Pub Date : 2025-01-01DOI: 10.17116/hirurgia202501129
Yu I Vedenin, M I Turovets, V V Mandrikov, G V Mikhailichenko
Objective: To develop the personalized model for predicting the risk of acute pancreatitis after endoscopic transpapillary interventions.
Material and methods: A retrospective analysis of treatment outcomes included 366 patients with benign and malignant pancreaticobiliary diseases who underwent endoscopic transpapillary interventions. Risk factors associated with patients, underlying diseases and interventions were analyzed. Logistic regression analysis was used to present the personalized model for predicting the risk of acute pancreatitis.
Results: Female gender (p=0.028), age <40 years (p=0.001-0.018), calculous cholecystitis (p=0.010) and stenosis of the major duodenal papilla (p=0.008) are patient-associated risk factors of acute postoperative pancreatitis. Stenting of the main pancreatic duct and thoracic epidural analgesia reduced this risk by 6.5 and 4.6 times, respectively. We developed significant (p<0.001) regression model to determine the likelihood of acute post-manipulation pancreatitis.
Conclusion: Original prediction model is valuable to determine the risk of acute pancreatitis after endoscopic transpapillary interventions. This model justifies various methods to prevent this complication.
{"title":"[Personalized prediction of acute pancreatitis after endoscopic transpapillary interventions].","authors":"Yu I Vedenin, M I Turovets, V V Mandrikov, G V Mikhailichenko","doi":"10.17116/hirurgia202501129","DOIUrl":"10.17116/hirurgia202501129","url":null,"abstract":"<p><strong>Objective: </strong>To develop the personalized model for predicting the risk of acute pancreatitis after endoscopic transpapillary interventions.</p><p><strong>Material and methods: </strong>A retrospective analysis of treatment outcomes included 366 patients with benign and malignant pancreaticobiliary diseases who underwent endoscopic transpapillary interventions. Risk factors associated with patients, underlying diseases and interventions were analyzed. Logistic regression analysis was used to present the personalized model for predicting the risk of acute pancreatitis.</p><p><strong>Results: </strong>Female gender (<i>p</i>=0.028), age <40 years (<i>p</i>=0.001-0.018), calculous cholecystitis (<i>p</i>=0.010) and stenosis of the major duodenal papilla (<i>p</i>=0.008) are patient-associated risk factors of acute postoperative pancreatitis. Stenting of the main pancreatic duct and thoracic epidural analgesia reduced this risk by 6.5 and 4.6 times, respectively. We developed significant (<i>p</i><0.001) regression model to determine the likelihood of acute post-manipulation pancreatitis.</p><p><strong>Conclusion: </strong>Original prediction model is valuable to determine the risk of acute pancreatitis after endoscopic transpapillary interventions. This model justifies various methods to prevent this complication.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"29-36"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123607","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 : 2025-01-01DOI: 10.17116/hirurgia202502177
A P Vlasov, V A Trofimov, T I Vlasova, N A Myshkina, T A Muratova, N Y Leshchankina, K M Dukhovnova
<p><strong>Objective: </strong>To study several non-respiratory lung functions in conjunction with the respiratory component in acute abdominal diseases with different natures of the inflammatory process; to identify the key mechanisms of organ damage; and, based on the data, establish a new syndrome in urgent surgery-pulmonary distress syndrome-and evaluate the effectiveness of Remaxol in its treatment.</p><p><strong>Material and methods: </strong>Chronic experiments have been done on dogs. Under anesthesia, progressive acute peritonitis was simulated in the first group (24) (the first subgroup (12) received infusion therapy, the second subgroup (12) received Remaxol (20 mL/kg)), in the second group (8) acute destructive pancreatitis, in the third group (8) acute obstructive ileus. The treatment outcomes of 78 patients with acute surgical pathology of the abdomen were analyzed: 38 patients with acute peritonitis caused by destructive appendicitis, hollow viscus perforation (the first subgroup (16) received standard of care, in the second (22) Remaxol was added to the standard of care); 18 with acute severe pancreatitis complicated by enzymatic peritonitis, 22 with acute intestinal obstruction. Surgeries were performed on all the patients. The extension and type of the surgeries depended on the condition. In the early postoperative period (up to 5 days), several indicators of respiratory lung function were evaluated in the experiment and patients, and non-respiratory function was assessed using several indicators of arterial and venous blood. In the experiment, the state of lipid metabolism and the hemostasis system was assessed in lung tissues.