Khirurgiya最新文献

{"title":"[Autologous fat transplantation into post-lymphadenectomy cavity for prevention of lymphorrhea after total mastectomy].","authors":"S R Bashirov, V M Garkusha, M V Zykova, V D Udodov, I Yu Degtyarev, K A Sadykova, A A Strezhneva, M B Arzhanik","doi":"10.17116/hirurgia202507124","DOIUrl":"https://doi.org/10.17116/hirurgia202507124","url":null,"abstract":"<p><strong>Objective. to e: </strong>Valuate the effectiveness of autologous fat transplantation into post-lymphadenectomy cavity for prevention of lymphorrhea after total mastectomy with three-level lymphadenectomy in patients with breast cancer.</p><p><strong>Material and methods: </strong>A single-center retrospective-prospective non-randomized study was devoted to prevention of post-mastectomy lymphorrhea using autologous axillary lipofilling in patients with breast cancer who underwent total mastectomy with three-level lymphadenectomy. The main group consisted of 78 patients who underwent autologous fat transplantation into post-lymphadenectomy cavity, the control group - 69 patients who underwent total mastectomy with subsequent vacuum drainage. We analyzed lymphorrhea, integration of adipose tissue using ultrasound and lymph drainage using hybrid method of radionuclide scintigraphy.</p><p><strong>Results: </strong>Surgery time was similar in both groups. Postoperative hospital-stay was 5 [3; 6] and 7 [4; 14] days, respectively. Total volume of in-hospital lymph output through the drainage tube in the control group was 1330 [1020; 1750] ml. In the main group, the volume of lymph removed through puncture was 170 [115; 225] ml. The number of outpatient visits including lymphocele puncture was 14 [9; 23] and 15 [11; 23], respectively. After a year, density of integrated adipose tissue in shear wave elastography was less than 3.1 kPa. Radionuclide lymphoscintigraphy a year after lipofilling indicated functional normalization of lymphatic system with increased accumulation of 99mTc in regional lymph nodes, recovered kinetics of 99mTc from injection site and no accumulation of isotope in lymphocele. The last one persisted in the zone of autologous adipose tissue integration for the first 1.5-2 months.</p><p><strong>Conclusion: </strong>Autologous fat transplantation into post-lymphadenectomy cavity in patients with breast cancer after total mastectomy with three-level lymphadenectomy is a simple and safe procedure. This method does not prolong surgery, reduces in-hospital lymphorrhea and simplifies outpatient puncture due to autologous fat tissue integration and restoration of collateral lymphatic drainage pathways.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 7","pages":"24-35"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545119","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":"[Predictors of mortality in neonatal spontaneous gastric perforation: a multiple-center study].","authors":"M Yu Tishukov, I I Tishukova, V M Voropaev, A V Muraviev, T A Garapov, V V Ignat'ev","doi":"10.17116/hirurgia202509144","DOIUrl":"10.17116/hirurgia202509144","url":null,"abstract":"<p><strong>Objective: </strong>To analyze clinical data and predictors of mortality <b>in</b> neonatal spontaneous gastric perforation (SGP).</p><p><strong>Material and methods: </strong>A two-center retrospective cohort study included neonates diagnosed with SGP between 1999 and 2023. This cohort was divided into survivors and dead neonates to identify prognostic factors of mortality.</p><p><strong>Results: </strong>There were 11 neonates (male-to-female ratio 8:3). Mean gestational age was 33±3.2 weeks. Nine (82%) ones were preterm infants. The mortality rate was 54.5% (6/11), mean age - 7.7 days (range 2-20). The most common signs were abdominal distension and respiratory distress. All patients had pneumoperitoneum upon admission. Concomitant gastrointestinal anomalies were necrotizing enterocolitis (3 patients), gastroschisis (1 patient), and tracheoesophageal fistula (1 patient). Neonatal respiratory distress syndrome (RDS) is a prognostic factor of fatal outcome in patients with SGP. RDS in patients with SGP increases the probability of death by 39 times (OR 39.0; 95% CI 1.3 - 1191; <i>p</i>=0.04).</p><p><strong>Conclusion: </strong>RDS is a prognostic factor of mortality in neonates with SGP. Identification of modifiable prognostic factors of mortality in critical periods of life of neonates with SPG will facilitate effective strategies for prevention and treatment of this pathology.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 9","pages":"44-53"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024321","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":"[Staged treatment of complex pressure sores after spinal injuries].","authors":"A A Lebed, A A Bregadze, A V Zavaruev, T N Klepikova, O V Fomina, O N Kositsyna, Yu A Pomelova","doi":"10.17116/hirurgia2025091115","DOIUrl":"10.17116/hirurgia2025091115","url":null,"abstract":"<p><p>The authors present treatment of patients with spinal injury complicated by extensive multiple pressure sores. A comprehensive preoperative management was followed by staged surgical treatment. Advisability of deep bedsore closure with full-layer flaps and staged interventions was justified.