Pub Date : 2020-11-08DOI: 10.24884/0042-4625-2020-179-4-62-71
A. P. Koshel, E. S. Drozdov, S. Klokov, T. Dibina, R. S. Nustafaev, А. S. Provotorov
Introduction. The implementation of ERAS (Enhanced recovery after surgery) protocols has been shown to be effective in orthopedics, bariatric and colorectal surgery. However, the safety and feasibility of implementing accelerated rehabilitation protocols in patients underwent distal pancreatic resection is not well studied. The objective was to analyze the results of the application of accelerated rehabilitation protocols in patients underwent distal pancreatic resection. Methods and materials . A retrospective - prospective, single-center study was conducted. The study included 60 patients. Patients were divided into two groups (control group - 30 patients, perioperative management was carried out according to standard methods and the main group - 30 patients, perioperative management was carried out according to the accelerated rehabilitation protocol). All patients included in the study underwent distal pancreas resection. Results. Patients in the analyzed groups were comparable by gender, age, body mass index, and ASA score. The frequency and severity of postoperative complications in the compared groups was comparable. The frequency of early activation of patients was significantly higher in the main group (86.7 vs 56.7; p<0.001). Postoperative recovery of gastrointestinal tract function was faster in the main group ((2.4±0.9) vs (3.6±1.2); p<0.001). The total duration of the postoperative hospital bed in the compared groups was comparable ((12.9±6.8) vs (14.1±6.1); p=0.2), however, when analyzing a subgroup of patients without complications and with minor complications, the differences in the duration of the postoperative hospital bed in the main and control groups was statistically significant ((8.9±3.6) and (11.7±3.4), respectively, p=0.01). Conclusion. The study showed the safety and effectiveness of implementing accelerated rehabilitation protocols in patients underwent distal pancreatic resection.
{"title":"Experience of application of accelerated rehabilitation programs in patients with distal pancreas resection","authors":"A. P. Koshel, E. S. Drozdov, S. Klokov, T. Dibina, R. S. Nustafaev, А. S. Provotorov","doi":"10.24884/0042-4625-2020-179-4-62-71","DOIUrl":"https://doi.org/10.24884/0042-4625-2020-179-4-62-71","url":null,"abstract":"Introduction. The implementation of ERAS (Enhanced recovery after surgery) protocols has been shown to be effective in orthopedics, bariatric and colorectal surgery. However, the safety and feasibility of implementing accelerated rehabilitation protocols in patients underwent distal pancreatic resection is not well studied. The objective was to analyze the results of the application of accelerated rehabilitation protocols in patients underwent distal pancreatic resection. Methods and materials . A retrospective - prospective, single-center study was conducted. The study included 60 patients. Patients were divided into two groups (control group - 30 patients, perioperative management was carried out according to standard methods and the main group - 30 patients, perioperative management was carried out according to the accelerated rehabilitation protocol). All patients included in the study underwent distal pancreas resection. Results. Patients in the analyzed groups were comparable by gender, age, body mass index, and ASA score. The frequency and severity of postoperative complications in the compared groups was comparable. The frequency of early activation of patients was significantly higher in the main group (86.7 vs 56.7; p<0.001). Postoperative recovery of gastrointestinal tract function was faster in the main group ((2.4±0.9) vs (3.6±1.2); p<0.001). The total duration of the postoperative hospital bed in the compared groups was comparable ((12.9±6.8) vs (14.1±6.1); p=0.2), however, when analyzing a subgroup of patients without complications and with minor complications, the differences in the duration of the postoperative hospital bed in the main and control groups was statistically significant ((8.9±3.6) and (11.7±3.4), respectively, p=0.01). Conclusion. The study showed the safety and effectiveness of implementing accelerated rehabilitation protocols in patients underwent distal pancreatic resection.","PeriodicalId":23485,"journal":{"name":"Vestnik khirurgii imeni I. I. Grekova","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69112686","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}
Pub Date : 2020-11-08DOI: 10.24884/0042-4625-2020-179-4-102-108
А. Агасян, Б. Миронков, Д. Прямиков, G. A. Agasyan, Aleksey B. Mironkov, A. D. Pryamikov, Aleksey I. Khripun
The paper presents the latest data on applications of various types of endovascular interventions on the superior mes- enteric artery. Efficiency of a number of devices for reperfusion therapy with acute mesenteric ischemia is described. The results of works with the largest samples of patients (frequency of laparotomy, intestinal resection and lethality), timing of endovascular surgery and comparative results of open and endovascular operations in the basin of the superior mesenteric artery are also discussed.
