Khirurgiya最新文献

{"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":"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":"[Vacuum-assisted laparostomy for diffuse postoperative peritonitis in patients with abdominal cancers].","authors":"I B Uvarov, A M Manuilov, D D Sichinava","doi":"10.17116/hirurgia202504153","DOIUrl":"https://doi.org/10.17116/hirurgia202504153","url":null,"abstract":"<p><strong>Objective: </strong>To improve the outcomes in patients with abdominal cancers complicated by diffuse postoperative peritonitis (DPP) using vacuum-assisted laparostomy (VAL) with elective staged peritoneal lavage.</p><p><strong>Material and methods: </strong>There were 141 patients with DPP: group I (63 patients) - VAL, group II (78 patients) - redo laparotomy on demand (RD). Negative pressure therapy was performed using commercial vacuum systems with vacuum dressing changes after 48 - 72 hours. We assessed mortality, morbidity, abdominal cavity status (Björck classification) and incidence of primary fascial closure of abdominal cavity.</p><p><strong>Results: </strong>There were 10 (15.9%) and 24 (30.8%) deaths, respectively (<i>p</i>=0.040). Complications Clavien-Dindo grade 3-5 were significantly more common in the 2^nd group. According to the Björck classification, grades 2A (39.7%) and 2B (41.3%) became more common after the 2^nd peritoneal lavage in the 1^st group. After the 3^rd and further staged peritoneal lavages, «frozen open abdomen» (grade 3A and 4) prevailed. This classification revealed significant correlations with abdominal index, intra-abdominal hypertension and C-reactive protein. Primary fascial closure of abdominal cavity was performed in 40 (63.5%) patients in the 1^st group.</p><p><strong>Conclusion: </strong>Vacuum-assisted laparostomy is effective for diffuse postoperative peritonitis compared to on-demand relaparotomy. This approach provides lower mortality and morbidity rates, as well as better control over local inflammatory process and intra-abdominal pressure.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 4","pages":"53-60"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049865","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":"[Bilioduodenal stenting with fully covered self-expandable stent with anti-migration flaps in patients with benign obstructive jaundice].","authors":"Yu D Kulikov, Yu S Teterin, K R Brysyakina, B G Bembeev, P A Yartsev, S V Novikov","doi":"10.17116/hirurgia202505123","DOIUrl":"https://doi.org/10.17116/hirurgia202505123","url":null,"abstract":"<p><strong>Objective: </strong>To improve treatment outcomes in patients with mechanical jaundice by using fully covered self-expandable stents with anti-migration mechanism.</p><p><strong>Material and methods: </strong>The study included 100 patients who underwent endoscopic retrograde biliary duodenal stenting with fully covered self-expandable stent. All patients were divided into 2 groups: group 1 - fully covered self-expandable stent with anti-migration flap, group 2 - fully covered self-expandable stent.</p><p><strong>Results: </strong>Technical success was achieved in all patients of both groups. In group 1, fully covered self-expandable stent with anti-migration flap significantly reduced the incidence of stent dislocation (<i>p</i><0.05). There were no significant differences in the incidence of complications such as acute pancreatitis, purulent cholangitis, acute cholecystitis and sludge. There were no significant between-group differences in stent function (χ²=2.35; <i>p</i>=0.1250).</p><p><strong>Conclusion: </strong>Fully covered self-expandable stent with anti-migration flap reduces the incidence of stent dislocation without increase in the incidence of other complications and effect on duration of functioning.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 5","pages":"23-28"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050753","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":"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":"[Features of comprehensive treatment in a patient with complicated type 2 diabetes mellitus: A clinical case].","authors":"M V Varganov, A A Miklichev","doi":"10.17116/hirurgia2025061128","DOIUrl":"https://doi.org/10.17116/hirurgia2025061128","url":null,"abstract":"<p><p>The purpose of presenting a clinical observation is to illustrate the possibility of increasing the effectiveness of complex therapy for a patient with type 2 diabetes mellitus due to both a general effect (improving metabolic processes due to the infusion of a 1.5% solution of meglumine sodium succinate) and a local effect - the use of an individual unloading dressing in the postoperative period. The treatment options used contributed to improving the patient's quality of life and increased his or her adherence to treatment.