Khirurgiya最新文献

{"title":"[The use of low-frequency ultrasound in the treatment of patients with infected pancreatic necrosis].","authors":"A M Zainutdinov, I S Malkov, A V Berdnikov","doi":"10.17116/hirurgia202502186","DOIUrl":"10.17116/hirurgia202502186","url":null,"abstract":"<p><strong>Objective: </strong>To improve the treatment of patients with infected pancreatic necrosis by using non-contact ultrasound treatment of purulent-necrotic foci (NUST).</p><p><strong>Material and methods: </strong>We analyzed the results of treatment of 39 patients with infected pancreatic necrosis, admitted to the surgical department No. 2 of the City Clinical Hospital No. 7 in Kazan from 2017 to 2021. The central method of their surgical treatment was open draining operations combined with sequestrectomy. The study group consisted of 20 patients (4 women, 16 men) aged from 39 to 60 years (mean age - 49±9.5 years). In this group, the effectiveness of non-contact ultrasound treatment of purulent-necrotic foci using the SONOCA-185 apparatus was studied.</p><p><strong>Results: </strong>The application of ultrasound treatment of purulent foci of infected pancreatic necrosis in the study group allowed to increase their drainage effectiveness, which was reflected in the dynamics of reparative-proliferative process and relief of systemic inflammatory reaction. Wound healing occurred on the 7-9 day (on average, on the 7.6±2^th day) without resuturing.</p><p><p>The pronounced bactericidal effect of low-frequency ultrasound and its phonophoretic effect are confirmed by the reduction of microbial content of wounds and cavities from 105 CFU and 104 CFU to 102 CFU after 3 sessions.</p><p><p>The sparing ultrasound sequestrectomy allows to remove only devitalized tissues, without causing destructions of the ductal system, vascular wall and hollow organs.</p><p><p>Ultrasound treatment of cavities in the study group resulted in a pronounced increase in transparency indicators and its approximation to reference solution, decreased peripheral blood leukocytosis, temperature reaction in patients on the 3^rd, 7^th, 12^th days compared to the control group, where the temperature response is maintained at this time, and reduction in hospitalization duration on the 2.6±1 day in the study group of patients.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"86-93"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366163","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":"[Artificial intelligence in surgery. Reducing the risks related to polypharmacy in perioperative period].","authors":"V I Panteleev, A G Kriger, N L Shimanovsky","doi":"10.17116/hirurgia202507159","DOIUrl":"https://doi.org/10.17116/hirurgia202507159","url":null,"abstract":"<p><p>In recent years, active development of artificial intelligence (AI) leads to its widespread introduction into various spheres of human activity, including healthcare and surgery. The ongoing research of AI in surgery is aimed at potential benefits of AI at all stages of examination and treatment of patients. The ultimate goal is improvement of quality, effectiveness and safety of treatment. This review examines the main directions of AI (machine learning, natural language processing, artificial neural networks, computer vision) and provides examples of their current use including reducing the risks of polypharmacy in perioperative period. The prospects for further development of AI in surgery and possible risks associated with this technology are also discussed.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 7","pages":"59-66"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545118","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":"[Circular tracheal resection in a 9-year-old child with posttracheotomy cicatricial stenosis with tracheomalacia: the first experience in the Siberian Federal District].","authors":"E B Topolnitskiy, A B Yushmanova, V G Pogorelko, S D Ivanov","doi":"10.17116/hirurgia202507181","DOIUrl":"10.17116/hirurgia202507181","url":null,"abstract":"<p><p>Acquired cicatricial stenosis in children most often occurs in subglottic region of the larynx and cervical trachea. It is associated with prolonged intubation and tracheostomy. Optimal surgical correction of cicatricial stenosis and treatment algorithm in standard cases in adults are largely determined. However, there are no clear criteria for surgical options in children. In most cases, surgical treatment of acquired cicatricial stenosis of the larynx and trachea in children under primary school age implies intraluminal endoscopic recanalization and reconstruction of cicatricial tissue for adequate breathing. We present circular tracheal resection in a 9-year-old child with post-tracheostomy cicatricial stenosis of the trachea and tracheomalacia, as well as features of perioperative support.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 7","pages":"81-86"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545120","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":"[Interleukin-6 as a biochemical marker of intestinal anastomotic leakage].","authors":"M A Chernykh, A M Belousov, K G Shostka","doi":"10.17116/hirurgia202509187","DOIUrl":"https://doi.org/10.17116/hirurgia202509187","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate diagnostic significance of IL-6 compared to CRP for early detection of anastomotic leakage after colon resection for colorectal cancer.