{"title":"Endovascular techniques in the treatment of acute mesenteric ischemia (review of literature)","authors":"А. Агасян, Б. Миронков, Д. Прямиков, G. A. Agasyan, Aleksey B. Mironkov, A. D. Pryamikov, Aleksey I. Khripun","doi":"10.24884/0042-4625-2020-179-4-102-108","DOIUrl":"https://doi.org/10.24884/0042-4625-2020-179-4-102-108","url":null,"abstract":"The paper presents the latest data on applications of various types of endovascular interventions on the superior mes- enteric artery. Efficiency of a number of devices for reperfusion therapy with acute mesenteric ischemia is described. The results of works with the largest samples of patients (frequency of laparotomy, intestinal resection and lethality), timing of endovascular surgery and comparative results of open and endovascular operations in the basin of the superior mesenteric artery are also discussed.","PeriodicalId":23485,"journal":{"name":"Vestnik khirurgii imeni I. I. Grekova","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69111373","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}
Pub Date : 2020-11-08DOI: 10.24884/0042-4625-2020-179-4-9-16
D. Granov, A. Polikarpov, P. Tarazov, I. V. Timergalin, V. N. Polysalov
ЦЕЛЬ. Определить эффективность холангиодренирования/стентирования до поступления в специализированное отделение гепатобилиарной хирургии у пациентов с опухолями Клатскина и возможности последующего противоопухолевого лечения. МЕТОДЫ И МАТЕРИАЛЫ. За 2015–2019 гг. у 58 пациентов с воротной холангиокарциномой (Bismuth – Corlette типы: I – 4 больных; II – 6; III – 36; IV – 12) были выполнены холангиодренирования по месту жительства. У 45 (78 %) больных из-за некупированного холангита и (или) механической желтухи потребовалась коррекция и (или) дополнительное дренирование желчных протоков: переустановка из наружного в наружно-внутренний (n=23), дополнительное дренирование левой доли и SIV (n=16), удаление эндоскопических стентов и чрескожное холангиодрeнирование (n=6). Специфическое лечение (n=48) заключалось в последовательной внутрипротоковой фотодинамической и регионарной химиотерапии. После 2–8 (в среднем 3) циклов 14 (24 %) пациентам осуществлены хирургические вмешательства: правосторонняя гемигепатэктомия – 4; левосторонняя расширенная гемигепатэктомия – 4; левосторонняя гемигепатэктомия – 3; резекция желчных протоков с SIV – 2; ортотопическая трансплантация печени – 1. РЕЗУЛЬТАТЫ. Период от появления механической желтухи до начала специфического лечения составил от 1 до 9 (в среднем 3,1) месяцев. Технический успех корригирующих эндобилиарных вмешательств составил 100 %. Серьезных осложнений и летальности не было. Явления холангита и механической желтухи были купированы у 35 (78 %) больных. У 14 (30 %) из 48 пациентов получили метаболический и биологический ответ и выполнены радикальные вмешательства. У 10 (17 %) пациентов с длительной желтухой и развитием холестатического гепатита (n=6) или хронического холангита (n=4) специфическую терапию не проводили. ЗАКЛЮЧЕНИЕ. До поступления в специализированное отделение ранее установленные дренажи/стенты желчных протоков были эффективными у 22 % пациентов. Адекватное холангиодренирование с регулярным рентгенологическим контролем позволяет начать специфическое лечение у 83 % пациентов с опухолью Клатскина. Преимущество фотодинамической и регионарной химиотерапии после чрескожного холангиодренирования в их повторяемости и возможности добиться локального контроля роста опухоли с последующим радикальным лечением. Ключевые слова: опухоль Клатскина, холангит, механическая желтуха, внутриартериальная химиотерапия, внутрипротоковая фотодинамическая терапия
