Khirurgiya最新文献

{"title":"[Intraoperative ultrasound for assessment of collateral liver arterial blood supply after acute blockade of hepatic blood flow].","authors":"V I Egorov, A S Sorokin, S N Perekhodov, M V Grigorievsky, P Zelter, T V Zhurenkova, Yu A Zhurina, M V Petukhova","doi":"10.17116/hirurgia202504112","DOIUrl":"https://doi.org/10.17116/hirurgia202504112","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the role of intraoperative ultrasound in assessment of collateral liver arterial blood supply after acute blockade of hepatic blood flow.</p><p><strong>Material and methods: </strong>Intraoperative analysis of hemodynamic changes in liver blood supply after temporary arterial blockade of hepatic blood flow was carried out in 135 patients who underwent total resection of pancreatic, liver, and gastric cancers. In addition to analysis of ischemic complications, we studied arterial architecture, pulsation of hepatoduodenal ligament, linear arterial blood flow velocity in liver parenchyma and hepatoduodenal ligament before and after hepatic blood flow blockade, as well as diameters of the main celiac-mesenteric arteries before surgery. These parameters were compared in groups of DP CAR and other interventions.</p><p><strong>Results: </strong>There were no ischemic liver events after DP CAR and hepatic blood flow blockade. After hepatic blood flow blockade in the overall group, hepatoduodenal ligament pulsation disappeared in 8% of cases, while linear arterial blood flow velocity decreased by more than 50%. Pulsatile blood flow was preserved in 77% of cases. Despite significant decrease in linear arterial blood flow velocity and even disappearance of hepatoduodenal ligament pulsation, arterial blood flow in liver parenchyma never ceased. None patient had arterial blood flow in liver parenchyma< 20 cm/s. When dividing the groups into DP CAR and non-DP CAR, we found no significant differences in age- and gender-adjusted distribution, Michels vascular architecture and linear arterial blood flow velocity decrease. Pulse disappearance significantly depended on diameter of gastroduodenal artery (GDA) and largely on the ratio of its diameter to the diameter of the common hepatic artery (CHA). IF CHA/GDA diameter ≈ 2, the probability of hepatoduodenal ligament pulse disappearance increased by more than 5 times.</p><p><strong>Conclusion: </strong>High adaptive capacity of collateral arterial blood supply to the liver is revealed after CHA or celiac artery blockade. Intraoperative ultrasound is a highly reliable method for analysis of blood supply. Linear blood flow velocity in parenchymal arteries ≥20 cm/s is sufficient to prevent ischemic liver damage.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 4","pages":"12-22"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038464","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":"[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":"[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":"[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":"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":"[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":"[Testing of friction node simulators for hip prostheses].","authors":"G P Kotelnikov, A N Nikolaenko, V V Ivanov, S O Doroganov, I M Mikailov, A P Borisov","doi":"10.17116/hirurgia202505172","DOIUrl":"https://doi.org/10.17116/hirurgia202505172","url":null,"abstract":"<p><strong>Objective: </strong>To estimate advisability of prototypes of ultra-high molecular weight polyethylene (UHMWPE) in hip arthroplasty.</p><p><strong>Material and methods: </strong>We used 34 UHMWPE specimens for tests and developed a test program consisting of incoming control of specimen geometrical parameters, tribotechnical tests, assessment of liner surface condition and deviation from roundness.</p><p><strong>Results: </strong>Input control of geometrical parameters of specimens showed their heterogeneity. UHMWPE specimens with negative value <i>(D</i>_c<i>-D</i>_h<i>)</i> failed tribotechnical tests. Specimens with value <i>(D</i>_c<i>-D</i>_h<i>)</i> within 0.6-0.8 mm demonstrated lower value of <i>T</i> moment compared to other specimens.</p><p><strong>Conclusion: </strong>About 75% of UHMWPE prototype liners are suitable for arthroplasty.