Khirurgiya最新文献

{"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}

{"title":"[Choosing the optimal surgical method for duodenal ulcer complicated by bleeding].","authors":"S R Genrikh, V M Durleshter, A G Kalachev, K M Bedanokov","doi":"10.17116/hirurgia2025021111","DOIUrl":"10.17116/hirurgia2025021111","url":null,"abstract":"<p><p>The treatment tactics for gastrointestinal bleeding (GIB), recommended by surgical societies, involve a certain sequence of actions taking into account the capabilities of the clinical institution. A mandatory requirement for all levels of care is the stabilization of post-hemorrhagic disorders and stopping bleeding by any available means. A mandatory requirement for all levels of care is the stabilization of post-hemorrhagic disorders and stopping bleeding by any available means. A clinical case of treatment of a patient with duodenal ulcer complicated by recurrent bleeding is presented. Taking into account morbid obesity, the indications for the endoscopic method of stopping recurrent bleeding against the background of adequate replacement therapy have been expanded. An analysis of the selected treatment tactics for complicated peptic ulcer was carried out.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"111-118"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366106","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 ALPPS procedure: a series of cases].","authors":"V K Lyadov, A N Moskalenko, M M Magomedov, V N Galkin","doi":"10.17116/hirurgia202502120","DOIUrl":"10.17116/hirurgia202502120","url":null,"abstract":"<p><p>The combination of liver resection and chemotherapy is the most effective way to treat primary and secondary malignant liver tumors. One of the methods for increasing resectability is the use of two-stage liver resection (associated liver partition and portal vein ligation for staged hepatectomy - ALPPS).</p><p><strong>Objective: </strong>To demonstrate the feasibility of laparoscopic ALPPS with good short-term and long-term results.</p><p><strong>Material and methods: </strong>From 2020 to 2021, in the oncology department No. 4 of the State Budgetary Healthcare Institution \"GKOB 1 DZM\" 6 laparoscopic ALPPS were performed for metastases of colorectal cancer in the liver in 4 patients and cholangiocellular cancer in two in the presence of an insufficient volume of remaining liver parenchyma (13-32.1%).</p><p><strong>Results: </strong>All patients underwent the first stage of ALPPS laparoscopically without conversions or intraoperative complications. The duration of the operation ranged from 300 to 470 minutes (average 347.5±74 minutes), blood loss - from 100 to 300 ml (average 175±88 ml). The duration of the second stage is from 165 to 470 minutes (average 281.5±132.9 minutes) with blood loss from 100 to 850 ml (average 484.5±392.3 ml). The increase in the volume of residual liver parenchyma was 36-68%. The period between the ALPPS stages ranged from 13 to 22 days. Final resection to the extent of R0 was performed in 4 of 6 patients. The second stage of ALPPS was complicated in two patients by the formation of an external biliary fistula and in another two by right-sided hydrothorax.</p><p><p>The median follow-up was 25 months, during which time 3 patients died: two patients with incomplete second stage ALPPS due to cancer progression and one patient from coronavirus infection.</p><p><strong>Conclusion: </strong>ALPPS can be performed entirely laparoscopically with good short-term and long-term results, but should be performed in high-volume liver surgery centers by an experienced surgical team.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"20-26"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366131","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":"[Hemorrhage after pancreaticoduodenectomy].","authors":"V A Solodky, A G Kriger, D S Gorin, A A Goev, A B Varava, V I Panteleev","doi":"10.17116/hirurgia202501114","DOIUrl":"https://doi.org/10.17116/hirurgia202501114","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the incidence, clinical manifestations and treatment of post-pancreaticoduodenectomy hemorrhage in patients with pancreaticoduodenal tumors.</p><p><strong>Material and methods: </strong>There were 362 pancreaticoduodeneectomies for ductal adenocarcinoma of the pancreatic head and pancreatoduodenal tumors in 2016-2023. Post-pancreatectomy hemorrhage (PPH) occurred in 52 (14.4%) patients. Delayed post-pancreatectomy hemorrhage followed postoperative pancreatitis, pancreatic fistula or non-drained fluid collections. Bleeding was diagnosed considering clinical manifestations with verification through contrast-enhanced CT.