{"title":"Klatskin tumor complicated by obstructive jaundice and cholangitis in real practice: unresectable tumor or incurable patient?","authors":"D. Granov, A. Polikarpov, P. Tarazov, I. V. Timergalin, V. N. Polysalov","doi":"10.24884/0042-4625-2020-179-4-9-16","DOIUrl":"https://doi.org/10.24884/0042-4625-2020-179-4-9-16","url":null,"abstract":"ЦЕЛЬ. Определить эффективность холангиодренирования/стентирования до поступления в специализированное отделение гепатобилиарной хирургии у пациентов с опухолями Клатскина и возможности последующего противоопухолевого лечения. МЕТОДЫ И МАТЕРИАЛЫ. За 2015–2019 гг. у 58 пациентов с воротной холангиокарциномой (Bismuth – Corlette типы: I – 4 больных; II – 6; III – 36; IV – 12) были выполнены холангиодренирования по месту жительства. У 45 (78 %) больных из-за некупированного холангита и (или) механической желтухи потребовалась коррекция и (или) дополнительное дренирование желчных протоков: переустановка из наружного в наружно-внутренний (n=23), дополнительное дренирование левой доли и SIV (n=16), удаление эндоскопических стентов и чрескожное холангиодрeнирование (n=6). Специфическое лечение (n=48) заключалось в последовательной внутрипротоковой фотодинамической и регионарной химиотерапии. После 2–8 (в среднем 3) циклов 14 (24 %) пациентам осуществлены хирургические вмешательства: правосторонняя гемигепатэктомия – 4; левосторонняя расширенная гемигепатэктомия – 4; левосторонняя гемигепатэктомия – 3; резекция желчных протоков с SIV – 2; ортотопическая трансплантация печени – 1. РЕЗУЛЬТАТЫ. Период от появления механической желтухи до начала специфического лечения составил от 1 до 9 (в среднем 3,1) месяцев. Технический успех корригирующих эндобилиарных вмешательств составил 100 %. Серьезных осложнений и летальности не было. Явления холангита и механической желтухи были купированы у 35 (78 %) больных. У 14 (30 %) из 48 пациентов получили метаболический и биологический ответ и выполнены радикальные вмешательства. У 10 (17 %) пациентов с длительной желтухой и развитием холестатического гепатита (n=6) или хронического холангита (n=4) специфическую терапию не проводили. ЗАКЛЮЧЕНИЕ. До поступления в специализированное отделение ранее установленные дренажи/стенты желчных протоков были эффективными у 22 % пациентов. Адекватное холангиодренирование с регулярным рентгенологическим контролем позволяет начать специфическое лечение у 83 % пациентов с опухолью Клатскина. Преимущество фотодинамической и регионарной химиотерапии после чрескожного холангиодренирования в их повторяемости и возможности добиться локального контроля роста опухоли с последующим радикальным лечением. Ключевые слова: опухоль Клатскина, холангит, механическая желтуха, внутриартериальная химиотерапия, внутрипротоковая фотодинамическая терапия","PeriodicalId":23485,"journal":{"name":"Vestnik khirurgii imeni I. I. Grekova","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69112476","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}
Pub Date : 2020-11-08DOI: 10.24884/0042-4625-2020-179-4-91-97
E. Y. Dyakonova, A. Gurskaya, O. N. Nakovkin, K. A. Kazakova, M. A. Varichkina, N. V. Zhurkova, R. R. Baiazitov, D. M. Akhmedova, A. O. Tarzian, A. A. Shchukina
Congenital short bowel syndrome is a rare condition of the newborn, with several reports demonstrating high mortality. For the first time in Russia, we report a case of treatment of a newborn girl with genetically confirmed congenital short bowel syndrome, and also provide a review of the literature on this syndrome. After birth, the child experienced constant vomiting of bile with a progressive decrease in body weight. The laparotomy for congenital adhesions between the loops of the small intestine with severe violations of the evacuation function revealed that the small bowel was 50 cm in length, confirming the diagnosis of congenital short bowel syndrome. The genetic test, using whole exome sequencing, identified a homozygous mutation in the CLMP gene in this patient. A positive result in the postoperative period was achieved using the protocol for the management of patients with short bowel syndrome. Currently, the girl is 11 months old, body weight is 9 kg, development is harmonious. Long-term survival of children with congenital short bowel syndrome is now possible if enteral feeds are introduced early to promote intestinal adaptation, with subsequent weaning off parenteral nutrition.
