Khirurgiya最新文献

{"title":"[Thoracoscopic resection of azygos vein aneurysm].","authors":"A N Lednev, A A Pechetov, N V Gulova","doi":"10.17116/hirurgia2024071124","DOIUrl":"10.17116/hirurgia2024071124","url":null,"abstract":"<p><p>Azygos vein aneurysm is a rare thoracic disease that often mimics posterior mediastinum tumors. Pathogenesis of azygos vein aneurysm is unclear. Discussions about possible causes are still ongoing. Most aneurysms are asymptomatic and diagnosed incidentally during standard examinations. Severe complications of azygos vein aneurysm include rupture with massive bleeding and pulmonary embolism. Contrast-enhanced chest CT and MRI are essential. Differential diagnosis includes tumors, cysts and rare neoplasms of the mediastinum. Treatment algorithm is not established. There are traditional surgical and endovascular methods. We present minimally invasive surgical treatment of azygos vein aneurysm in a 53-year-old woman. The patient underwent thoracoscopic resection of aneurysm. Histological examination revealed a partially thrombosed azygos vein aneurysm.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 7","pages":"124-129"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621169","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":"[Endoscopic stenting for malignant pancreatobiliary strictures].","authors":"Yu D Kulikov, Yu S Teterin, A S Mironova, P A Yartsev, T E Rohas Tadevosyan, K A Nugumanova","doi":"10.17116/hirurgia202401129","DOIUrl":"10.17116/hirurgia202401129","url":null,"abstract":"<p><strong>Objective: </strong>To improve the outcomes in patients with malignant obstructive jaundice using intraluminal stenting.</p><p><strong>Material and methods: </strong>The present study included 62 patients with clinical symptoms of malignant obstructive jaundice. In the main group, we performed biliary stenting with self-expanding multi-perforated stents (Hanarostent Multi-hole Biliary). Microscopic perforations of these stents prevent migration and reduce the risk of blocking the cystic and main pancreatic ducts. In the control group, stenting was performed with fully and partially covered self-expanding stents.</p><p><strong>Results: </strong>Lower incidence of obstructive cholecystitis and acute pancreatitis in the main group was associated with multiperforated stents reducing the risk of blocking the main pancreatic and cystic ducts.</p><p><strong>Conclusion: </strong>In our study, multiperforated stents excluded migration and reduced the incidence of complications (acute cholecystitis from 11.5 to 3.8%, acute pancreatitis from 15.3 to 7.7%).</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"29-33"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139521848","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 surgical treatment of patients with pathological tortuosity of the internal carotid artery].","authors":"A V Gavrilenko, A V Abramyan, V A Kochetkov, E A Tarabrin","doi":"10.17116/hirurgia202401164","DOIUrl":"10.17116/hirurgia202401164","url":null,"abstract":"<p><p>No multicenter randomized clinical trial has been conducted worldwide to date on indications, types of surgery and their comparison with conservative treatment in patients with PI BSA.</p><p><strong>Objective: </strong>Of the study is to improve the results of surgical treatment in patients with pathological tortuosity of the internal carotid artery.</p><p><strong>Material and methods: </strong>The study included 119 patients (41 (34%) men and 78 (66%) women) with PI ICA aged 34 to 71 years (average age 53.2±7.5 years) divided into 2 groups. 64 patients (54%) of group I underwent BSA resection with lower mouth and 55 patients (46%) of group II underwent BSA prosthetics. Depending on the degree of neurological disorders, patients were distributed according to the classification of A.V. Pokrovsky.</p><p><strong>Results: </strong>In the early postoperative period, TIA was noted in one patient, and transient lesions of the cranial nerves were observed in 5 patients. During 5 years of follow-up, none of the patients developed TIA, IS or other vascular events. In the early surgical period, there were no significant differences in effectiveness between the groups of patients. In the long-term period (5 years after surgery), a higher frequency of asymptomatic patients was noted in group I.</p><p><strong>Conclusion: </strong>Resection and replacement of a pathologically tortuous internal carotid artery (ICA) is a safe and effective surgical treatment. A multicenter randomized trial should be conducted to compare the effectiveness of surgical treatment of PI ICA with a conservative approach to effectively treat patients.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"64-70"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139521889","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":"[First experience of applying domestic video fluorescent equipment for visualization and blood flow evaluation of the parathyroid glands].","authors":"M B Saliba, V A Zhivova, F P Vetshev, D I Gabaidze, K T Efendiev, A M Udeneev, E A Pavlova, A A Shiryaev","doi":"10.17116/hirurgia202401171","DOIUrl":"10.17116/hirurgia202401171","url":null,"abstract":"<p><p>In recent years, predictive methods for assessing the preservation of the parathyroid glands have been actively implemented. The article describes the first experience of evaluating the blood supply of the parathyroid glands by quantitative determination of the indocyanine green (ICG) accumulation index in real time in 6 patients before and after a thyroidectomy with central neck lymph node dissection for papillary thyroid cancer. Intraoperative fluorescent angiography was performed by using domestic equipment with a fluorescent module, as well as by using a domestic medication of ICG. Intraoperative values of the ICG accumulation index were compared with the levels of ionized calcium and parathyroid hormone perioperatively. No clinical manifestations of hypocalcemia were detected in the postoperative period. The obtained results showed the informativeness of the numerical assessment of the intensity of ICG fluorescence. The evaluation of the distribution (accumulation) of ICG has prospects for practical application in thyroid surgery in the formation of tactics for preserving the parathyroid glands and predicting postoperative hypoparathyreosis.