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[Strangulated hernia of the foramen of Winslow complicated by acute colonic obstruction]. [温斯洛孔绞窄疝并发急性结肠梗阻]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia202408192
P V Kikhlyarov, K K Murvatova, A A Yunusov

Internal hernias, in particular, hernia of the foramen of Winslow, are rare and occur in typical sites. Laparotomy is common in these cases while laparoscopic surgery is rarely used in such urgent cases. However, modern diagnosis and treatment including computed tomography and laparoscopy allowing minimally invasive interventions are not an exception for patients with hernia of the foramen of Winslow. This approach is effective for this problem and prevents adverse outcomes of disease.

内疝,尤其是温斯洛孔疝,比较罕见,多发生在典型部位。在这类病例中,开腹手术很常见,而腹腔镜手术很少用于这类急诊病例。然而,对于温氏孔疝患者来说,包括计算机断层扫描和腹腔镜在内的现代诊断和治疗方法允许微创介入。这种方法对这一问题很有效,并能防止疾病的不良后果。
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引用次数: 0
[Experience of articaine use in surgical treatment of patients with whitlow]. [阿替卡因在外科治疗whitlow患者中的应用体会]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia202412187
S G Shtofin, D V Zhukov, A S Polyakevich, N V Ustikova, A V Volosevich

The issue of the treatment of purulent-inflammatory conditions affecting the fingers is a significant one, given the high prevalence of such cases, with up to 1.5 million instances reported annually in our country. The results of surgical treatment are frequently unsatisfactory, particularly in regard to functional indices, even in cases of mild soft tissue injury. The primary determinant of successful whitlow treatment is adequate anaesthesia, which enables the performance of high-quality surgical wound treatment.

Objective: To conduct a comparative analysis of the efficacy of local anaesthetics (2% Novocain, 2% Lidocain and 2% solution of Artikain-Binergy) in conducting anaesthesia in accordance with the Oberst-Lukashevich technique for surgical treatment of patients with whitlow.

Material and methods: The retrospective observational study included 124 patients, of whom 83 (67%) were male and 41 (33%) were female, with an age range of 27 to 64 years. The patients were divided into three groups: the first group received 2% Novocaine (n=42), the second group received 2% Lidocaine solution (n=41), and the third group received 2% Articaine solution (n=41). The rapidity of onset of the analgesic effect (duration of latent period), its duration, and the absence of the need for repeated application of the drug were evaluated.

Results: For local anesthesia with articaine and lidocaine the same amount of drug was required - 2-3 ml, which is less than when using novocaine - 3-4 ml (p<0.05); articaine has the shortest latent period of 5-7 minutes, in contrast to lidocaine - 6-9 minutes and novocaine - 8-10 minutes (p<0.05); the duration of the analgesic effect of articaine is longer than that of lidocaine, novocaine - 3-3.5 hours, 0.83-1.33 hours and 0.58-0.66 hours, respectively (p<0.05); in the articaine group repeated anesthesia was not required either after 1 hour or after 2 hours.

Conclusion: Articaine demonstrated the greatest efficacy as a local anaesthetic in the surgical treatment of whitlow. It has the shortest latency period, which facilitates manipulation. The prolonged analgesic effect with a reduced anaesthetic dose allows for surgical procedures to be conducted without the necessity for post-procedure analgesics.

鉴于此类病例的高患病率,治疗影响手指的化脓性炎症是一个重要问题,我国每年报告的病例多达150万例。手术治疗的结果往往不令人满意,特别是在功能指标方面,即使在轻度软组织损伤的情况下。成功的whitlow治疗的主要决定因素是充分的麻醉,这使得高质量的外科伤口治疗的性能。目的:比较分析局部麻醉剂(2%奴佛卡因、2%利多卡因、2%阿提卡因-宾能溶液)在手术治疗whitlow患者中按照Oberst-Lukashevich技术麻醉的效果。材料与方法:回顾性观察性研究纳入124例患者,其中男性83例(67%),女性41例(33%),年龄27 ~ 64岁。将患者分为三组,第一组接受2%奴佛卡因治疗(n=42),第二组接受2%利多卡因溶液治疗(n=41),第三组接受2%阿替卡因溶液治疗(n=41)。评估了镇痛作用的发生速度(潜伏期持续时间)、持续时间以及不需要重复使用该药物。结果:阿替卡因与利多卡因局麻用量相同,均为2 ~ 3 ml,少于诺佛卡因局麻用量3 ~ 4 ml。结论:阿替卡因作为局麻在whitlow手术治疗中疗效最好。它的潜伏期最短,便于操作。在减少麻醉剂量的情况下,延长的镇痛效果使外科手术无需术后镇痛即可进行。
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引用次数: 0
[Short- and mid-term outcomes after posterolateral endoscopic discectomy in patients with lumbosacral junction disc herniations]. [腰骶交界处椎间盘突出症后外侧内镜椎间盘切除术后的中短期预后]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia202412152
I A Stepanov, V A Beloborodov

Objective: To analyze the short- and mid-term results of posterolateral endoscopic discectomy (PLED) in patients with lumbosacral junction intervertebral discs (IVD) herniations.