{"title":"Врожденный синдром короткой тонкой кишки: клиническое наблюдение и обзор литературы","authors":"E. Y. Dyakonova, A. Gurskaya, O. N. Nakovkin, K. A. Kazakova, M. A. Varichkina, N. V. Zhurkova, R. R. Baiazitov, D. M. Akhmedova, A. O. Tarzian, A. A. Shchukina","doi":"10.24884/0042-4625-2020-179-4-91-97","DOIUrl":"https://doi.org/10.24884/0042-4625-2020-179-4-91-97","url":null,"abstract":"Congenital short bowel syndrome is a rare condition of the newborn, with several reports demonstrating high mortality. For the first time in Russia, we report a case of treatment of a newborn girl with genetically confirmed congenital short bowel syndrome, and also provide a review of the literature on this syndrome. After birth, the child experienced constant vomiting of bile with a progressive decrease in body weight. The laparotomy for congenital adhesions between the loops of the small intestine with severe violations of the evacuation function revealed that the small bowel was 50 cm in length, confirming the diagnosis of congenital short bowel syndrome. The genetic test, using whole exome sequencing, identified a homozygous mutation in the CLMP gene in this patient. A positive result in the postoperative period was achieved using the protocol for the management of patients with short bowel syndrome. Currently, the girl is 11 months old, body weight is 9 kg, development is harmonious. Long-term survival of children with congenital short bowel syndrome is now possible if enteral feeds are introduced early to promote intestinal adaptation, with subsequent weaning off parenteral nutrition.","PeriodicalId":23485,"journal":{"name":"Vestnik khirurgii imeni I. I. Grekova","volume":"179 1","pages":"91-97"},"PeriodicalIF":0.0,"publicationDate":"2020-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69112516","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}
Pub Date : 2020-11-08DOI: 10.24884/0042-4625-2020-179-4-79-86
T. Britvin, E. Bondarenko, A. Krivosheev, O. Nechaeva, T. S. Tamazyan, D. V. Podrez, L. Gurevich, P. A. Korosteleva
The diagnosis and treatment of multiple endocrine neoplasia type 2A syndrome or Sipple’s syndrome, as well as other endocrine hereditary syndromes, presents certain difficulties for several reasons. One of them is the rarity of this pathology and, as a result, the lack of awareness of physicians. In addition, the diagnosis requires a comprehensive examination and a high level of clinical, laboratory, radiation and morphological diagnostics. And finally, surgical treatment, which is essentially the only method, involves an individual approach to each patient. We present the clinical case of Sipple's syndrome in a 39-year-old man. The diagnosis was carried out of medical history, clinical examination, laboratory tests (24-hour urine excretion of metanephrines and normetanephrines; serum calcium, calcitonin and parathyroid hormone levels), neck ultrasound and abdominal CT scan and was confirmed by histopathological examination and genetic testing for RET mutation. The achievement of the endpoint in the form of normalization of blood pressure and the absence of adrenal insufficiency was due to radical surgical treatment.
