Khirurgiya最新文献

{"title":"[Surgical treatment of a patient with pancreatic trauma AAST grade IV].","authors":"S V Zuev, A Yu Tsibin, N A Gorte, R V Bondarenko, N Yu Tsibina","doi":"10.17116/hirurgia2025031164","DOIUrl":"10.17116/hirurgia2025031164","url":null,"abstract":"<p><p>Isolated pancreatic injuries following blunt abdominal trauma are extremely rare and often occur with various complications. Diagnosis is limited by hospital's capabilities and severe clinical status of patients. We present a patient with pancreatic trauma AAST grade IV. Damage to the pancreas was detected intraoperatively. Preoperative examination revealed no specific signs of injury. Hemostasis and irrigation, as well as drainage of abdominal cavity and pancreatic rupture site was performed. Postoperative period was uneventful. Detection of pancreatic trauma, grade of damage and involvement of nearby organs is possible only after laparotomy. Minimally traumatic measures for pancreatic trauma, prevention of postoperative pancreatitis and delayed reconstructive interventions are essential for favorable outcomes.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"164-168"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658949","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":"[Surgical treatment of children with celiac axis compression syndrome].","authors":"R A Zainulabidov, A Yu Razumovsky, Z B Mitupov, G Yu Chumakova, V A Teplov, E A Titova, L S Zolotareva","doi":"10.17116/hirurgia202506158","DOIUrl":"https://doi.org/10.17116/hirurgia202506158","url":null,"abstract":"<p><strong>Objective: </strong>To establish the indications for surgical treatment of celiac axis compression syndrome (CACS) in childhood, efficacy of laparoscopic decompression in these patients, possible complications and risks of surgical treatment.</p><p><strong>Material and methods: </strong>A total of 148 patients aged 4-17 years underwent surgical treatment for CACS between 2015 and 2023. Of these, 92 patients were followed-up in long-term postoperative period. The leading clinical manifestation was abdominal pain. The diagnosis was based on anamnesis, physical examination, Doppler ultrasound of celiac axis with blood flow velocity measurement, endoscopic ultrasonography and angiography. After examination, all patients underwent celiac axis decompression. According to intraoperative data, the main cause of celiac axis compression was the median arcuate ligament combined with neurofibrous tissue of celiac plexus.</p><p><strong>Results: </strong>Mean surgery time was 55 min. Intraoperative blood loss did not exceed 5-30 ml. There were 2 conversions. Patients were discharged. Postoperative examination was performed in 3-36 months after full recovery.</p><p><strong>Conclusion: </strong>The authors identified the indications for surgical treatment of CACS, estimated clinical status of patients in pre- and postoperative period, proposed the diagnostic and treatment algorithm, as well as described the benefits of laparoscopic celiac axis decompression in children. Our experience demonstrates the possibility of early diagnosis of CACS and successful laparoscopic treatment.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 6","pages":"58-68"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200307","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 endothelium and certain parameters of hemostasis for thrombotic complications in endovascular surgery of coronary arteries].","authors":"T S Broyan, R E Kalinin, I A Suchkov, N D Mzhavanadze","doi":"10.17116/hirurgia202506189","DOIUrl":"https://doi.org/10.17116/hirurgia202506189","url":null,"abstract":"<p><p>Cardiovascular diseases are still the main cause of death despite various measures in all countries around the world. Coronary artery disease is the most common cardiovascular disease following atheromatous lesions of coronary arteries. Coronary artery disease describes a range of clinical disorders from asymptomatic atherosclerosis and stable angina to acute coronary syndrome. One of the most effective methods of surgical treatment for coronary artery disease is percutaneous coronary intervention (PCI). The number of PCIs has actively increased in recent years. Thrombotic events in various vascular basins are serious complications of PCI. This article describes the role of endothelium, platelet activation, and hemostatic parameters in occurrence of thrombotic complications after PCI.