</p><p><strong>Results: </strong>Emergency re-laparotomy was required in 15 (28.8%) patients with unstable hemodynamics; 9 (60%) people died. Thirty-seven patients with stable hemodynamics underwent emergency contrast-enhanced CT and subsequent endovascular hemostasis. Bleeding was stopped in 31 patients (89.2%). Endovascular hemostasis was ineffective in 1 patient who underwent re-laparotomy. We found no the cause of bleeding in 3 patients, and there was no hemorrhage recurrence. Six (18.7%) people died. The overall mortality among patients with PPH was 28.8% (15 out of 52 postoperative patients).</p><p><strong>Conclusion: </strong>PPH follows postoperative pancreatitis, pancreatic fistula or non-drained fluid collection. In case of stable hemodynamics, endovascular hemostasis is preferable for this complication.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"14-21"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123132","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":"[The role of early predictors in diagnosis of stapler suture and anastomotic failure in bariatric patients].","authors":"A G Khitaryan, A V Mezhunts, O V Voronova, M Yu Shtilman, A A Orekhov, D A Melnikov, O S Pen, D Yu Pukovsky","doi":"10.17116/hirurgia202503176","DOIUrl":"https://doi.org/10.17116/hirurgia202503176","url":null,"abstract":"<p><strong>Objective: </strong>To study the role of early predictors in diagnosis of stapler suture and anastomotic failure in bariatric patients and to determine the indications for redo laparoscopy.</p><p><strong>Material and methods: </strong>A single-center retrospective study enrolled 2011 patients who underwent surgery. All patients were categorized into two groups: group 1 (1983 patients) - standard postoperative period; group 2 (28 patients) - major inflammatory complications with redo laparoscopy.</p><p><strong>Results: </strong>We found no significant differences in BMI, weight and age between patients with and without complications. Conversely, high serum glucose, duration of type 2 DM over 5 years, tachycardia > 100 bpm and high VAS score of abdominal pain significantly increased the risk of complications. Contrast-enhanced CT of the abdomen has the greatest informative value. To ascertain critical value of each factor for between-group differentiation, we performed ROC analysis and demonstrated specificity of these indicators.</p><p><strong>Conclusion: </strong>The challenge of early diagnosis of intra-abdominal inflammatory complications in bariatric patients is compounded by no typical symptoms and small informative value of laboratory and instrumental diagnostic methods. According to ROC analysis, combination of fever, hypotension, tachycardia and tachypnoea resulted AUC 0.80. Sensitivity 65% and specificity 82% indicated the need for immediate repeated surgery. However, availability of standardized surgical technique and clear algorithms for the entire team are essential for timely diagnosis and management of all potential complications in patients with serious postoperative bariatric complications.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"76-86"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658953","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":"[Ultrasound-guided core-needle biopsy for diagnosis of thyroid cancer].","authors":"D D Dolidze, S D Kovantsev, Z A Bagatelia, A V Bumbu, Yu V Barinov, G M Chechenin, N V Pichugina, D G Gogolashvili","doi":"10.17116/hirurgia202503187","DOIUrl":"https://doi.org/10.17116/hirurgia202503187","url":null,"abstract":"<p><strong>Objective: </strong>To improve preoperative examination of patients with follicular thyroid tumors using ultrasound-guided core-needle biopsy.</p><p><strong>Material and methods: </strong>All patients with Bethesda IV (follicular tumor) underwent ultrasound-guided core-needle biopsy of thyroid neoplasm according to original technique (patent No. 2826474 RU). Preoperative histological specimen after core needle biopsy was compared with urgent and elective histological examination. Statistical analysis was carried out using Kolmogorov-Smirnov and Kruskal-Wallis tests. Differences were significant at <i>p</i><0.05.</p><p><strong>Results: </strong>Thyroid tumors were available for core needle biopsy in all 45 cases (100%). Repeated cytological analysis confirmed TI-RADS category 3 in 22 (48.89%), TI-RADS 4 in 15 (33.33%) and TI-RADS 5 in 8 (17.77%) patients. Histological examination revealed colloidal goiter in 13 patients (28.89%), adenomatous hyperplasia in 15 (33.33%), follicular adenoma in 9 (20%), and follicular neoplasia with undetermined malignant potential in 2 (4.44%) cases. The quality of histological material made it possible to assess morphological type of tumor, capsule vascularization and cell atypia, invasion into capsule or vessels. In case of colloidal goiter, we were able to assess dimensions of follicles, presence of colloid, cell polymorphism, mitosis and cytoplasm content.