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 9","pages":"115-122"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024354","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":"[Dissociation of posttraumatic arteriovenous fistula on the leg].","authors":"V I Steklov, M P Krasnikov, D Yu Gorin, N V Morozova","doi":"10.17116/hirurgia2025091128","DOIUrl":"10.17116/hirurgia2025091128","url":null,"abstract":"<p><p>Widespread fragmentation shells in combat operations with frequent multiple damage to organs and systems force to use all available diagnostic methods for treating severe injuries including lesion of great vessels of extremities. One of the consequences of these lesions is arteriovenous fistula (AVF). The last one may be asymptomatic at first. However, serious complications including circulatory disorders in extremities and severe heart failure can occur later. Thus, timely and correct surgical treatment can prevent these events. Open surgical treatment involves more careful mobilization of the artery and vein to prevent bleeding from dilated veins, as well as ensure arterial reconstruction. The authors present open surgical treatment of AVF in the right lower limb after previous mine explosion injury.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 9","pages":"128-133"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024406","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":"[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":"[Repeated breast reconstruction after previous complications].","authors":"V N Sipki, M Yu Vlasova, E A Zanozina, M V Moshurova, A D Zikiryakhodzhaev","doi":"10.17116/hirurgia202506151","DOIUrl":"https://doi.org/10.17116/hirurgia202506151","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness of repeated breast reconstruction in cancer patients depending on complications after primary reconstruction.</p><p><strong>Material and methods: </strong>There were 117 patients who underwent primary one-stage breast reconstruction with endoprosthesis, autograft and/or their combination.</p><p><strong>Results: </strong>A retrospective analysis included 117 patients who underwent complex treatment in 2017-2021. Surgical treatment (subcutaneous/skin-sparing mastectomy with one-stage reconstruction) was realized at the department of oncology and reconstructive surgery of the breast and skin. Analysis included patients after one-stage reconstruction with silicone endoprosthesis (<i>n</i>=96, 82%), different flaps (<i>n</i>=3, 2.5%), combination of auto- and allogenic materials (<i>n</i>=18, 15.3%). The most common complications were Backer grade III/IV capsular contracture, implant rupture, endoprosthesis protrusion and flap necrosis. The most preferable redo surgery was implant-to-implant replacement (<i>n</i>=58). Of these, there were 40 (68.9%) redo surgeries for Backer grade III/IV capsular contracture, implant protrusion (<i>n</i>=7, 12%) and rupture (<i>n</i>=5, 8.6%). Flap necrosis required flap replacement with implant, flap reduction and implant placement under the flap.</p><p><strong>Conclusion: </strong>Each technique has certain advantages and disadvantages, and the choice of method depends on individual characteristics of each patient.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 6","pages":"51-57"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200303","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":"[Efficacy and safety of pancreatic stenting in acute biliary pancreatitis].","authors":"A I Khripun, A N Alimov, S Yu Orlov, T P Chelyapina, M V Monakhov, A M Olenichev, E E Kudryavitskii","doi":"10.17116/hirurgia202508123","DOIUrl":"https://doi.org/10.17116/hirurgia202508123","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy and safety of early pancreatic stenting in patients with acute biliary pancreatitis.</p><p><strong>Material and methods: </strong>We retrospectively analyzed the effect of early (within 48 hours after admission) pancreatic stenting on severity of disease, incidence of complications, mortality and hospital-stay in patients with severe acute biliary pancreatitis. Moreover, there were patients with acute biliary pancreatitis who underwent delayed endoscopic retrograde intervention and only conservative therapy.</p><p><strong>Results: </strong>Early pancreatic stenting reduced the risk of local (<i>p</i>=0.047) and systemic complications (<i>p</i>=0.027) compared to delayed intervention and conservative treatment. Early pancreatic stenting contributed to shorter hospital-stay when compared with delayed intervention (<i>p</i>=0.038). There was no between-group difference in mortality or severity of disease. Pancreatic stenting after 48 hours had no advantages over early stenting or conservative treatment, but significantly increased the risk of infected pancreatic necrosis (<i>p</i>=0.023).</p><p><strong>Conclusion: </strong>Early pancreatic stenting seems to be safe and effective procedure in reducing the number of complications in patients with acute biliary pancreatitis. Neither early nor late pancreatic stenting has a significant effect on disease severity, mortality and hospital-stay.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 8","pages":"23-29"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817703","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}