Material and methods: A retrospective observational cohort study included 95 medical records of respondents (35 (36.8%) males, 60 (63.2%) females, age 21 - 72 years), who underwent PLED for lumbar IVD herniations. Mean postoperative follow-up period was 14.4±3.2 months. Clinical outcomes and incidence of complications were studied.

Results: VAS scores of back and lower limb pain significantly decreased after 1, 3, 6, 9 and 12 months (p<0.01). Disability significantly improved in short- and mid-term follow-up period (Oswestry Disability Index, p<0.01). Analysis of subjective satisfaction with surgical intervention (modified MacNab scale) revealed that 92 (92.9%) respondents had excellent results. Complications occurred in 5 (5.2%) patients.

Conclusion: PLED is effective and safe in patients with lumbosacral joint IVD herniations. No significant complications were noted in our respondents.

目的:分析后外侧内镜下椎间盘切除术(PLED)治疗腰骶交界处椎间盘(IVD)突出症的中短期疗效。材料和方法:回顾性观察队列研究纳入95份病历,其中男性35例(36.8%),女性60例(63.2%),年龄21 - 72岁,因腰椎IVD突出接受了PLED。术后平均随访14.4±3.2个月。观察两组患者的临床结局及并发症发生率。结果:1、3、6、9、12个月后腰骶关节IVD突出症患者腰下肢疼痛VAS评分明显降低(ppp)。结论:plp治疗腰骶关节IVD突出症有效、安全。在我们的应答者中没有发现明显的并发症。
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引用次数: 0
[Thoracoscopic resection of recurrent atypically located parathyroid adenoma of anterior mediastinum in a patient with hyperparathyroidism undergoing renal replacement therapy]. [正在接受肾脏替代疗法的甲状旁腺功能亢进症患者前纵隔甲状旁腺腺瘤复发的非典型位置胸腔镜切除术]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia202406181
I V Makarov, S Yu Pushkin, M A Dmitrieva

We present successful surgical treatment of a patient with chronic kidney disease (CKD) and hyperparathyroidism undergoing renal replacement therapy. At baseline, parathyroidectomy via cervical access was performed for parathyroid adenomas. After 6 years, clinical and laboratory relapse of disease required thoracoscopic resection of atypically located anterior mediastinal adenoma. This case demonstrates that this disease is one of the most difficult in modern medicine requiring a special approach in diagnosis and treatment. Patients with CKD and hyperparathyroidism need for follow-up, control of total and ionized serum calcium, inorganic phosphorus and parathormone, osteodensitometry, ultrasound and scintigraphy of thyroid and parathyroid glands, and, if necessary, CT or MRI of the neck and chest organs.

我们为正在接受肾脏替代疗法的慢性肾脏病(CKD)和甲状旁腺功能亢进症患者提供了成功的手术治疗。基线时,患者因甲状旁腺腺瘤而通过颈部入路进行了甲状旁腺切除术。6年后,由于临床和实验室检查结果显示疾病复发,需要在胸腔镜下切除位置不典型的前纵隔腺瘤。该病例表明,这种疾病是现代医学中最难治疗的疾病之一,需要采用特殊的方法进行诊断和治疗。患有慢性肾脏病和甲状旁腺功能亢进症的患者需要进行随访,控制血清总钙和离子化钙、无机磷和副甲状腺激素,进行骨密度测定,对甲状腺和甲状旁腺进行超声波检查和闪烁扫描,必要时对颈部和胸部器官进行CT或MRI检查。
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引用次数: 0
[Prediction of papillary thyroid cancer recurrence according to preoperative data]. [根据术前数据预测甲状腺乳头状癌复发]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia202409176
N S Kuznetsov, M V Skibitskaya, A P Vaynshtok, E A Vashchenko

Objective: To create a formalized method for predicting papillary thyroid cancer recurrence after hemithyroidectomy based on preoperative data.