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 6","pages":"89-97"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200309","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 bandage in the treatment of pleural empyema after pneumonectomy].","authors":"V A Porkhanov, I S Polyakov, A L Kovalenko, A A Sirota, A V Akobyan, E A Bondarenko","doi":"10.17116/hirurgia202506119","DOIUrl":"https://doi.org/10.17116/hirurgia202506119","url":null,"abstract":"<p><strong>Objective: </strong>To improve the treatment of patients with postoperative pleural empyema without fistula of the main bronchus through staged debridement of postpneumonectomy pleural cavity using vacuum-assisted dressing for relief of symptoms in acute period of empyema and earlier reconstructive treatment.</p><p><strong>Material and methods: </strong>About 60 pneumonectomies for cancer and 15 pneumonectomies for purulent-necrotic lung diseases are performed annually in the thoracic surgical center. Over 350 pneumonectomies were performed between 2018 and 2023. Of these, there were 70 interventions for purulent-inflammatory lung diseases (including pulmonary gangrene). The incidence of complications within postoperative thoracotomy is 1.2%, pleural cavity (pleural empyema and early fragmentation of pleural cavity) - 0.9%. A combination of postoperative thoracotomy suppuration with pleural empyema is an even rarer complication (0.8%). We compared 2 groups of patients who were treated at different periods for postpneumonectomy pleural empyema without fistula of the main bronchus. The 1^st group included 11 patients (6 men and 5 women) who received treatment between 2006 and 2011 (thoracostomy using ointment dressings and multiple daily dressings (sometimes up to 4 times a day) under antibacterial therapy). Such approach required daily multiple dressings at the exudation stage. Wound healing and granulation required much time that caused discomfort to the patient and reduced quality of life. In 10 out of 11 patients in this group, the complication developed after surgery for lung gangrene. After surgery, one patient died from multiple organ failure following pneumonia of a single lung and severe sepsis. Mean length of hospital-stay was 40±3 days. The 2^nd group (2011-2023) included 9 patients (5 men and 4 women). Vacuum-assisted dressings were used. In 8 patients, this complication developed after surgery for lung gangrene. There were no fatal outcomes. Mean length of hospital-stay was 16±2 days.</p><p><strong>Results: </strong>Vacuum-assisted dressing reduced the risk of fatal erosive bleeding and the number of dressings, as well as provided certain comfort and mobility of the patient. The need for bone resections for chronic osteomyelitis was 0.1% vs. 40% in case of ointment dressings. In addition, two clinical cases of vacuum dressings combined with cell therapy for prevention of complications after pneumonectomy for pulmonary gangrene were considered. Good clinical results were obtained.</p><p><strong>Conclusion: </strong>Vacuum-assisted dressing for postpneumonectomy pleural empyema without fistula of the main bronchus reduces duration of wound healing phases and hospital-stay. Prophylactic vacuum-assisted dressings after pneumonectomy for purulent-inflammatory lung diseases excluded empyema of postpneumonectomy cavity and improved tissue healing.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 6","pages":"19-25"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200312","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":"[Validation of the Russian version of the Carolinas Comfort Scale in patients after previous abdominal hernia repair with mesh].","authors":"A V Andriyashkin, S M Titkova, M V Anurov, G B Ivakhov, N S Glagolev, V V Suglob, A A Kalinina, D Kuzmauskas, V A Mamadumarov, O A Smirnova, K M Loban, A S Nikishkov, M D Indrukh, A V Sazhin","doi":"10.17116/hirurgia202504130","DOIUrl":"https://doi.org/10.17116/hirurgia202504130","url":null,"abstract":"<p><strong>Objective: </strong>To validate the Russian version of the Carolinas Comfort Scale CCS.</p><p><strong>Material and methods: </strong>Translation of the original CCS questionnaire into Russian was carried out in accordance with the WHO recommendations. The Russian-language version of this questionnaire was present to 253 patients who underwent hernia repair with mesh for various abdominal wall hernias upon discharge and 4 weeks later.</p><p><strong>Results: </strong>The study included 222 patients who completed all stages of survey. The response rate was 87.7%, mean age - 58.6±13.3 years, Cronbach's α - 0.957 (high internal consistency). In test-retest analysis, correlation coefficients between two time points ranged from 0.204 to 0.669 and were significant for all CCS questions in overall patient population. When assessing convergent validity, we found significant negative correlation from -0.160 to -0.363 (<i>p</i><0.001) between total CCS score and domains of the Russian version of the SF-36 except for the domains of role functioning and role emotional functioning. Discriminant analysis showed that CCS scores for all items in 11 out of 222 participants (4.95%) who were dissatisfied with treatment outcomes were significantly higher compared to satisfied patients (<i>p</i><0.0001).