{"title":"Surgical treatment of a patient with multiple endocrine neoplasia type 2A","authors":"T. Britvin, E. Bondarenko, A. Krivosheev, O. Nechaeva, T. S. Tamazyan, D. V. Podrez, L. Gurevich, P. A. Korosteleva","doi":"10.24884/0042-4625-2020-179-4-79-86","DOIUrl":"https://doi.org/10.24884/0042-4625-2020-179-4-79-86","url":null,"abstract":"The diagnosis and treatment of multiple endocrine neoplasia type 2A syndrome or Sipple’s syndrome, as well as other endocrine hereditary syndromes, presents certain difficulties for several reasons. One of them is the rarity of this pathology and, as a result, the lack of awareness of physicians. In addition, the diagnosis requires a comprehensive examination and a high level of clinical, laboratory, radiation and morphological diagnostics. And finally, surgical treatment, which is essentially the only method, involves an individual approach to each patient. We present the clinical case of Sipple's syndrome in a 39-year-old man. The diagnosis was carried out of medical history, clinical examination, laboratory tests (24-hour urine excretion of metanephrines and normetanephrines; serum calcium, calcitonin and parathyroid hormone levels), neck ultrasound and abdominal CT scan and was confirmed by histopathological examination and genetic testing for RET mutation. The achievement of the endpoint in the form of normalization of blood pressure and the absence of adrenal insufficiency was due to radical surgical treatment.","PeriodicalId":23485,"journal":{"name":"Vestnik khirurgii imeni I. I. Grekova","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69112417","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}
Pub Date : 2020-11-08DOI: 10.24884/0042-4625-2020-179-4-116-119
S. M. Lazarev, A. A. Kurygin, I. S. Tarbaev, V. Semenov
Pavel Nikolaevich entered of Don where he as his future In 1930, by the invitation of Professor V. A. Oppel, P. N. Napalkov moved to Leningrad, where he began working in the hospital named after I. I. Mechnikov (now Peter the Great). During World War II, Pavel Nikolaevich was in the ranks of the Red Army. P. N. Napalkov summarized the experience of his work in the chapters « Putrid Infection » and « Peritonitis » in the fundamental multi-volume publication « Experience of Soviet Medicine in the Great Patriotic War of 1941–1945 » . After demobilization, Professor P. N. Napalkov was elected head of the Department of Faculty Surgery of the 2 nd Leningrad Medical Institute and headed the department for 28 years – until 1974. Many works, including a dissertation and a mono- graph, were devoted to ventral hernias. Pavel Nikolaevich was the author and co-author of more than 400 scientific papers and 14 monographs on various sections of specialty surgery, military surgery, traumatology, anesthesiology, and health care organization. Professor P. N. Napalkov died on May 18, 1988 and was buried near Leningrad in the settlement Pesochny.
1930年，应v·a·奥佩尔教授的邀请，p·n·纳帕尔科夫搬到列宁格勒，开始在以梅奇尼科夫(现在的彼得大帝)命名的医院工作。第二次世界大战期间，帕维尔·尼古拉耶维奇在红军中服役。P. N. Napalkov在基础多卷出版物“1941-1945年伟大卫国战争中的苏联医学经验”中总结了他在“腐臭感染”和“腹膜炎”章节中的工作经验。复员后，P. N. Napalkov教授被选为列宁格勒第2医学院外科学系主任，领导该系长达28年，直到1974年。许多著作，包括一篇论文和一篇专著，都是关于腹疝的。Pavel Nikolaevich是400多篇科学论文和14部专著的作者和合著者，这些专著涉及专业外科、军事外科、创伤学、麻醉学和卫生保健组织的各个领域。p·n·纳帕尔科夫教授于1988年5月18日去世，被埋葬在列宁格勒附近的Pesochny定居点。
{"title":"Professor Pavel Nikolaevich Napalkov (1900-1988) (on the 120th anniversary of the birthday)","authors":"S. M. Lazarev, A. A. Kurygin, I. S. Tarbaev, V. Semenov","doi":"10.24884/0042-4625-2020-179-4-116-119","DOIUrl":"https://doi.org/10.24884/0042-4625-2020-179-4-116-119","url":null,"abstract":"Pavel Nikolaevich entered of Don where he as his future In 1930, by the invitation of Professor V. A. Oppel, P. N. Napalkov moved to Leningrad, where he began working in the hospital named after I. I. Mechnikov (now Peter the Great). During World War II, Pavel Nikolaevich was in the ranks of the Red Army. P. N. Napalkov summarized the experience of his work in the chapters « Putrid Infection » and « Peritonitis » in the fundamental multi-volume publication « Experience of Soviet Medicine in the Great Patriotic War of 1941–1945 » . After demobilization, Professor P. N. Napalkov was elected head of the