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 6","pages":"128-132"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200289","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 spleen-preserving distal pancreatectomy in a patient with serous cystadenoma using a laparoscopic vascular suture].","authors":"E V Mogilevets, A K Bekish, O I Sluchich","doi":"10.17116/hirurgia2025061112","DOIUrl":"https://doi.org/10.17116/hirurgia2025061112","url":null,"abstract":"<p><p>Kimura technique is a common variant of spleen-preserving distal pancreatectomy and preferable for patients with benign pancreatic lesions. We performed spleen-preserving distal pancreatectomy with preservation of splenic vessels in a patient with serous pancreatic cystadenoma. Preoperative imaging revealed fusion of neoplasm with splenic artery and vein within a short segment. This prepared surgeons for potential laparoscopic vascular suture.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 6","pages":"112-116"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200290","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 a patient with patellar instability and lateral osteoarthritis of the knee joint under valgus limb deformity and low patellar position].","authors":"A P Prizov, M M Awad, F L Lazko, N V Zagorodniy, E A Belyak, M F Lazko, A J Al-Mamoori","doi":"10.17116/hirurgia202501174","DOIUrl":"10.17116/hirurgia202501174","url":null,"abstract":"<p><p>Patients with patellar instability have one or more anatomical predispositions that are important in pathogenesis of this disease. We present treatment of a patient with valgus deformity of the lower limb and low patellar position with chronic instability. The patient underwent medial closing-wedge distal femoral osteotomy and transposition of tibial tuberosity.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"74-79"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123681","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":"[Percutaneous retroperitoneal necrectomy for infected forms of acute necrotizing pancreatitis].","authors":"V N Ektov, A V Fedorov, M A Khodorkovsky, A V Kurkin","doi":"10.17116/hirurgia2025031149","DOIUrl":"10.17116/hirurgia2025031149","url":null,"abstract":"<p><p>The review is devoted to percutaneous retroperitoneal necrectomy in the treatment of infected forms of acute pancreatitis. The indications for retroperitoneal necrectomy are given, and technical features are described for open retroperitoneal necrectomy, percutaneous endoscopic retroperitoneal necrectomy, video-assisted retroperitoneal debridement and transfistular endoscopic retroperitoneal necrectomy. Available data on results of percutaneous retroperitoneal necrectomy indicate expediency of wider application of this treatment option for infected forms of acute necrotizing pancreatitis in large multidisciplinary centers.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"149-155"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658837","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":"[Effectiveness of ischemic limb revascularization through superficial or deep femoral artery in patients with critical ischemia undergoing hybrid interventions].","authors":"B S Sukovatykh, P M Nazarenko, N V Bolomatov, M B Sukovatykh, M Yu Gordov, A Yu Grigoryan, A V Alekseev","doi":"10.17116/hirurgia202503148","DOIUrl":"10.17116/hirurgia202503148","url":null,"abstract":"<p><strong>Objective: </strong>To compare the results of ischemic limb revascularization through superficial and deep femoral arteries in hybrid treatment of critical limb ischemia.</p><p><strong>Material and methods: </strong>Treatment outcomes were analyzed in 60 patients with lesions of infrainguinal arteries TASC grade IIC and IID who underwent hybrid treatment (balloon angioplasty with iliac stenting and open femoral artery reconstruction). Two equal groups of patients were identified depending on postoperative blood flow: group 1 - blood flow through superficial femoral artery, group 2 - blood flow through deep femoral artery. Treatment outcomes were assessed regarding postoperative morbidity and clinical status after 6 and 12 months (Rutherford scale).</p><p><strong>Results: </strong>Postoperative complications occurred in 6 (10%) patients equally in both groups. In one case (pulsatile hematoma), they were associated with endovascular procedure, in 5 cases (bleeding, lymphorrhea and wound infection) - with surgical intervention. After 6 months, circulation improved in both groups (more significant in the first group). After 12 months, 16.7% of patients in group 1 experienced negative dynamics due to repeated occlusion of superficial femoral artery. Deep femoral artery remained patent in group 2.</p><p><strong>Conclusion: </strong>Recovery of circulation through deep femoral artery is more effective than superficial femoral artery.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"48-54"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658922","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}