</p><p><strong>Results: </strong>It was established that in acute abdominal diseases, lung damage occurs regardless of the nature of the inflammatory process. It manifested not only with changes in the homeostasis indicators due to modifications of the respiratory component but also non-respiratory functions of the organ. It was shown that the signs of the non-respiratory dysfunction of the lungs, as indicated by the parameters of blood inflowing to the lungs and outflowing from the lungs, included a deterioration in their detoxification and lipid-modifying ability and changes in the blood coagulation system. The key and unifying feature of respiratory and non-respiratory lung damage in various types of inflammatory processes are disorders of the lipid metabolism of lung cells. In the pathogenesis of membrane destabilization, the peroxidation of membrane lipids and the high activity of phospholipases play a decisive role. In the pathological process, a certain role is assigned to the tissue (pulmonary) coagulation-lytic system. The inclusion of Remaxol in the treatment of acute peritonitis increased lung tolerance to trigger pathogenetic agents, as indicated by improved laboratory and clinical parameters.</p><p><strong>Conclusion: </strong>Experimental and clinical evidence was obtained for establishing th
{"title":"[Pulmonary distress syndrome in urgent surgery: A concept, pathogenesis, and fundamentals of treatment].","authors":"A P Vlasov, V A Trofimov, T I Vlasova, N A Myshkina, T A Muratova, N Y Leshchankina, K M Dukhovnova","doi":"10.17116/hirurgia202502177","DOIUrl":"10.17116/hirurgia202502177","url":null,"abstract":"<p><strong>Objective: </strong>To study several non-respiratory lung functions in conjunction with the respiratory component in acute abdominal diseases with different natures of the inflammatory process; to identify the key mechanisms of organ damage; and, based on the data, establish a new syndrome in urgent surgery-pulmonary distress syndrome-and evaluate the effectiveness of Remaxol in its treatment.</p><p><strong>Material and methods: </strong>Chronic experiments have been done on dogs. Under anesthesia, progressive acute peritonitis was simulated in the first group (24) (the first subgroup (12) received infusion therapy, the second subgroup (12) received Remaxol (20 mL/kg)), in the second group (8) acute destructive pancreatitis, in the third group (8) acute obstructive ileus. The treatment outcomes of 78 patients with acute surgical pathology of the abdomen were analyzed: 38 patients with acute peritonitis caused by destructive appendicitis, hollow viscus perforation (the first subgroup (16) received standard of care, in the second (22) Remaxol was added to the standard of care); 18 with acute severe pancreatitis complicated by enzymatic peritonitis, 22 with acute intestinal obstruction. Surgeries were performed on all the patients. The extension and type of the surgeries depended on the condition. In the early postoperative period (up to 5 days), several indicators of respiratory lung function were evaluated in the experiment and patients, and non-respiratory function was assessed using several indicators of arterial and venous blood. In the experiment, the state of lipid metabolism and the hemostasis system was assessed in lung tissues.</p><p><strong>Results: </strong>It was established that in acute abdominal diseases, lung damage occurs regardless of the nature of the inflammatory process. It manifested not only with changes in the homeostasis indicators due to modifications of the respiratory component but also non-respiratory functions of the organ. It was shown that the signs of the non-respiratory dysfunction of the lungs, as indicated by the parameters of blood inflowing to the lungs and outflowing from the lungs, included a deterioration in their detoxification and lipid-modifying ability and changes in the blood coagulation system. The key and unifying feature of respiratory and non-respiratory lung damage in various types of inflammatory processes are disorders of the lipid metabolism of lung cells. In the pathogenesis of membrane destabilization, the peroxidation of membrane lipids and the high activity of phospholipases play a decisive role. In the pathological process, a certain role is assigned to the tissue (pulmonary) coagulation-lytic system. The inclusion of Remaxol in the treatment of acute peritonitis increased lung tolerance to trigger pathogenetic agents, as indicated by improved laboratory and clinical parameters.</p><p><strong>Conclusion: </strong>Experimental and clinical evidence was obtained for establishing th","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"77-85"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366155","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 : 2025-01-01DOI: 10.17116/hirurgia202503140
B M Belik, Z A Abduragimov, R Sh Tenchurin, A V Rodakov, S Yu Efanov
Objective: To improve surgical tactics for acute biliary pancreatitis.
