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[Intraductal radiofrequency ablation under endosonography and cholangioscopy for residual adenoma of the major duodenal papilla with intraductal component]. [在内窥镜和胆道镜下进行导管内射频消融术治疗十二指肠大乳头伴导管内残留腺瘤]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia2024051138
Yu G Starkov, A I Vagapov, R D Zamolodchikov, S V Dzhantukhanova, D D Avdeeva

All adenomas of the major duodenal papilla (MDP) require resection regardless of morphological structure due to high risk of malignancy. Currently, intraluminal endoscopic interventions are preferable for these adenomas. MDP neoplasms with intraductal spread (type III and IV) are of particular difficulty for endoscopic techniques. Intraductal radiofrequency ablation provides new opportunities for minimally invasive treatment of patients with MDP adenomas and intraductal component. A 72-year-old patient after previous endoscopic papillectomy for MDP adenoma admitted to the Vishnevsky National Research Medical Center of Surgery due to residual adenomatous growths within the papillectomy zone extending to the common bile duct throughout 13 mm. The patient underwent intraductal RFA under endosonography and cholangioscopy. Despite difficult localization of residual growths extending to the common bile duct, endosonography-guided intraductal RFA provided total destruction of residual tumor that was confirmed by cholangioscopy. Length of treatment was 4 months, relapse-free period - 10 months. Minimally invasive endoscopic technology for residual MDP adenoma provided good clinical results.

所有十二指肠大乳头腺瘤(MDP)都需要切除,无论其形态结构如何,因为恶变风险很高。目前,腔内内镜介入治疗是治疗这些腺瘤的首选方法。导管内扩散的 MDP 肿瘤(III 型和 IV 型)对内镜技术来说尤其困难。导管内射频消融术为微创治疗伴有导管内成分的MDP腺瘤患者提供了新的机会。一位72岁的患者曾因MDP腺瘤接受过内镜乳头切除术,后因乳头切除区内残留的腺瘤生长延伸至总胆管13毫米而入住维什涅夫斯基国立外科医学研究中心。患者在内窥镜和胆道镜下接受了导管内射频消融术。尽管很难定位延伸至胆总管的残余肿瘤,但内镜引导下的导管内射频消融术完全摧毁了残余肿瘤,胆道镜检查证实了这一点。治疗时间为4个月,无复发期为10个月。微创内镜技术治疗残余MDP腺瘤取得了良好的临床效果。
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引用次数: 0
[Implementation of fluorescent imaging technology in endovideosurgical treatment of colorectal endometriosis]. [荧光成像技术在大肠子宫内膜异位症腔内视频手术治疗中的应用]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia2024051129
A K Politova, M I Rokhlina, Yu E Puchkova, I V Vashkevich, K Yu Belichuk

The article includes a clinical case of a patient with deep infiltrating endometriosis with rectum involving and using intraoperative controlled fluorescence in order to increase the radicality of surgery and improve the prognosis of the disease. Surgical excision of the endometrioitic nodules is the only effective way of treating patients with colorectal endometriosis in terms of relieving pain, improving quality of life and restoring reproductive function. The possible types of surgical interventions can be performed: endometrioid lesion shaving, discoid or circular intestinal resection with anastomosis. The extent of the operation is determined by the following morphological parameters: the number of endometrioid infiltrates of the intestinal wall, the size of each of them, the degree of involvement of the intestine circumference, the depth of the intestinal wall lesion, the distance from the level of anus to the endometriotic nodule and lymphatic dissemination.