</p><p><strong>Conclusion: </strong>Ultrasound-guided core-needle biopsy can reduce the number of unjustified surgical interventions in patients with follicular tumors and optimize management of patients with nodular thyroid lesions.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"87-95"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Endovascular treatment and selection criteria for acute mesenteric ischemia].","authors":"A B Mironkov, A D Pryamikov, S A Rautbart, A I Khripun","doi":"10.17116/hirurgia202502113","DOIUrl":"10.17116/hirurgia202502113","url":null,"abstract":"<p><strong>Objective: </strong>To demonstrate the results of endovascular intervention in patients with acute arterial mesenteric ischemia, while observing the indications developed in the clinic.</p><p><strong>Material and methods: </strong>In total, endovascular approach in the treatment of acute mesenteric ischemia were used in 49 patients in the clinic. In compliance with the developed indications and criteria, endovascular intestinal revascularization was performed in 27 patients. Various endovascular intervention techniques were used (aspiration, balloon dilation, artery stenting and their combinations). Extracorporeal filtration techniques were used as a treatment for reperfusion syndrome after intestinal revascularization in 10 patients.</p><p><strong>Results: </strong>Angiographic success in the form of complete restoration of the main blood flow in the basin of the superior mesenteric artery and its large branches was obtained in 85% of cases. Intestinal viability was preserved in 15 (56%) patients. After successful endovascular surgery, intestinal necrosis was diagnosed on laparoscopy in the remaining 12 (44%) patients, which required extensive (<i>n</i>=2) or non-extensive (<i>n</i>=10) resection. Postoperative mortality was 48% (13 patients).</p><p><strong>Conclusion: </strong>Endovascular surgery in acute mesenteric ischemia is an effective method of intestinal revascularization. To optimize the indications for these interventions, it is necessary to gain experience and conduct large-scale studies.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"13-19"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366128","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":"[Phage therapy analysis of effectiveness in comorbid patients with wounds and surgical infections of various etiology based on the results of a comparative clinical study].","authors":"Yu S Paskhalova, V A Mitish, G V Khamidulin, I A Chekmareva, R P Terekhova, V S Demidova, O V Paklina","doi":"10.17116/hirurgia2025031124","DOIUrl":"https://doi.org/10.17116/hirurgia2025031124","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The continued importance of addressing the issue of treating purulent wounds and surgical infections of different origins and localization against the background of increased resistance of their main pathogens dictates the need to develop alternative protocols and search for new treatment strategies, the effectiveness of which is confirmed by objective diagnostic methods.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of the study was to analyze the effectiveness of phage therapy in comparison with traditional methods of local drug and systemic treatment in comorbid patients with surgical infection of various etiologies and localization by studying the microbiological spectrum, cytology of wound impressions and morphological, including electron microscopic examination of tissue biopsies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Material and methods: &lt;/strong&gt;The results of the research are presented: a post-marketing, prospective, randomized, comparative clinical trial enrolling 70 adult patients with complicated skin, soft tissue, and bone infections of various etiologies and localizations, conducted at the Department of Wounds and Wound Infections, National Medical Research Center for Surgery named after A. Vishnevsky, Ministry of Health of the Russian Federation. During the study, clinical (edema, pain, the nature of wound discharge, the appearance of granulation tissue), laboratory (the presence and regression of signs of a systemic response to the presence of a surgical infection), microbiological (qualitative and quantitative), cytological and electron microscopic parameters were analyzed in all patients. Parametric data were evaluated based on the mean and standard deviation (SD) at 4 study points: point 1 (2±1 days), point 2 (4±1 days), point 3 (6±1 days) and point 4 (8±1 days). The key endpoint was the transition of the wound process into the regeneration phase.