Material and methods: Treatment outcomes were analyzed in 502 patients with acute biliary pancreatitis. Patients were divided into two groups depending on surgical tactics: control group (n=293) - standard diagnosis and treatment of biliary pancreatitis, main group (n=209) - treatment of biliary pancreatitis based on original algorithm. In these patients, therapeutic and diagnostic program included functional state of biliary tract and stratification of patients depending on severity of acute pancreatitis (APACHE II and Imrie/Glasgow scale) in addition to standard procedures.
Results: There are 2 fundamentally different clinical variants of ductal hypertension and biliary pancreatitis: with acute blockade of pancreatobiliary tract (obstructive variant) and without this blockade (non-obstructive variant). Each variant included various clinical forms of acute biliary pancreatitis etiologically associated with specific biliary disease. In the 2nd group, a differentiated surgical approach was applied taking into account clinical variant of biliary pancreatitis. The first stage implied correction of pancreatobiliary ductal hypertension through minimally invasive methods. At the second stage, radical surgical debridement of biliary tract was performed with elimination of etiological factor of biliary pancreatitis within the same hospitalization in patients with mild-to-moderate disease. In patients with severe biliary pancreatitis, the second stage of treatment was carried out 3 months after discharge. This treatment strategy reduced the number of infectious and inflammatory complications from 26.6% to 11.5%, mortality from 7.5% to 3.3% and avoid recurrent biliary pancreatitis.
Conclusion: Original therapeutic and diagnostic algorithm optimizes surgical strategy and improves the effectiveness of treatment of acute biliary pancreatitis.
目的：改善急性胆源性胰腺炎的手术策略：改进急性胆源性胰腺炎的手术策略：对 502 名急性胆源性胰腺炎患者的治疗结果进行分析。根据手术策略将患者分为两组：对照组（人数=293）--胆源性胰腺炎的标准诊断和治疗；主要组（人数=209）--根据原始算法治疗胆源性胰腺炎。在这些患者中，除了标准程序外，治疗和诊断方案还包括胆道功能状态以及根据急性胰腺炎的严重程度（APACHE II 和 Imrie/Glasgow 量表）对患者进行分层：结果：胆管高压和胆源性胰腺炎有两种根本不同的临床变体：胰胆管急性阻塞（阻塞性变体）和无阻塞（非阻塞性变体）。每种变体都包括与特定胆道疾病相关的急性胆源性胰腺炎的各种临床形式。在第二组中，考虑到胆源性胰腺炎的临床变异，采用了有区别的手术方法。第一阶段意味着通过微创方法矫正胰胆管高压。在第二阶段，对轻度至中度胆源性胰腺炎患者进行胆道根治性外科清创术，并在同一次住院中消除胆源性胰腺炎的致病因素。重症胆源性胰腺炎患者则在出院 3 个月后进行第二阶段治疗。这一治疗策略将感染和炎症并发症的发生率从26.6%降至11.5%，死亡率从7.5%降至3.3%，并避免了胆源性胰腺炎的复发：原创的治疗和诊断算法优化了手术策略，提高了急性胆源性胰腺炎的治疗效果。
{"title":"[Improvement of surgical strategy for acute biliary pancreatitis].","authors":"B M Belik, Z A Abduragimov, R Sh Tenchurin, A V Rodakov, S Yu Efanov","doi":"10.17116/hirurgia202503140","DOIUrl":"10.17116/hirurgia202503140","url":null,"abstract":"<p><strong>Objective: </strong>To improve surgical tactics for acute biliary pancreatitis.</p><p><strong>Material and methods: </strong>Treatment outcomes were analyzed in 502 patients with acute biliary pancreatitis. Patients were divided into two groups depending on surgical tactics: control group (<i>n</i>=293) - standard diagnosis and treatment of biliary pancreatitis, main group (<i>n</i>=209) - treatment of biliary pancreatitis based on original algorithm. In these patients, therapeutic and diagnostic program included functional state of biliary tract and stratification of patients depending on severity of acute pancreatitis (APACHE II and Imrie/Glasgow scale) in addition to standard procedures.</p><p><strong>Results: </strong>There are 2 fundamentally different clinical variants of ductal hypertension and biliary pancreatitis: with acute blockade of pancreatobiliary tract (obstructive variant) and without this blockade (non-obstructive variant). Each variant included various clinical forms of acute biliary pancreatitis etiologically associated with specific biliary disease. In the 2<sup>nd</sup> group, a differentiated surgical approach was applied taking into account clinical variant of biliary pancreatitis. The first stage implied correction of pancreatobiliary ductal hypertension through minimally invasive methods. At the second stage, radical surgical debridement of biliary tract was performed with elimination of etiological factor of biliary pancreatitis within the same hospitalization in patients with mild-to-moderate disease. In patients with severe biliary pancreatitis, the second stage of treatment was carried out 3 months after discharge. This treatment strategy reduced the number of infectious and inflammatory complications from 26.6% to 11.5%, mortality from 7.5% to 3.3% and avoid recurrent biliary pancreatitis.