantitative assessment of carotid artery tortuosity.</p><p><strong>Material and methods: </strong>The study included 41 patients with carotid artery tortuosity confirmed by CT angiography.</p><p><strong>Results: </strong>All 3 mathematical models for quantitative assessment of carotid artery tortuosity demonstrated high sensitivity and specificity: model 1 - 80.0% sensitivity and 100.0% specificity; model 2 - 90.5% sensitivity and 93.3% specificity; model 3 - 86.7% sensitivity and 93.3% specificity.</p><p><strong>Conclusion: </strong>All three mathematical models are valid for quantitative assessment of carotid artery tortuosity. The third method is the most convenient and quickest, as it requires only two parameters for calculation.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"63-68"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658948","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}