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;According to the study protocol, all the patients included in the analysis had purulent-necrotic wounds of soft tissues and bones different etiology and localization, requiring surgical debridement. To randomize patients into groups, upon admission or intraoperatively, material was collected for qualitative and quantitative microbiological, cytological, morphological and electron microscopic studies. Randomization into groups of bacteriophages was possible in the presence of sensitivity of isolated cultures to the \"Piobacteriophage complex\" liquid (Piofag, JSC NPO Microgen, Russia). In the postoperative period, patients of group 1 (&lt;i&gt;n&lt;/i&gt;=20) received systemic and local phage therapy (20 ml 3 times a day, according to the instructions), in group 2 (&lt;i&gt;n&lt;/i&gt;=20) - systemic and local phage therapy, combined with local negative pressure (-120 mmHg, constant mode), delivery of bacteriophages to the surgical infection site was carried out using VitMobil instillation (VitMedical, Russia), systemic (levofloxacin 500 mg twice a day) and local (multicompo","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"124-138"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658843","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":"[Risk factors for bronchopleural complications after pneumonectomy].","authors":"D B Giller, B M Giller, B D Giller, S V Smerdin, A E Ergeshov, S S Saenko, G V Shcherbakova, M A Kulaeva, I I Martel","doi":"10.17116/hirurgia20250317","DOIUrl":"10.17116/hirurgia20250317","url":null,"abstract":"<p><strong>Objective: </strong>To assess various risk factors for bronchopleural complications, as well as effectiveness of some techniques for bronchial stump closure and covering.</p><p><strong>Material and methods: </strong>We studied the results of 2022 pneumonectomies between 1958 and 2023. Different techniques for bronchial stump closure and covering were used. We studied the influence of the following factors on the incidence of bronchial fistula: pulmonary disease; pulmonary lesion complicated by bleeding, empyema; acute progression of tuberculosis as caseous pneumonia; Mycobacterium tuberculosis with multiple and extensive drug resistance; tuberculosis of the main bronchus; preoperative destructive tuberculosis-related lesion of contralateral lung; pulmonary gangrene; partial resection of cancer; extended bilateral lymph node dissection, etc.</p><p><strong>Results: </strong>The incidence of bronchopleural complications and mortality significantly decreased over time. Nevertheless, these events remained the main cause of death after pneumonectomy until the last decade. Most often, death following bronchopleural complications was noted in patients with bronchial fistula within 21 days. Among 111 patients with this complication, 48 (43.24%) ones died.</p><p><strong>Conclusion: </strong>According to our data, bronchial suturing technique and side of surgery are the most significant factors regarding the incidence of bronchial fistula. The highest risk is associated with surgery for pulmonary gangrene, the lowest risk - with total resection of cancer. The incidence of delayed bronchial fistula in tuberculosis exceeds the incidence of early bronchial fistula.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"7-15"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658925","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 patellar instability following valgus deformity of the lower extremity and high-riding patella (a series of clinical cases)].","authors":"A P Prizov, M M Awad, N V Zagorodniy, E A Belyak, G A Airapetov","doi":"10.17116/hirurgia202502160","DOIUrl":"10.17116/hirurgia202502160","url":null,"abstract":"<p><p>The article discusses a series of clinical cases involving 8 patients with lateral knee osteoarthritis, valgus deformity, and patellofemoral instability, who underwent simultaneous medial closing-wedge distal femoral osteotomy (MCDFO) + transposition of the tibial tubercle (TTT). In another case, isolated TTT was performed on one patient.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"60-66"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366167","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}