</p><p><strong>Conclusion: </strong>Original therapeutic and diagnostic algorithm optimizes surgical strategy and improves the effectiveness of treatment of acute biliary pancreatitis.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"40-47"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658835","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 : 2025-01-01DOI: 10.17116/hirurgia202501154
L P Kotelnikova, S A Plaksin
Objective: To evaluate the effectiveness of surgical approach for resection of retrosternal and intrathoracic goiter.
Material and methods: There were 33 patients who underwent surgery for retrosternal (31) and intrathoracic goiter (2) through various surgical approaches. For retrosternal goiter, a Farabeuf hook was used to remove a large retrosternal component of tumor.
Results: In 28 cases (84.8%), substernal goiter was resected through cervical collar incision. In 4 cases, a Farabeuf hook was used to extract retrosternal part of the goiter to the neck and avoid sternotomy. In one case, a combined approach was used (thoracoscopy and cervical collar incision). Sternotomy was performed in only one patient for suspected thyroid malignancy. In two patients with tumors of posterior mediastinum, intrathoracic goiter was removed through thoracoscopic access.
Conclusion: Cervical collar incision allows resection of retrosternal goiter in 84.4% of cases. Retrosternal part can be effectively displaced to the neck wound using a Farabeuf hook. Thoracoscopy is preferable for removal of intrathoracic goiter and can be used to mobilize a large node in mediastinum as an alternative to sternotomy.
{"title":"[Surgical access for thoracic and intrathoracic goiter].","authors":"L P Kotelnikova, S A Plaksin","doi":"10.17116/hirurgia202501154","DOIUrl":"10.17116/hirurgia202501154","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness of surgical approach for resection of retrosternal and intrathoracic goiter.</p><p><strong>Material and methods: </strong>There were 33 patients who underwent surgery for retrosternal (31) and intrathoracic goiter (2) through various surgical approaches. For retrosternal goiter, a Farabeuf hook was used to remove a large retrosternal component of tumor.</p><p><strong>Results: </strong>In 28 cases (84.8%), substernal goiter was resected through cervical collar incision. In 4 cases, a Farabeuf hook was used to extract retrosternal part of the goiter to the neck and avoid sternotomy. In one case, a combined approach was used (thoracoscopy and cervical collar incision). Sternotomy was performed in only one patient for suspected thyroid malignancy. In two patients with tumors of posterior mediastinum, intrathoracic goiter was removed through thoracoscopic access.</p><p><strong>Conclusion: </strong>Cervical collar incision allows resection of retrosternal goiter in 84.4% of cases. Retrosternal part can be effectively displaced to the neck wound using a Farabeuf hook. Thoracoscopy is preferable for removal of intrathoracic goiter and can be used to mobilize a large node in mediastinum as an alternative to sternotomy.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"54-61"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123679","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 : 2025-01-01DOI: 10.17116/hirurgia202502186
A M Zainutdinov, I S Malkov, A V Berdnikov
Objective: To improve the treatment of patients with infected pancreatic necrosis by using non-contact ultrasound treatment of purulent-necrotic foci (NUST).