Department of Faculty Surgery of the 2 nd Leningrad Medical Institute and headed the department for 28 years – until 1974. Many works, including a dissertation and a mono- graph, were devoted to ventral hernias. Pavel Nikolaevich was the author and co-author of more than 400 scientific papers and 14 monographs on various sections of specialty surgery, military surgery, traumatology, anesthesiology, and health care organization. Professor P. N. Napalkov died on May 18, 1988 and was buried near Leningrad in the settlement Pesochny.","PeriodicalId":23485,"journal":{"name":"Vestnik khirurgii imeni I. I. Grekova","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69111407","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}
Pub Date : 2020-11-08DOI: 10.24884/0042-4625-2020-179-4-29-35
E. Khomyakov, D. Mtvralashvili, Yu. E. Vaganov, S. Chernyshov, O. M. Iugai, T. Kachanova
Introduction. Endoscopic submucosal dissection (ESD) is a standard method of local excision of benign colon tumors. Nevertheless, it is not widely used because of its technical difficulty and risk of complication especially in right colon. The OBJECTIVE was to improve the results of treatment of patients with right colon neoplasms.Methods and materials. The results of 152 consecutive patients (median age 66 years, 88 female) with lateral spreading tumors (LST) were analyzed. Logistic regression was performed to evaluate risk factors of conversion and complications.Results. ESD as planned performed in 133 out of 152 patients. Conversion to bowel resection occurred in 19 cases. In the logistic regression model, lifting less than 3 mm (p=0.034) was independent risk factor of the conversion. Postoperative complications up to 30 days occurred in 5 out of 133 (3.8 %) of patients underwent ESD. There was no mortality after ESD. Severe fibrosis the base of the neoplasm was the only risk factor of postoperative complications (95 % CI=1.0—1.2; p=0.007). Final pathology revealed that 127 out of 133 patients (95.5 %) had adenomas and 6 out of 133 (4.5 %) patients had early adenocarcinomas. R0 resections was performed in 94/133 (70.7 %) cases.Conclusions. ESD is the safe and efficient method of local excision of benign right colon neoplasms. Unfavorable lifting (p=0.05) and submucosal fibrosis (p=0.007) are risk factors of ESD failure.
介绍。内镜下粘膜剥离术(ESD)是结肠良性肿瘤局部切除的标准方法。然而，由于其技术难度和并发症的风险，特别是在右结肠，它并没有被广泛应用。目的:提高右结肠肿瘤患者的治疗效果。方法和材料。分析了152例连续的横向扩散肿瘤(LST)患者(中位年龄66岁，88例女性)的结果。采用Logistic回归评价转归和并发症的危险因素。在152例患者中，133例患者按计划实施ESD。19例转为肠切除术。在logistic回归模型中，举升小于3 mm (p=0.034)是影响转换的独立危险因素。133例ESD患者中有5例(3.8%)出现30天的术后并发症。ESD术后无死亡。肿瘤基底严重纤维化是术后并发症的唯一危险因素(95% CI= 1.0-1.2;p = 0.007)。最终病理显示133例患者中127例(95.5%)为腺瘤，133例患者中6例(4.5%)为早期腺癌。133例患者中94例(70.7%)行R0切除。ESD是一种安全有效的右结肠良性肿瘤局部切除方法。不利的举升(p=0.05)和粘膜下纤维化(p=0.007)是ESD失败的危险因素。
{"title":"Effectiveness and risk factors of endoscopic submucosal dissection for right colon neoplasms","authors":"E. Khomyakov, D. Mtvralashvili, Yu. E. Vaganov, S. Chernyshov, O. M. Iugai, T. Kachanova","doi":"10.24884/0042-4625-2020-179-4-29-35","DOIUrl":"https://doi.org/10.24884/0042-4625-2020-179-4-29-35","url":null,"abstract":"Introduction. Endoscopic submucosal dissection (ESD) is a standard method of local excision of benign colon tumors. Nevertheless, it is not widely used because of its technical difficulty and risk of complication especially in right colon. The OBJECTIVE was to improve the results of treatment of patients with right colon neoplasms.Methods and materials. The results of 152 consecutive patients (median age 66 years, 88 female) with lateral spreading tumors (LST) were analyzed. Logistic regression was performed to evaluate risk factors of conversion and complications.Results. ESD as planned performed in 133 out of 152 patients. Conversion to bowel resection occurred in 19 cases. In the logistic regression model, lifting less than 3 mm (p=0.034) was independent risk factor of the conversion. Postoperative complications up to 30 days occurred in 5 out of 133 (3.8 %) of patients underwent ESD. There was no mortality after ESD. Severe fibrosis the base of the neoplasm was the only risk factor of postoperative complications (95 % CI=1.0—1.2; p=0.007). Final pathology revealed that 127 out of 133 patients (95.5 %) had adenomas and 6 out of 133 (4.5 %) patients had early adenocarcinomas. R0 resections was performed in 94/133 (70.7 %) cases.Conclusions. ESD is the safe and efficient method of local excision of benign right colon neoplasms. Unfavorable lifting (p=0.05) and submucosal fibrosis (p=0.007) are risk factors of ESD failure.","PeriodicalId":23485,"journal":{"name":"Vestnik khirurgii imeni I. I. Grekova","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69111946","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}