</p><p><strong>Conclusion: </strong>The presented Russian version of the Carolina Comfort Scale is a valid tool for assessing various physical aspects of the quality of life after hernia repair with mesh. This scale may be recommended for clinical practice and researches.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 4","pages":"30"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051797","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":"[Textbook outcome for liver resection. Survey of respondents in national centers].","authors":"M G Efanov, M A Sudakov, V V Tsvirkun, I E Khatkov","doi":"10.17116/hirurgia20250415","DOIUrl":"https://doi.org/10.17116/hirurgia20250415","url":null,"abstract":"<p><strong>Objective: </strong>To develop a domestic model of the textbook outcome (TO) for liver resection and to compare it with the European model.</p><p><strong>Material and methods: </strong>We surveyed 73 respondents from Russian centers. A list of parameters was sent to respondents by email. The voting result was positive when 70% consolidation of opinions was achieved.</p><p><strong>Results: </strong>Considering Russian and European surveys, we formed TO models including 8 criteria for laparoscopic resection and 7 criteria for open resection. In Russian survey, 70% agreement was reached on 6 criteria for both types of resection. Two additional criteria were included In Russian TO as the most consolidated although they did not reach 70% threshold. Differences between European and Russian models include no redo intervention after resection (endoscopic or percutaneous), acceptability of grade A bile leakage (ISGLS), and no liver failure criterion in European TO. Other positions were the same. The most questionable criterion was duration of in-hospital treatment after liver resections. Both models include the most popular judgments without 70% consolidation.</p><p><strong>Conclusion: </strong>TO models for liver resection demonstrated similar judgments of surveyed respondent In Russia and Europe. Nevertheless, certain differences prompt to further evaluation of some criteria, as well as TO validation in domestic practice.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 4","pages":"5-11"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030948","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":"[History of acute intestinal obstruction: evolution of views from antiquity to the present].","authors":"T Sh Morgoshiya, N Yu Kokhanenko, A V Glebova, E V Lipskaya, A L Ivanov, Yu V Grebtsov, L Z Gurtskaya","doi":"10.17116/hirurgia202505196","DOIUrl":"https://doi.org/10.17116/hirurgia202505196","url":null,"abstract":"<p><p>The contribution of various scientists to development of intestinal obstruction doctrine from its origins to the present time is analyzed. The little-known facts of history and treatment are noted. In 2023, it will be 185 years since publication of the first fundamental Russian-language report on intestinal obstruction. The author of this monograph, published in 1838, was Vikenty Dobrovolsky. The book was called \"On the disease called ileus\" (1838). Like most researchers of that time, he considered <i>ileus</i> as a disease of intestinal canal in which everything contained not only in stomach and small intestines, but sometimes in large intestines is ejected through the mouth or vomiting with feces appears under persistent constipation\". V.P. Dobrovolsky knew almost all forms of acute intestinal obstruction. He considered the following causes of <i>ileus</i>: 1) intestinal inflammation, 2) effect of spicy, irritating and toxic substances, 3) <i>ileus spasmodicus nervosus</i>, 4) mechanical effects including strangulation, intussusception, organic narrowing of intestines, obturation and helminthic obstruction. Researches of national surgeons of the 19^th century had a significant impact on the problem of intestinal obstruction. They contributed to introduction of modern progressive methods of surgical treatment of acute intestinal obstruction in the Soviet Union. We note that the problem of acute ileus is still one of the most important in emergency surgery. Modern views on diagnosis and treatment of this terrible syndrome are also presented.