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"71-78"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139521922","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 excision versus open excision for the treatment of choledochal cysts: a systematic review and meta-analysis].","authors":"G Plasencia, J C Alvarado, C Z Corvera, W P Angulo","doi":"10.17116/hirurgia202403154","DOIUrl":"10.17116/hirurgia202403154","url":null,"abstract":"<p><strong>Objective: </strong>To determine if laparoscopic excision is more effective than open excision in the treatment of choledochal cysts.</p><p><strong>Material and methods: </strong>A systematic review of randomized clinical trials in 3 databases measuring the efficacy of laparoscopic and open excision of choledochal cysts was performed. The authors considered international and national reports, whose results were analyzed in detail.</p><p><strong>Results: </strong>Mean duration of laparoscopic excision was 51 min, open excision - 35.4 min. Length of hospital-stay after laparoscopic excision ranged between 5 and 74 days, after open excision - between 7 and 146 days. Bile leakage rate was 1-2% and 4%, respectively. Laparoscopic excision was followed by lower complication rate. Morbidity and mortality in laparoscopic excision was 20% and 0%, in open excision - 60% and 3.3%, respectively.</p><p><strong>Conclusion: </strong>Laparoscopic excision is more effective than open excision in the treatment of choledochal cysts.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"54-62"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111740","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":"[Liver transplantation program at the Burnasyan Federal Biophysical Center: experience in 500 procedures].","authors":"S E Voskanyan, A I Sushkov, A I Artemiev, V S Rudakov, I Yu Kolyshev, K K Gubarev, D A Zabezhinskiy, M V Popov","doi":"10.17116/hirurgia202407145","DOIUrl":"https://doi.org/10.17116/hirurgia202407145","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the features and outcomes of 500 liver transplantations in adults over a 12-year period.</p><p><strong>Materials and methods: </strong>The study included data on 500 liver transplantations between May 2010 and April 2023. We analyzed 483 adults who underwent transplantation and 438 candidates for this procedure. All data were obtained from local liver transplantation registry. Clinical outcomes were recorded as of June 1, 2023. Statistical analysis was performed using the Statistica 12 (StatSoft Inc., USA) and Jamovi version 2.3.21.0 software (Jamovi project).</p><p><strong>Results: </strong>Among 438 patients in the waiting list between January 2012 and May 2023, liver transplantation was performed in 198 (45%) cases including 27 (6%) transplantations from living-related donors and 37 (8%) procedures in other centers. There were 109 (25%) deaths. The 1- and 3-year survival rates were 81% (95% CI 76-85%) and 50% (95% CI 42-59%), respectively. Organs from deceased donors (<i>n</i>=134, 27%) and living-related donors (<i>n</i>=366, 73%) were used for transplantations. Redo transplantations were necessary in 21 (4%) cases. The median age of recipients was 45 years (range 18-72), median MELD-Na score - 16 (range 6-43). The most common indications for transplantation were viral cirrhosis (37%), cholestatic liver disease (16%), and hepatocellular carcinoma (14%). Monotherapy with calcineurin inhibitors was performed in 39% of cases, combination of calcineurin inhibitors and glucocorticoids, antimetabolites or mTOR inhibitors - 52%, three-component schemes - 8% of cases. Annual, 5- and 7-year survival rates of recipients after primary transplantation were 87% (95% CI: 84-90%), 79% (95% CI: 75-83%) and 75% (95% CI: 70-80%), respectively. In case of liver transplantation from living-related donors, these values were 89% (95% CI: 86-92%), 84% (95% CI: 80-88%) and 80% (95% CI: 75-85%), after transplantation from deceased donors - 81% (95% CI: 74-88%), 66% (95% CI: 57-76%) and 58% (95% CI: 45-72%), respectively.</p><p><strong>Conclusion: </strong>Liver transplantation is highly effective for patients with diffuse and focal liver diseases. Living donors not only significantly improve availability of this technology, but also provide substantial advantages in outcomes compared to liver transplantation from deceased donors, reducing the likelihood of recipient mortality by 10% after one post-transplantation year and by more than 20% after five years.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 7","pages":"45-60"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621130","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":"[Dynamic functional assessment of internal carotid artery tortuosity in patients with multifocal atherosclerosis].","authors":"L A Medvedeva, O I Zagorulko, E R Charchyan, O V Drakina, E F Dutikova","doi":"10.17116/hirurgia202405195","DOIUrl":"10.17116/hirurgia202405195","url":null,"abstract":"<p><p>A personalized approach with attention to anamnesis and specific symptoms is necessary in patients with internal carotid artery tortuosity. Neuroimaging (especially before elective surgery) or functional stress tests following ultrasound of supra-aortic vessels may be necessary depending on medical history and complaints. In addition to standard Doppler ultrasound, these patients should undergo rotational and orthostatic transformation tests. We analyze changes in shape and hemodynamic parameters within the tortuosity area in various body positions. This is especially valuable for patients with concomitant carotid artery stenosis. The article presents a clinical case illustrating the importance of such approach.