Material and methods: At this stage of the study, we selected 101 patients with papillary thyroid cancer who underwent surgical treatment in 2017-2023. Recurrence was observed in in 47 patients. Fifty-four patients had no recurrence within 5 years after surgical treatment, i.e. these patients underwent surgery in 2017-2018. To find prediction rules, we used original classification method based on searching for subsets of variables and piecewise linear rules separating classes in pairs with subsequent voting of such rules to make a decision.

Results: The exam was carried out using a training sample (101 cases) and sliding control method (10 tests on 10 random cases). On the training sample, sensitivity of predictive algorithm was 91%, specificity 78% and error rate 13%. The aggregated result of 10 trials using sliding control method revealed sensitivity of predictive algorithm 86%, specificity 75% and error rate 15%. This result is close to overall sample and confirms the effectiveness of this method for predicting recurrence.

Conclusion: The pilot experiments revealed the patterns in data for potential prediction of recurrence based on preoperative indicators. Further study of this problem may be valuable for decision-making and adjustments in the management of patients with papillary thyroid cancer.

目的根据术前数据,建立预测甲状腺乳头状癌半甲状腺切除术后复发的正规化方法:在本研究阶段,我们选取了2017-2023年接受手术治疗的101例甲状腺乳头状癌患者。47例患者出现复发。54名患者在手术治疗后5年内没有复发,即这些患者在2017-2018年接受了手术治疗。为了找到预测规则,我们使用了原始分类方法,该方法基于搜索变量子集和成对分离类别的片断线性规则,随后对这些规则进行投票以做出决定:测试使用了训练样本(101 个案例)和滑动控制法(对 10 个随机案例进行 10 次测试)。在训练样本上,预测算法的灵敏度为 91%,特异度为 78%,错误率为 13%。使用滑动控制法进行的 10 次测试的综合结果显示,预测算法的灵敏度为 86%,特异度为 75%,误差率为 15%。这一结果与总体样本接近,证实了该方法在预测复发方面的有效性:试点实验揭示了根据术前指标预测复发的潜在数据模式。对这一问题的进一步研究可能对甲状腺乳头状癌患者的管理决策和调整很有价值。
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引用次数: 0
[Consensus on topical issues of multidisciplinary management of elderly patients with frailty in planned surgical care delivery]. [关于在有计划的外科护理服务中对体弱老年患者进行多学科管理的热点问题的共识]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia20240823
G G Melkonyan, D N Protsenko, N K Runikhina, O N Tkacheva, A Sh Revishvili, S V Tsarenko, K A Eruslanova

The number of elderly and senile patients who are in need of surgical care delivery is growing steadily year over year. This category of patients is characterized by comorbidity, polypragmasy and high prevalence of geriatric syndromes including loss of autonomy, malnutrition and cognitive impairments that increase the risk of developing perioperative complications. Management of these patients at all stages requires a comprehensive multidisciplinary approach. Nevertheless, there is no uniform understanding of solution of this problem at present. Determination of consensus on certain issues using the Delphi method will allow to gather and unite expert opinions. In this regard, the working group formulated the main points of management of elderly and senile patients before, during and after surgical treatment and conducted a cross-sectional analysis of experts' opinions.

需要手术治疗的老年患者人数逐年稳步增长。这类患者的特点是合并症、多瘫和老年综合症高发,包括丧失自主能力、营养不良和认知障碍,这些都增加了围手术期并发症的风险。对这些患者各个阶段的管理都需要综合的多学科方法。然而,目前对这一问题的解决方案还没有统一的认识。使用德尔菲法就某些问题达成共识将有助于收集和统一专家意见。为此,工作组制定了老年患者手术治疗前、治疗中和治疗后的管理要点,并对专家意见进行了横向分析。
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引用次数: 0
[Morphological predictors of water-electrolyte disorders in patients with preventive ileostomy after rectal resection for cancer]. [癌症直肠切除术后预防性回肠造口术患者水电解质紊乱的形态学预测因素]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia202404116
A I Maksimkin, Z A Bagatelia, V M Kulushev, E N Gordienko, M S Lebedko, S S Anikina, E P Shin

Objective: To analyze morphological changes in wall of functioning and non-functioning small intestine in patients with preventive ileostomy and to determine histological predictors of water-electrolyte disorders.