文章收录了一例直肠深部浸润性子宫内膜异位症患者的临床病例,采用术中可控荧光技术,以提高手术的根治性,改善疾病的预后。手术切除子宫内膜异位结节是治疗结肠直肠子宫内膜异位症患者的唯一有效方法,可以缓解疼痛、改善生活质量和恢复生育功能。可以采取的手术治疗方式有:子宫内膜样病灶刮除、盘状或环状肠切除并吻合。手术范围由以下形态参数决定:肠壁子宫内膜样浸润的数量、每个浸润的大小、肠周受累的程度、肠壁病变的深度、肛门到子宫内膜样结节的距离以及淋巴播散情况。
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引用次数: 0
[Clinical and economic justification of icg-cholangiography in «difficult» laparoscopic cholecystectomy]. [在 "困难 "腹腔镜胆囊切除术中使用冰胆管造影术的临床和经济理由]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia2024041105
P N Romashchenko, A K Aliev, A S Pryadko, Sh Yu Abasov, N A Maistrenko

Objective: To prove from a clinical and economic point of view the expediency of using ICG cholangiography in patients with «difficult» laparoscopic cholecystectomy for the prevention of damage to the bile ducts.

Material and methods: The results of treatment of 173 patients with cholelithiasis at various levels of health care providing were analyzed with regard to assessment of indicators of surgery complexity, developed complications and economic costs.

Results: The effectiveness of the original scale of «difficult» laparoscopic cholecystectomy has been proved. The financial and economic costs of treatment of patients with damage of biliary ducts and patients with cholelithiasis without development of complications have been analyzed and evaluated. A comparative description of financial costs for patients with «difficult» laparoscopic cholecystectomy with the use of ICG-cholangiography has been given. A program on care delivery for patients suffering from cholelithiasis in the conditions of region with regard to safety and economic effectiveness has been developed.

Conclusion: The implementation of this program provides the minimization of postoperative complications and fatality at all levels of surgical care delivery. It has been established that a rational approach to reducing the number of biliary ducts damages is their prevention by prediction of «difficult» laparoscopic cholecystectomy and performance of such interventions in medical organizations of III level with the possibility of modern technologies use.

目的从临床和经济角度证明在 "疑难 "腹腔镜胆囊切除术患者中使用ICG胆管造影术预防胆管损伤的有效性:分析了各级医疗机构对173名胆石症患者的治疗结果,评估了手术复杂程度、并发症发生情况和经济成本等指标:结果:"高难度 "腹腔镜胆囊切除术原定标准的有效性已得到证实。对胆管受损患者和未出现并发症的胆石症患者治疗的经济和经济成本进行了分析和评估。对使用 ICG-cholangiography 进行 "高难度 "腹腔镜胆囊切除术的患者的经济成本进行了比较说明。结论:在该地区条件下为胆石症患者提供安全、经济有效的护理方案:结论:该方案的实施可最大限度地减少各级手术护理的术后并发症和死亡率。通过预测 "高难度 "腹腔镜胆囊切除术,并在可能使用现代技术的三级医疗机构中实施此类干预措施,减少胆管损伤数量的合理方法已经确立。
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引用次数: 0
[Methodological recommendations for surgical care in patients with hemophilia A receiving prophylactic therapy with emicizumab]. [关于接受埃米珠单抗预防性治疗的 A 型血友病患者外科护理的方法学建议]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia20240323
T A Andreeva, P A Zharkov, N I Zozulya, V Y Zorenko, V N Konstantinova, I N Lavrentieva, I L Davydkin, V Y Petrov, T Yu Polyanskaya, V E Soldatenkov, S A Shutov

Methodological recommendations for surgical care in patients with hemophilia A receiving prophylactic therapy with emicizumab. Recommendations of the expert group. Moscow, 2024.

对接受埃米珠单抗预防性治疗的 A 型血友病患者进行外科护理的方法学建议。专家组建议。莫斯科,2024 年。
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引用次数: 0
[Treatment of primary malignant melanoma of the esophagus]. [食道原发性恶性黑色素瘤的治疗]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia2024041118
D V Erygin, I A Sklyar, Yu S Esakov, D V Ruchkin, I Yu Nedoluzhko, V N Galkin

Objective: To present treatment of primary esophageal melanoma in a young patient, as well as review of modern data on this issue.

Material and methods: We describe the results of treatment of a patient with primary melanoma of the esophagus. PubMed, SCOPUS, and elibrary databases were used for the review.

Results: We present a rare case of primary esophageal melanoma and variant of radical surgical treatment. The review is devoted to historical information about this nosology, statistical data, options for diagnosis and treatment.