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 5","pages":"96-108"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003886","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":"[Photodynamic inactivation of antibiotic-resistant microflora of gunshot wounds under fluorescence control].","authors":"A A Shiryaev, M P Ivankov, N A Kalyagina, A V Voitova, K T Efendiev, M R Kuznetsov, I V Reshetov, A M Udeneev, V B Loshchenov","doi":"10.17116/hirurgia202502150","DOIUrl":"10.17116/hirurgia202502150","url":null,"abstract":"<p><strong>Objective: </strong>Antimicrobial photodynamic therapy or photodynamic inactivation (PDI) of antibiotic-resistant microflora seems to be a very promising alternative, including for the treatment of long-term non-healing wounds, due to its potential and extremely low possibility of resistance.</p><p><strong>Material and methods: </strong>The authors describe an effective approach to preparing the wounds for delayed surgical treatment (secondary suturing, split-flap autodermoplasty, wound defect closure with local tissues), as well as healing by secondary intention of wounds using PDI of antibiotic-resistant microflora under spectroscopic control of fluorescence intensity in tissues. For this purpose, laser and LED radiation with wavelengths 660-680 nm was used. Various photosensitizers (methylene blue, aluminum phthalocyanine, chlorin e6 and their emulsion forms) were used. The study included 90 patients with various wounds.</p><p><strong>Results: </strong>Positive treatment outcomes were obtained in most patients. The first PDI procedure decreased concentration of microflora by 3-4 times. There was significant or complete inactivation of bacteria by the end of the treatment. In all patients, concentration of photosensitizers significantly decreased by more than 75% after PDI. Surgical treatment was successful in 100% of cases (<i>n</i>=56; 62%).</p><p><strong>Conclusion: </strong>PDI is a promising method for inactivating antibiotic-resistant microflora, including patients with long-term non-healing wounds. This method contributes to safe and high-quality surgical treatment. A great advantage of PDI is its multi-purpose mechanism and no resistance of microorganisms.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"50-59"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366151","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":"[Prediction and prevention of fascial dehiscence after laparotomy].","authors":"V A Samartsev, V A Gavrilov, M P Kuznetsova, B S Pushkarev, A A Domrachev","doi":"10.17116/hirurgia202501147","DOIUrl":"10.17116/hirurgia202501147","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy of fascial dehiscence prevention suture in patients with perioperative risk factors regarding the incidence of this complication after laparotomies in abdominal surgery.</p><p><strong>Material and methods: </strong>A retrospective-prospective controlled randomized study included 112 patients with abdominal surgical diseases who underwent surgery between 2013 and 2023. Patients were divided into three groups. In the first group (<i>n</i>=57), fascial dehiscence occurred in early postoperative period. The second group (<i>n</i>=41) retrospectively included random patients without fascial dehiscence in postoperative period. In the third group (<i>n</i>=22), original preventive suturing of laparotomy was applied. The validity of differences in continuous variables was assessed using the Kruskal-Wallis test. Categorical variables were analyzed using chi-square test, as well as Dunn's and Fisher's post-hoc tests. Differences were significant at <i>p</i><0.05. The third group did not statistically differ from the first one.</p><p><strong>Results: </strong>A comprehensive perioperative assessment of risk factors and original aponeurosis suturing technique prevented fascial dehiscence.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"47-53"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123641","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":"[Aortic valve reimplantation combined with total arch replacement in type A aortic dissection].","authors":"S Yu Boldyrev, O S Bezdenezhnykh, S B Abidzakh, V A Sapunov, K O Barbukhatti","doi":"10.17116/hirurgia202501180","DOIUrl":"10.17116/hirurgia202501180","url":null,"abstract":"<p><p>We present simultaneous aortic valve reimplantation, replacement of aortic arch, right common carotid artery and proximal parts of the right subclavian and left common carotid arteries in a patient with type I aortic dissection. Involvement of supra-aortic arteries is the main predictor of cerebral malperfusion and mortality in acute aortic dissection. Optimal surgical intervention in such patients is still unclear. Moreover, patients with acute ascending aortic dissection rarely undergo valve-sparing surgery, since such interventions require much time and prolong myocardial ischemia.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"80-85"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123124","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}