Pub Date : 2020-11-08DOI: 10.24884/0042-4625-2020-179-4-72-75
S. Boldyrev, V. Suslova, V. Pekhterev, K. Barbukhatti, V. Porhanov
1 Государственное бюджетное учреждение здравоохранения «Научно-исследовательский институт – Краевая клиническая больница 1 1 имени профессора С. В. Очаповского» Министерства здравоохранения Краснодарского края, г. Краснодар, Россия 2 Федеральное государственное бюджетное образовательное учреждение высшего образования «Кубанский государственный медицинский университет» Министерства здравоохранения Российской Федерации, г. Краснодар, Россия
俄罗斯克拉斯诺达尔斯克州克拉斯诺达尔斯克州卫生部克拉斯诺达尔斯克州医疗大学联邦预算高等教育机构
{"title":"Reimplantation of a bicuspid aortic valve with simultaneous correction of the aortic ductus diverticulum","authors":"S. Boldyrev, V. Suslova, V. Pekhterev, K. Barbukhatti, V. Porhanov","doi":"10.24884/0042-4625-2020-179-4-72-75","DOIUrl":"https://doi.org/10.24884/0042-4625-2020-179-4-72-75","url":null,"abstract":"1 Государственное бюджетное учреждение здравоохранения «Научно-исследовательский институт – Краевая клиническая больница 1 1 имени профессора С. В. Очаповского» Министерства здравоохранения Краснодарского края, г. Краснодар, Россия 2 Федеральное государственное бюджетное образовательное учреждение высшего образования «Кубанский государственный медицинский университет» Министерства здравоохранения Российской Федерации, г. Краснодар, Россия","PeriodicalId":23485,"journal":{"name":"Vestnik khirurgii imeni I. I. Grekova","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69112766","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}
Pub Date : 2020-11-08DOI: 10.24884/0042-4625-2020-179-4-22-28
В. Зайцев, В. Кошкина, Д. А. Хубезов, А. Юдин, В. Барсуков, Oleg V. Zaitsev, A. V. Koshkina, D. A. Khubezov, Vladimir A. Yudin, V. V. Barsukov, I. Bragina
The objective of this study was to conduct comparative analysis of the immediate and long-term results of laparoscopic inguinal hernioplasty performed with and without fixation of the mesh endoprosthesis.Methods and materials. The base group included 77 patients who underwent laparoscopic inguinal hernioplasty without fixation of the mesh by herniostepler. The control group included 76 patients who underwent laparoscopic inguinal hernioplasty with mesh fixation by herniostepler. To assess the postoperative period, the following criteria were studied: the severity of postoperative pain on a Visual Analog Scale; postoperative complications on the Clavien-Dindo scale; an early recurrence of inguinal hernias determined by ultrasound.Results. In both groups, the severity of postoperative complications did not exceed grade I. Among the entire list of complications, there were observed: pain in the area of surgery, an increase in body temperature above 38.5 °C, acute urinary retention, swelling and hematoma of the scrotum, seroma. There were no cases of conversion, intraoperative damage to internal organs and vascular structures. Complications in both groups do not differ significantly and do not depend on the method of laparoscopic inguinal hernioplasty: with fixation of the endoprosthesis by herniostepler or without fixation. The level of pain in the early postoperative period in patients operated by laparoscopic inguinal hernioplasty with mesh fixation was significantly higher. During control examinations of patients on the day after surgery, at the time of discharge and 6 months after surgery, no cases of dislocation of mesh endoprosthesis and relapse of inguinal hernia were detected.Conclusion. The obtained data indicate the effectiveness of laparoscopic hernioplasty in inguinal hernias with polypropylene mesh without fixing with herniostepler.