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 5","pages":"72-78"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989103","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":"[Scientific legacy of Theodor Billroth (1829-1894) - a brilliant scientist, clinician and mentor to a galaxy of outstanding surgeons, who was ahead of his time... (by the 195th anniversary and the 130th anniversary of his death)].","authors":"T Sh Morgoshiya, N A Syroezhin","doi":"10.17116/hirurgia2025061133","DOIUrl":"https://doi.org/10.17116/hirurgia2025061133","url":null,"abstract":"<p><p>At the solemn meeting of the Russian Surgical Society named after N.I. Pirogov, held on April 29, 1929 in Moscow and dedicated to the 100th anniversary of the birth of the great surgeon-innovator and clinician Professor Christian Albert Theodore Bilroth (Fig. 1), Vladimir Andreyevich Oppel regretfully noted that none of those present in the room will live to see the day when mankind will honor the memory of Theodore Bilroth, the greatest surgeon of the XIX century, on the 100th anniversary of his death. Today, 130 years have already passed (the scientist died in 1894), and we have seen that great deeds and names do survive the ages.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 6","pages":"133-139"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200305","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":"[Single-stage resection of giant thoracic aortic aneurysm and pneumonectomy].","authors":"V A Porkhanov, S Y Boldyrev, V Yu Ivashchuk, S B Abidzakh, A M Kazaryan, A A Kalajyan, Ya V Rusakova, K O Barbukhatti","doi":"10.17116/hirurgia2025061117","DOIUrl":"https://doi.org/10.17116/hirurgia2025061117","url":null,"abstract":"<p><p>The authors present surgical treatment for giant thoracic aortic aneurysm complicated by aorto-bronchial fistula in a 65-year-old patient. Descending aortic replacement and left-sided pneumonectomy were carried out. Despite the high risks and complexity of intervention, the patient was discharged after 38 days and returned to normal life 3 months later.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 6","pages":"117-121"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200306","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 first thousand of VATS anatomical lung resections at the Herzen Moscow Oncology Research Institute].","authors":"A B Ryabov, O V Pikin, O A Aleksandrov, V A Bagrov, V V Barmin, D E Martynova, A R Dotdaev","doi":"10.17116/hirurgia20250617","DOIUrl":"https://doi.org/10.17116/hirurgia20250617","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the first thousand of anatomical resections at the Herzen Moscow Oncology Research Institute between 2009 and 2023.</p><p><strong>Material and methods: </strong>A retrospective study included 1078 patients who underwent thoracoscopic anatomical lung resection: lobectomy (TL - group 1) or segmentectomy (TS - group 2) between 2009 and 2023. Perioperative parameters including gender, age, side of surgery, resected lobe, histological data, surgery time, blood loss, tumor size, duration of pleural drainage were assessed. Postoperative complications were classified according to the TM&M system. Statistical analysis was performed using the Student's t, Mann-Whitney U and Pearson's χ2 tests.</p><p><strong>Results: </strong>There were 513 men (47.59%) and 565 women (52.41%). The median age was 61.3 and 59.7 years in both groups, respectively (<i>p</i>=0.672). Lung cancer patients predominated (70.6% and 43.5%, respectively). Stage I of disease was diagnosed in 70.36% of patients. Lymph nodes were affected in 160 patients (14.84%), including 100 (62.5%) ones with N1 and 60 (37.5%) ones with N2. TL was performed in 92% of N1 cases and 91.67% of N2 cases. The overall complication rate was 10.76% (<i>n</i>=116). Complications were less common after TS compared to TL (<i>p</i>=0.007). The conversion rate decreased from 35% in the first years to 1.8% over 10 years. In 2023, this parameter slightly increased to 6.3%.</p><p><strong>Conclusion: </strong>Successful development of thoracoscopic anatomical lung resection program is based on standardization of technique and interchangeability of surgical team. This shortens the learning curve, increases safety of surgeries and reduces conversion rate.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 6","pages":"7-18"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200308","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}