Material and methods: We prospectively analyzed 57 patients >18 years old who underwent rectal resection with preventive ileostomy between January 2022 and November 2023. Anthropometric data included gender, age, body mass index, ECOG and ASA classes. Complications associated with large losses through ileostomy were water-electrolyte disorders, dehydration and acute renal failure with repeated hospitalization. Morphological analysis implied intraoperative full-layer biopsy of small intestine on anterior abdominal wall (ileostomy). Intraoperative biopsy of efferent and afferent loops was also carried out. Tissue samples were examined by light microscopy. We analyzed mean height of mucous membrane villi and depth of crypts, as well as their ratio. Fibrosis and swelling of submucosa were evaluated too. The results were analyzed in the SPSS Statistics 20 software.

Results: Mean height of intestinal villi <465 microns (p=0.028), ratio of their height to crypt depth <4.38 (p=0.034) and submucosal fibrosis (p=0.031) significantly affected malabsorption and readmission of patients. The risk of readmission was 11.5 and 5.5 times higher in univariate analysis. Multivariate analysis revealed in-hospital dehydration with resumption of infusion therapy as a predictor of readmission (p=0.046).

Conclusion: Ileostomy is a certain stress for the patient's body. Not every patient is able for adaptation. One of the adaptation mechanisms is hypertrophy of mucous membrane villi involved in digestion. This mechanism is less pronounced in patients with repeated hospitalizations. Preoperative morphological examination of ileum mucosa may be an additional objective predictor of possible complications of preventive ileostomy.

摘要分析预防性回肠造口术患者有功能和无功能小肠壁的形态学变化,并确定水电解质紊乱的组织学预测因素:我们对2022年1月至2023年11月期间接受直肠切除术并行预防性回肠造口术的57名年龄大于18岁的患者进行了前瞻性分析。人体测量数据包括性别、年龄、体重指数、ECOG 和 ASA 分级。通过回肠造口术造成大量流失的并发症包括水电解质紊乱、脱水和急性肾功能衰竭,需要反复住院治疗。形态学分析显示,术中对前腹壁(回肠造口)的小肠进行了全层活检。术中还对传出襻和传入襻进行了活检。组织样本经光学显微镜检查。我们分析了粘膜绒毛的平均高度、隐窝的深度及其比例。此外,还对黏膜下层的纤维化和肿胀进行了评估。结果用 SPSS 统计 20 软件进行分析:结果:肠绒毛平均高度(P=0.028)、肠绒毛高度与隐窝深度之比(P=0.034)和黏膜下纤维化(P=0.031)对患者吸收不良和再入院有显著影响。在单变量分析中,再次入院的风险分别高出 11.5 倍和 5.5 倍。多变量分析显示,恢复输液治疗后的院内脱水是再入院的预测因素(p=0.046):结论:回肠造口术对患者的身体有一定的压力。并非每位患者都能适应。适应机制之一是参与消化的粘膜绒毛肥大。这种机制在反复住院的患者中不那么明显。回肠粘膜的术前形态学检查可能是预防性回肠造口术可能出现并发症的另一个客观预测指标。
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引用次数: 0
[Mckittrick-Wheelock syndrome as a rare manifestation of villous adenoma of the rectum]. [作为直肠绒毛状腺瘤罕见表现的 Mckittrick-Wheelock 综合征]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia202403176
V E Khoronenko, V S Trifanov, N V Chebotareva, M Yu Meshcheryakova, M V Kosogolov

McKittrick-Wheelock syndrome is a rare disease when villous adenoma of the distal colon predisposes to profuse watery diarrhea with subsequent severe electrolyte disturbances and acute renal damage. A differentiated approach to correct diagnosis requires in-depth pathophysiological knowledge of regulation of water-electrolyte metabolism, functional and organic disorders of gastrointestinal tract and clinical manifestations of hypoosmolar dehydration. The peculiarity of the McKittrick-Wheelock syndrome is a 100% probability of death without treatment and complete regression of symptoms under complex correction of homeostasis and total resection of tumor. We demonstrate the main clinical trends of the McKittrick-Wheelock syndrome. This report may be useful for general practitioners, gastroenterologists, oncologists, nephrologists and anesthesiologists.