{"title":"Immediate and long-term results of laparoscopic hernioplasty in inguinal hernias with and without mesh endoprosthesis fixation","authors":"В. Зайцев, В. Кошкина, Д. А. Хубезов, А. Юдин, В. Барсуков, Oleg V. Zaitsev, A. V. Koshkina, D. A. Khubezov, Vladimir A. Yudin, V. V. Barsukov, I. Bragina","doi":"10.24884/0042-4625-2020-179-4-22-28","DOIUrl":"https://doi.org/10.24884/0042-4625-2020-179-4-22-28","url":null,"abstract":"The objective of this study was to conduct comparative analysis of the immediate and long-term results of laparoscopic inguinal hernioplasty performed with and without fixation of the mesh endoprosthesis.Methods and materials. The base group included 77 patients who underwent laparoscopic inguinal hernioplasty without fixation of the mesh by herniostepler. The control group included 76 patients who underwent laparoscopic inguinal hernioplasty with mesh fixation by herniostepler. To assess the postoperative period, the following criteria were studied: the severity of postoperative pain on a Visual Analog Scale; postoperative complications on the Clavien-Dindo scale; an early recurrence of inguinal hernias determined by ultrasound.Results. In both groups, the severity of postoperative complications did not exceed grade I. Among the entire list of complications, there were observed: pain in the area of surgery, an increase in body temperature above 38.5 °C, acute urinary retention, swelling and hematoma of the scrotum, seroma. There were no cases of conversion, intraoperative damage to internal organs and vascular structures. Complications in both groups do not differ significantly and do not depend on the method of laparoscopic inguinal hernioplasty: with fixation of the endoprosthesis by herniostepler or without fixation. The level of pain in the early postoperative period in patients operated by laparoscopic inguinal hernioplasty with mesh fixation was significantly higher. During control examinations of patients on the day after surgery, at the time of discharge and 6 months after surgery, no cases of dislocation of mesh endoprosthesis and relapse of inguinal hernia were detected.Conclusion. The obtained data indicate the effectiveness of laparoscopic hernioplasty in inguinal hernias with polypropylene mesh without fixing with herniostepler.","PeriodicalId":23485,"journal":{"name":"Vestnik khirurgii imeni I. I. Grekova","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69111889","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}
Pub Date : 2020-11-06DOI: 10.24884/0042-4625-2020-179-4-7-8
В. П. Морозов, М. Ш. Вахитов, Р. В. Чеминава
Professor Lev Vasilievich Potashov was born on May 21, 1930, and graduated from the 1st LMI in 1954. In 1964, he was the first in the country to perform a coronarography. He studied problems of gastrointestinal bleedings, lymphology, ultraviolet blood irradiation, ischemic diseases of the digestive system. Until the last year of 2020, he worked at the University.
Lev Vasilievich Potashov教授出生于1930年5月21日，1954年毕业于第一届LMI。1964年，他是该国第一个进行冠状病毒检查的人。他研究了胃肠道出血、淋巴病、紫外线血液照射、消化系统缺血性疾病等问题。直到2020年的最后一年，他还在该大学工作。
{"title":"Corresponding member of the Russian Academy of Sciences Professor Lev Vasilievich Potashov (1930-2020)","authors":"В. П. Морозов, М. Ш. Вахитов, Р. В. Чеминава","doi":"10.24884/0042-4625-2020-179-4-7-8","DOIUrl":"https://doi.org/10.24884/0042-4625-2020-179-4-7-8","url":null,"abstract":"Professor Lev Vasilievich Potashov was born on May 21, 1930, and graduated from the 1st LMI in 1954. In 1964, he was the first in the country to perform a coronarography. He studied problems of gastrointestinal bleedings, lymphology, ultraviolet blood irradiation, ischemic diseases of the digestive system. Until the last year of 2020, he worked at the University.","PeriodicalId":23485,"journal":{"name":"Vestnik khirurgii imeni I. I. Grekova","volume":"179 1","pages":"7-8"},"PeriodicalIF":0.0,"publicationDate":"2020-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43826481","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}
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