Material and methods: We analyzed the results of treatment of 39 patients with infected pancreatic necrosis, admitted to the surgical department No. 2 of the City Clinical Hospital No. 7 in Kazan from 2017 to 2021. The central method of their surgical treatment was open draining operations combined with sequestrectomy. The study group consisted of 20 patients (4 women, 16 men) aged from 39 to 60 years (mean age - 49±9.5 years). In this group, the effectiveness of non-contact ultrasound treatment of purulent-necrotic foci using the SONOCA-185 apparatus was studied.
Results: The application of ultrasound treatment of purulent foci of infected pancreatic necrosis in the study group allowed to increase their drainage effectiveness, which was reflected in the dynamics of reparative-proliferative process and relief of systemic inflammatory reaction. Wound healing occurred on the 7-9 day (on average, on the 7.6±2th day) without resuturing.
The pronounced bactericidal effect of low-frequency ultrasound and its phonophoretic effect are confirmed by the reduction of microbial content of wounds and cavities from 105 CFU and 104 CFU to 102 CFU after 3 sessions.
The sparing ultrasound sequestrectomy allows to remove only devitalized tissues, without causing destructions of the ductal system, vascular wall and hollow organs.
Ultrasound treatment of cavities in the study group resulted in a pronounced increase in transparency indicators and its approximation to reference solution, decreased peripheral blood leukocytosis, temperature reaction in patients on the 3rd, 7th, 12th days compared to the control group, where the temperature response is maintained at this time, and reduction in hospitalization duration on the 2.6±1 day in the study group of patients.
{"title":"[The use of low-frequency ultrasound in the treatment of patients with infected pancreatic necrosis].","authors":"A M Zainutdinov, I S Malkov, A V Berdnikov","doi":"10.17116/hirurgia202502186","DOIUrl":"10.17116/hirurgia202502186","url":null,"abstract":"<p><strong>Objective: </strong>To improve the treatment of patients with infected pancreatic necrosis by using non-contact ultrasound treatment of purulent-necrotic foci (NUST).</p><p><strong>Material and methods: </strong>We analyzed the results of treatment of 39 patients with infected pancreatic necrosis, admitted to the surgical department No. 2 of the City Clinical Hospital No. 7 in Kazan from 2017 to 2021. The central method of their surgical treatment was open draining operations combined with sequestrectomy. The study group consisted of 20 patients (4 women, 16 men) aged from 39 to 60 years (mean age - 49±9.5 years). In this group, the effectiveness of non-contact ultrasound treatment of purulent-necrotic foci using the SONOCA-185 apparatus was studied.</p><p><strong>Results: </strong>The application of ultrasound treatment of purulent foci of infected pancreatic necrosis in the study group allowed to increase their drainage effectiveness, which was reflected in the dynamics of reparative-proliferative process and relief of systemic inflammatory reaction. Wound healing occurred on the 7-9 day (on average, on the 7.6±2<sup>th</sup> day) without resuturing.</p><p><p>The pronounced bactericidal effect of low-frequency ultrasound and its phonophoretic effect are confirmed by the reduction of microbial content of wounds and cavities from 105 CFU and 104 CFU to 102 CFU after 3 sessions.</p><p><p>The sparing ultrasound sequestrectomy allows to remove only devitalized tissues, without causing destructions of the ductal system, vascular wall and hollow organs.</p><p><p>Ultrasound treatment of cavities in the study group resulted in a pronounced increase in transparency indicators and its approximation to reference solution, decreased peripheral blood leukocytosis, temperature reaction in patients on the 3<sup>rd</sup>, 7<sup>th</sup>, 12<sup>th</sup> days compared to the control group, where the temperature response is maintained at this time, and reduction in hospitalization duration on the 2.6±1 day in the study group of patients.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"86-93"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366163","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 : 2025-01-01DOI: 10.17116/hirurgia202507159
V I Panteleev, A G Kriger, N L Shimanovsky
In recent years, active development of artificial intelligence (AI) leads to its widespread introduction into various spheres of human activity, including healthcare and surgery. The ongoing research of AI in surgery is aimed at potential benefits of AI at all stages of examination and treatment of patients. The ultimate goal is improvement of quality, effectiveness and safety of treatment. This review examines the main directions of AI (machine learning, natural language processing, artificial neural networks, computer vision) and provides examples of their current use including reducing the risks of polypharmacy in perioperative period. The prospects for further development of AI in surgery and possible risks associated with this technology are also discussed.