麦基特里克-韦洛克综合征(McKittrick-Wheelock Syndrome)是一种罕见的疾病,当远端结肠的绒毛状腺瘤易导致大量水样腹泻,随后出现严重的电解质紊乱和急性肾损伤。正确诊断需要对水电解质代谢调节、胃肠道功能性和器质性疾病以及低渗透压脱水的临床表现有深入的病理生理学了解。麦基特里克-韦洛克综合征的特殊性在于不经治疗死亡的可能性为100%,而在复杂的平衡调节和肿瘤全切除术后症状完全缓解。我们展示了麦基特里克-韦洛克综合征的主要临床趋势。这份报告可能对全科医生、消化科医生、肿瘤科医生、肾脏科医生和麻醉科医生有用。
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引用次数: 0
[Vascular reconstruction and transplantation technologies in liver surgery (part II)]. [肝脏手术中的血管重建和移植技术(第二部分)]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia202402124
S E Voskanyan, A I Artemiev, E V Naidenov, I Yu Kolyshev, M V Shabalin, A N Bashkov, D V Chursin, H A Subkhonov, D S Raspopov

Objective: To systematize tactical and technical aspects of liver resections with reconstruction of afferent and efferent blood supply and/or inferior vena cava; to study postoperative outcomes in patients with focal liver lesions using transplantation technologies.

Material and methods: We enrolled 413 patients with parasitic lesions, primary and secondary liver tumors involving great vessels (portal vein, hepatic artery, hepatic veins, inferior vena cava, right atrium). All ones underwent liver resections with vascular resection and reconstruction, as well as liver autotransplantation in vivo, ante situ (ex situ in vivo), extracorporeal liver resections with autotransplantation (ex vivo).

Results: We obtained satisfactory immediate results after liver resections using transplantation technologies.

Conclusion: Transplantation technologies in liver surgery can significantly increase resectability of tumors and survival of patients. Transplantation technologies are an important new surgical strategy and necessary option in modern hepatic surgery.

目的:对重建传入和传出血液供应和/或下腔静脉的肝脏切除术的战术和技术方面进行系统化研究;利用移植技术研究病灶性肝脏病变患者的术后效果:我们共招募了413名患有寄生性病变、原发性和继发性肝脏肿瘤并累及大血管(门静脉、肝动脉、肝静脉、下腔静脉、右心房)的患者。所有患者都接受了肝脏切除、血管切除和重建术,以及肝脏在体内、原位(体外原位)、体外肝脏切除和自体移植术(体外移植):结果:使用移植技术进行肝脏切除术后,我们立即获得了令人满意的效果:结论:移植技术在肝脏手术中的应用可显著提高肿瘤的切除率和患者的存活率。移植技术是一种重要的外科新策略,也是现代肝脏手术的必要选择。
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引用次数: 0
[Functional assessment of internal carotid artery tortuosity in patients with multifocal atherosclerosis]. [多灶性动脉粥样硬化患者颈内动脉迂曲的功能评估]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia2024051146
O I Zagorulko, L A Medvedeva, O V Drakina, E F Dutikova, S P Baidin

The review is devoted to diagnosis and treatment of internal carotid artery tortuosity. The authors consider modern classification, epidemiology and diagnostic options using neuroimaging or ultrasound-assisted functional stress tests depending on medical history and complaints. In addition to standard Doppler ultrasound, rotational and orthostatic tests are advisable due to possible changes of local shape and hemodynamic parameters following body position changes, especially in patients with concomitant atherosclerotic stenosis. Thus, a personalized approach is especially important for treatment and diagnostics of internal carotid artery tortuosity.

这篇综述专门讨论颈内动脉迂曲的诊断和治疗。作者根据病史和主诉,考虑了现代的分类、流行病学以及神经影像学或超声辅助功能压力测试的诊断方案。除了标准的多普勒超声检查外,由于体位变化可能导致局部形状和血液动力学参数发生变化,因此建议进行旋转和正位测试,尤其是对合并动脉粥样硬化性狭窄的患者。因此,个性化方法对于颈内动脉迂曲的治疗和诊断尤为重要。
{"title":"[Functional assessment of internal carotid artery tortuosity in patients with multifocal atherosclerosis].","authors":"O I Zagorulko, L A Medvedeva, O V Drakina, E F Dutikova, S P Baidin","doi":"10.17116/hirurgia2024051146","DOIUrl":"10.17116/hirurgia2024051146","url":null,"abstract":"<p><p>The review is devoted to diagnosis and treatment of internal carotid artery tortuosity. The authors consider modern classification, epidemiology and diagnostic options using neuroimaging or ultrasound-assisted functional stress tests depending on medical history and complaints. In addition to standard Doppler ultrasound, rotational and orthostatic tests are advisable due to possible changes of local shape and hemodynamic parameters following body position changes, especially in patients with concomitant atherosclerotic stenosis. Thus, a personalized approach is especially important for treatment and diagnostics of internal carotid artery tortuosity.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 5","pages":"146-151"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141089346","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}
引用次数: 0
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Khirurgiya
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