</p><p><strong>Material and methods: </strong>The study included 277 patients who underwent total resection for colorectal cancer. Patients were retrospectively divided into three groups: without complications (<i>n</i>=227), with anastomotic leakage (<i>n</i>=30), and other postoperative complications (<i>n</i>=20). CRP and IL-6 were measured daily for 5 postoperative days. Dynamics of markers and their diagnostic significance were estimated using ROC analysis.</p><p><strong>Results: </strong>Serum IL-6 in patients with anastomotic leakage reached significant values after 2 postoperative days (AUC=0.872, cut-off=51.2 pg/ml, sensitivity 79.3%, specificity 89.1%) and maximum after 3 days (AUC=0.949, cut-off=66.4 pg/ml, sensitivity 80.0%, specificity 96.8%). CRP demonstrated diagnostically significant values after 3-4 days (AUC=0.875 after 3 days and 0.926 after 4 days). Dynamics of IL-6 after intervention for anastomotic leakage indicated advisability of this marker to assess the quality of abdominal debridement.</p><p><strong>Conclusion: </strong>IL-6 is a perspective early marker of anastomotic leakage with high sensitivity and specificity after 2 days. This significantly reduces the diagnostic time compared to CRP. IL-6 can optimize postoperative management of patients contributing to early detection of complications and timely intervention.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 9","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":"145024369","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":"[Repeated common femoral artery bifurcation repair in patients with acute lower limb ischemia and unsatisfactory outflow pathways].","authors":"I P Mikhailov, V A Arustamyan, B V Kozlovsky, L S Kokov","doi":"10.17116/hirurgia202509178","DOIUrl":"https://doi.org/10.17116/hirurgia202509178","url":null,"abstract":"<p><strong>Objective: </strong>To analyze and improve postoperative outcomes in patients with acute lower limb ischemia (ALLI) and previous reconstructive infrainguinal interventions.</p><p><strong>Material and methods: </strong>The authors analyzed postoperative outcomes after 54 repeated interventions in patients with thrombosis of common femoral artery bifurcation, deep femoral artery and non-functioning femoropopliteal (tibial) prosthesis.</p><p><strong>Results: </strong>External-iliac-deep femoral replacement were performed in 28 (52%) patients, extended deep femoral artery repair - in 16 (29.6%), aorto(iliac)-deep femoral replacement - in 8 (14.8%) cases.</p><p><strong>Conclusion: </strong>External-iliac-deep femoral replacement is a preferable and effective method to restore pulsatile blood flow in deep femoral artery.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 9","pages":"78-86"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024372","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":"[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":"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":"[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":"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":"[Structural and functional tissue response to implants in patients with recurrent abdominal wall hernias in long-term period].","authors":"I A Chekmareva, B Sh Gogiya, O V Paklina, R R Alyautdinov","doi":"10.17116/hirurgia202504139","DOIUrl":"https://doi.org/10.17116/hirurgia202504139","url":null,"abstract":"<p><strong>Objective: </strong>To analyze long-term structural and functional changes of connective tissue in patients with recurrent hernias after repair with implants.</p><p><strong>Material and methods: </strong>Excisional biopsies from the hernia recurrence sites were performed in 60 patients who had previously undergone hernia repair with implants. In 37 (62%) patients, polypropylene mesh of the unidentified manufacturer was previously implanted. Eight (13%) patients underwent PROLENE polypropylene mesh implantation, 4 (5%) patients - Ultrapro partially absorbable lightweight mesh composed of approximately equal parts of non-absorbable polypropylene fibers and absorbable poliglecaprone fibers, 4 (7%) patients - polyethylene terephthalate meshes of the unidentified manufacturer, 8 (13%) patients - PROCEED™ surgical mesh with absorbable anti-adhesive coating.</p><p><strong>Results: </strong>There were chronic inflammation foci at the site of recurrence in 1-5 years after implantation. Macrophages and mast cells were in active functional state. After 6-10 years, implant-induced fibrosis with areas of hyalinosis around the implant developed. There were fractures, cracks and other defects on threads of unidentified polypropylene implant and Prolene endoprosthesis. After 19 years, fragments of polyethylene terephthalate endoprosthesis were surrounded by giant cell granulations with tissue hyalinosis at the site of recurrence.</p><p><strong>Conclusion: </strong>Polypropylene and polyethylene terephthalate endoprostheses were subject to destruction over time (after 7 years in our study). Any implant causes persistent inflammation many years later. Desynchronization of inflammation and regeneration phases can lead to excessive connective tissue with its subsequent fibrous transformation and implant deformation in long-term period (up to 19 years).</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 4","pages":"39-45"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017750","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}