{"title":"[Artificial intelligence in surgery. Reducing the risks related to polypharmacy in perioperative period].","authors":"V I Panteleev, A G Kriger, N L Shimanovsky","doi":"10.17116/hirurgia202507159","DOIUrl":"https://doi.org/10.17116/hirurgia202507159","url":null,"abstract":"<p><p>In recent years, active development of artificial intelligence (AI) leads to its widespread introduction into various spheres of human activity, including healthcare and surgery. The ongoing research of AI in surgery is aimed at potential benefits of AI at all stages of examination and treatment of patients. The ultimate goal is improvement of quality, effectiveness and safety of treatment. This review examines the main directions of AI (machine learning, natural language processing, artificial neural networks, computer vision) and provides examples of their current use including reducing the risks of polypharmacy in perioperative period. The prospects for further development of AI in surgery and possible risks associated with this technology are also discussed.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 7","pages":"59-66"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545118","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 : 2025-01-01DOI: 10.17116/hirurgia202507181
E B Topolnitskiy, A B Yushmanova, V G Pogorelko, S D Ivanov
Acquired cicatricial stenosis in children most often occurs in subglottic region of the larynx and cervical trachea. It is associated with prolonged intubation and tracheostomy. Optimal surgical correction of cicatricial stenosis and treatment algorithm in standard cases in adults are largely determined. However, there are no clear criteria for surgical options in children. In most cases, surgical treatment of acquired cicatricial stenosis of the larynx and trachea in children under primary school age implies intraluminal endoscopic recanalization and reconstruction of cicatricial tissue for adequate breathing. We present circular tracheal resection in a 9-year-old child with post-tracheostomy cicatricial stenosis of the trachea and tracheomalacia, as well as features of perioperative support.
{"title":"[Circular tracheal resection in a 9-year-old child with posttracheotomy cicatricial stenosis with tracheomalacia: the first experience in the Siberian Federal District].","authors":"E B Topolnitskiy, A B Yushmanova, V G Pogorelko, S D Ivanov","doi":"10.17116/hirurgia202507181","DOIUrl":"10.17116/hirurgia202507181","url":null,"abstract":"<p><p>Acquired cicatricial stenosis in children most often occurs in subglottic region of the larynx and cervical trachea. It is associated with prolonged intubation and tracheostomy. Optimal surgical correction of cicatricial stenosis and treatment algorithm in standard cases in adults are largely determined. However, there are no clear criteria for surgical options in children. In most cases, surgical treatment of acquired cicatricial stenosis of the larynx and trachea in children under primary school age implies intraluminal endoscopic recanalization and reconstruction of cicatricial tissue for adequate breathing. We present circular tracheal resection in a 9-year-old child with post-tracheostomy cicatricial stenosis of the trachea and tracheomalacia, as well as features of perioperative support.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 7","pages":"81-86"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545120","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 : 2025-01-01DOI: 10.17116/hirurgia202509187
M A Chernykh, A M Belousov, K G Shostka
Objective: To evaluate diagnostic significance of IL-6 compared to CRP for early detection of anastomotic leakage after colon resection for colorectal cancer.
Material and methods: The study included 277 patients who underwent total resection for colorectal cancer. Patients were retrospectively divided into three groups: without complications (n=227), with anastomotic leakage (n=30), and other postoperative complications (n=20). CRP and IL-6 were measured daily for 5 postoperative days. Dynamics of markers and their diagnostic significance were estimated using ROC analysis.
Results: Serum IL-6 in patients with anastomotic leakage reached significant values after 2 postoperative days (AUC=0.872, cut-off=51.2 pg/ml, sensitivity 79.3%, specificity 89.1%) and maximum after 3 days (AUC=0.949, cut-off=66.4 pg/ml, sensitivity 80.0%, specificity 96.8%). CRP demonstrated diagnostically significant values after 3-4 days (AUC=0.875 after 3 days and 0.926 after 4 days). Dynamics of IL-6 after intervention for anastomotic leakage indicated advisability of this marker to assess the quality of abdominal debridement.