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 5","pages":"95-100"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141089325","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":"[Economic and clinical aspects of postoperative bandages selection: in search of the best solution].","authors":"I K Petrukhina, T K Ryazanova, I A Zolotovskaya","doi":"10.17116/hirurgia202405175","DOIUrl":"10.17116/hirurgia202405175","url":null,"abstract":"<p><strong>Objective: </strong>Investigation of the clinical and economic advisability of using self-adhesive wound bandages of plaster type (on the example of Cosmopor E steril) compared to gauze bandages in the conditions of medical organization.</p><p><strong>Methods: </strong>Study design - a retrospective analysis of literature data. Methods of pharmacoeconomic analysis - cost minimization analysis, «impact on budget» analysis. The Unified Information System in Procurement was the information source of the self-adhesive bandages cost. The charges of gauze bandages production were calculated on the basis of data provided by structural subdivisions of SamSMU Clinics.</p><p><strong>Results: </strong>It was determined that the use of self-adhesive bandages of plaster type is economically feasible as a result of the analysis of cost minimization and impact on the budget. Saving during 1 year can be from 259 466 to 532 603 rubles (in total for three departments - 1.1 million rubles). Sensitivity analysis showed the stability of the obtained results to the variation of entry conditions (costs for gauze bandages and bandages of plaster type) in a wide range of values.</p><p><strong>Conclusion: </strong>The data obtained from the study showed that the use of bandages of plaster type for different types of surgical treatment is more justified in terms of cost saving.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 5","pages":"75-85"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141089335","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":"[Evaluation of revascularization efficiency using near-infrared oximetry in patients with diabetic foot syndrome].","authors":"I V Larin, I N Shchanitsyn, A S Tolstokorov, V S Arakelyan","doi":"10.17116/hirurgia202406120","DOIUrl":"https://doi.org/10.17116/hirurgia202406120","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate prognostic significance of tissue oximetry in healing of trophic defects in patients with diabetic foot syndrome (DFS) after endovascular revascularization.</p><p><strong>Material and methods: </strong>In 42 patients with DFS, tissue oximetry was performed in angiosome projection with the FORE-SIGHT MC-2000 (CASMED) device before and the next day after revascularization of lower limb arteries. The 1st group included 30 patients with wound healing throughout 3 months, the 2nd group included 12 patients with amputation or no healing of trophic defects.</p><p><strong>Results: </strong>Direct revascularization was more common in the 1st group (<i>p</i>=0.001). On the day after intervention, oxygen saturation (StO₂) increased in all angiosomes in both groups (<i>p</i><0.05). StO₂ increment differed significantly between groups in all angiosomes except for point I (<i>p</i><0.05). According to ROC analysis, StO₂ increment by 4.5% in absolute values and 7.9% in percentage leads to trophic defect healing within 3 months (sensitivity and specificity were 76.7% and 66.7% for absolute values, 80% and 58.3% for percentage, respectively).</p><p><strong>Conclusion: </strong>Evaluation of StO₂ in target angiosome may be valuable to predict trophic defect healing after endovascular surgery.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 6","pages":"20-27"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421255","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":"[A personalized approach to recurrent abdominal pain syndrome based on clinical and laboratory algorithms].","authors":"A A Baulin, L A Averyanova, V A Baulin, O A Baulina","doi":"10.17116/hirurgia202402159","DOIUrl":"10.17116/hirurgia202402159","url":null,"abstract":"<p><strong>Objective: </strong>To optimize the diagnosis of abdominal pain syndrome occurring under the «mask» of acute pancreatitis via algorithms for clinical and laboratory examination.</p><p><strong>Material and methods: </strong>We have retrospectively and prospectively analyzed patients with abdominal pain syndrome. We selected all patients with acute pancreatitis who repeatedly applied with abdominal pain syndrome to polyclinics and hospitals between 2017 and 2021. A personalized algorithm for patients with abdominal pain syndrome occurring under the «mask» of acute pancreatitis has been developed. This algorithm underlies an information system for decision-making support.</p><p><strong>Results: </strong>An optimal diagnostic algorithm is needed in reception departments of hospitals and polyclinics. This one depends on equipment of hospitals and needs to be constantly improved. When refusing hospitalization and discharging patients with recurrent pain syndromes, physicians should orient the doctors of general network to use more informative methods. Indeed, the last ones may be unavailable in reception departments and various districts due to technical, qualification and organizational shortcomings.</p><p><strong>Conclusion: </strong>Advanced clinical and laboratory diagnostic methods based on the above-described algorithm are necessary for recurrent abdominal pain syndrome occurring under the «mask» of acute pancreatitis.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"59-67"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724306","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}