Conclusion: IL-6 is a perspective early marker of anastomotic leakage with high sensitivity and specificity after 2 days. This significantly reduces the diagnostic time compared to CRP. IL-6 can optimize postoperative management of patients contributing to early detection of complications and timely intervention.
{"title":"[Interleukin-6 as a biochemical marker of intestinal anastomotic leakage].","authors":"M A Chernykh, A M Belousov, K G Shostka","doi":"10.17116/hirurgia202509187","DOIUrl":"https://doi.org/10.17116/hirurgia202509187","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate diagnostic significance of IL-6 compared to CRP for early detection of anastomotic leakage after colon resection for colorectal cancer.</p><p><strong>Material and methods: </strong>The study included 277 patients who underwent total resection for colorectal cancer. Patients were retrospectively divided into three groups: without complications (<i>n</i>=227), with anastomotic leakage (<i>n</i>=30), and other postoperative complications (<i>n</i>=20). CRP and IL-6 were measured daily for 5 postoperative days. Dynamics of markers and their diagnostic significance were estimated using ROC analysis.</p><p><strong>Results: </strong>Serum IL-6 in patients with anastomotic leakage reached significant values after 2 postoperative days (AUC=0.872, cut-off=51.2 pg/ml, sensitivity 79.3%, specificity 89.1%) and maximum after 3 days (AUC=0.949, cut-off=66.4 pg/ml, sensitivity 80.0%, specificity 96.8%). CRP demonstrated diagnostically significant values after 3-4 days (AUC=0.875 after 3 days and 0.926 after 4 days). Dynamics of IL-6 after intervention for anastomotic leakage indicated advisability of this marker to assess the quality of abdominal debridement.</p><p><strong>Conclusion: </strong>IL-6 is a perspective early marker of anastomotic leakage with high sensitivity and specificity after 2 days. This significantly reduces the diagnostic time compared to CRP. IL-6 can optimize postoperative management of patients contributing to early detection of complications and timely intervention.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 9","pages":"87-93"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024369","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 : 2025-01-01DOI: 10.17116/hirurgia202509178
I P Mikhailov, V A Arustamyan, B V Kozlovsky, L S Kokov
Objective: To analyze and improve postoperative outcomes in patients with acute lower limb ischemia (ALLI) and previous reconstructive infrainguinal interventions.
Material and methods: The authors analyzed postoperative outcomes after 54 repeated interventions in patients with thrombosis of common femoral artery bifurcation, deep femoral artery and non-functioning femoropopliteal (tibial) prosthesis.
Results: External-iliac-deep femoral replacement were performed in 28 (52%) patients, extended deep femoral artery repair - in 16 (29.6%), aorto(iliac)-deep femoral replacement - in 8 (14.8%) cases.
Conclusion: External-iliac-deep femoral replacement is a preferable and effective method to restore pulsatile blood flow in deep femoral artery.
{"title":"[Repeated common femoral artery bifurcation repair in patients with acute lower limb ischemia and unsatisfactory outflow pathways].","authors":"I P Mikhailov, V A Arustamyan, B V Kozlovsky, L S Kokov","doi":"10.17116/hirurgia202509178","DOIUrl":"https://doi.org/10.17116/hirurgia202509178","url":null,"abstract":"<p><strong>Objective: </strong>To analyze and improve postoperative outcomes in patients with acute lower limb ischemia (ALLI) and previous reconstructive infrainguinal interventions.</p><p><strong>Material and methods: </strong>The authors analyzed postoperative outcomes after 54 repeated interventions in patients with thrombosis of common femoral artery bifurcation, deep femoral artery and non-functioning femoropopliteal (tibial) prosthesis.</p><p><strong>Results: </strong>External-iliac-deep femoral replacement were performed in 28 (52%) patients, extended deep femoral artery repair - in 16 (29.6%), aorto(iliac)-deep femoral replacement - in 8 (14.8%) cases.</p><p><strong>Conclusion: </strong>External-iliac-deep femoral replacement is a preferable and effective method to restore pulsatile blood flow in deep femoral artery.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 9","pages":"78-86"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024372","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 : 2025-01-01DOI: 10.17116/hirurgia202510242
O V Dymova, A P Petrikina, N V Menshikh, B A Akselrod, V A Svetlov, I I Eremin
Background: Microcirculation disorders are common in cardiac surgery patients who underwent cardiopulmonary bypass (CPB). The impact of various damaging factors and microcirculation disorders cause structural changes in the endothelium, disrupting its cellular interactions and functions. The level of circulating endothelial cells (CECs) in the blood, determined by flow cytometry, can act as a direct cellular marker of endothelial damage and microcirculatory disorders.
Objective: To assess the possibility of flow cytometry application in order to determine circulating endothelial cells in cardiac surgery patients who were operated on CPB.
Material and methods: Blood samples of 9 cardiac surgery patients operated on CPB were investigated by flow cytometry in two replicates at 3 stages: before starting surgery, immediately after surgery and 6 hours after surgery. Using ModelFlower software, (2-4)·106 events per sample were collected and analyzed. CECs were defined as CD45dim CD34+CD31+CD146+CD133- among peripheral blood leukocytes.
Results: The level of CECs (n=9) in the peripheral blood amounted to 0.0046 [0.0020; 0.0171] % before surgery, 0.0052 [0.0020; 0.0220] % immediately after surgery and 0.0051 [0.0024-0.0184] % 6 hours after surgery (p>0.05). The absolute count of CECs in the peripheral blood was 153.5 [109.13; 247.38] c/ml before surgery. After surgery, a tendency to increase in the absolute count of CECs has been observed: 360.5 [166.5; 1228.5] c/ml - immediately after and 339 [241.38; 1033.13] c/ml - 6 hours after the surgery. Statistically significant differences were not found (p>0.05), which is most likely due to the small sample size.
Conclusion: Determination of the circulating endothelial cell level has demonstrated a tendency to increase after surgery, which may correspond to the degree of damage to the endothelium after surgery performed on CPB.
{"title":"[Possibilities of flow cytometry application for assessment of endothelial dysfunction in cardiac surgery].","authors":"O V Dymova, A P Petrikina, N V Menshikh, B A Akselrod, V A Svetlov, I I Eremin","doi":"10.17116/hirurgia202510242","DOIUrl":"https://doi.org/10.17116/hirurgia202510242","url":null,"abstract":"<p><strong>Background: </strong>Microcirculation disorders are common in cardiac surgery patients who underwent cardiopulmonary bypass (CPB). The impact of various damaging factors and microcirculation disorders cause structural changes in the endothelium, disrupting its cellular interactions and functions. The level of circulating endothelial cells (CECs) in the blood, determined by flow cytometry, can act as a direct cellular marker of endothelial damage and microcirculatory disorders.</p><p><strong>Objective: </strong>To assess the possibility of flow cytometry application in order to determine circulating endothelial cells in cardiac surgery patients who were operated on CPB.</p><p><strong>Material and methods: </strong>Blood samples of 9 cardiac surgery patients operated on CPB were investigated by flow cytometry in two replicates at 3 stages: before starting surgery, immediately after surgery and 6 hours after surgery. Using ModelFlower software, (2-4)·10<sup>6</sup> events per sample were collected and analyzed. CECs were defined as CD45dim CD34+CD31+CD146+CD133- among peripheral blood leukocytes.</p><p><strong>Results: </strong>The level of CECs (<i>n</i>=9) in the peripheral blood amounted to 0.0046 [0.0020; 0.0171] % before surgery, 0.0052 [0.0020; 0.0220] % immediately after surgery and 0.0051 [0.0024-0.0184] % 6 hours after surgery (<i>p</i>>0.05). The absolute count of CECs in the peripheral blood was 153.5 [109.13; 247.38] c/ml before surgery. After surgery, a tendency to increase in the absolute count of CECs has been observed: 360.5 [166.5; 1228.5] c/ml - immediately after and 339 [241.38; 1033.13] c/ml - 6 hours after the surgery. Statistically significant differences were not found (<i>p</i>>0.05), which is most likely due to the small sample size.</p><p><strong>Conclusion: </strong>Determination of the circulating endothelial cell level has demonstrated a tendency to increase after surgery, which may correspond to the degree of damage to the endothelium after surgery performed on CPB.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 10. Vyp. 2","pages":"42-47"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145597911","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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