Conclusion: Such a rare clinical case is of great scientific interest due to the rarity of this disease. In our opinion, a certain register of orphan malignant tumors is necessary for diagnosis and treatment of various rare malignancies.

摘要介绍一名年轻患者原发性食管黑色素瘤的治疗方法,并回顾有关这一问题的现代数据:我们描述了一名食道原发性黑色素瘤患者的治疗结果。研究使用了 PubMed、SCOPUS 和 elibrary 数据库:我们介绍了一例罕见的原发性食管黑色素瘤和根治性手术治疗的变异。结果:我们介绍了一个罕见的原发性食管黑色素瘤病例和根治性手术治疗的变体,综述内容包括该病种的历史信息、统计数据、诊断和治疗方案:结论:由于这种疾病的罕见性,这种罕见的临床病例具有极大的科学意义。我们认为,有必要对孤儿恶性肿瘤进行一定的登记,以便诊断和治疗各种罕见恶性肿瘤。
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引用次数: 0
[Oxidative toxemia, hypoxia and intra-abdominal hypertension in acute pancreatitis]. [急性胰腺炎中的氧化毒血症、缺氧和腹内高压]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia202411138
M K Gulov, K R Ruziboyzoda, E Sh Nosirov, S G Ali-Zade, B I Safarov

Objective: To study the changes in indicators of oxidative toxemia, hypoxia and intra-abdominal hypertension in various forms of acute pancreatitis.

Material and methods: The results of complex diagnostics in 62 patients with various forms of acute pancreatitis were analyzed. We estimated the indicators of oxidative status, hypoxia and intra-abdominal hypertension. Edematous pancreatitis was diagnosed in 35 (56.5%) patients, destructive acute pancreatitis - in 27 (43.5%) patients (sterile pancreatic necrosis in 14 (22.6%) patients, and infected pancreatic necrosis in 13 (20.9%) patients).

Results: Progression of disease is followed by active lipid peroxidation with accumulation of conjugated dienes and malondialdehyde, as well as increase in serum lactate and pyruvate levels. Intra-abdominal pressure increases with progression of disease and destructive processes. There was direct correlation between intra-abdominal pressure and clinical form of acute pancreatitis (r=0.8033, p<0.001). The same was true for intra-abdominal pressure and indicators of oxidative toxemia (conjugated dienes - p<0.001, malondialdehyde - p<0.001) and hypoxia (lactate - p<0.001, pyruvate - p<0.001, and hypoxia coefficient - p<0.001).

Conclusion: A comprehensive examination of patients with acute pancreatitis allows to analyze lipid peroxidation, hypoxia and intra-abdominal hypertension. These parameters depend on clinical form of disease.

摘要研究各种急性胰腺炎患者氧化毒血症、缺氧和腹内高压指标的变化:对 62 例不同形式急性胰腺炎患者的综合诊断结果进行分析。我们估算了氧化状态、缺氧和腹内高压的指标。35(56.5%)名患者被诊断为水肿性胰腺炎,27(43.5%)名患者被诊断为破坏性急性胰腺炎(14(22.6%)名患者被诊断为无菌性胰腺坏死,13(20.9%)名患者被诊断为感染性胰腺坏死):结果:随着病情的发展,脂质过氧化反应活跃,共轭二烯和丙二醛积累,血清乳酸和丙酮酸水平升高。腹内压会随着疾病的进展和破坏过程而增加。腹内压与急性胰腺炎的临床表现直接相关(r=0.8033,ppppp结论:对急性胰腺炎患者进行全面检查可以分析脂质过氧化、缺氧和腹内高压。这些参数取决于疾病的临床形式。
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引用次数: 0
[Acute appendicitis in adults]. [成人急性阑尾炎]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia20241115
A V Sazhin, A A Gulyaev, A S Ermolov, I I Zatevakhin, G B Ivakhov, A I Kirienko, M A Kurtser, O E Lutsevich, S V Mosin, T V Nechay, M I Prudkov, D A Son, E A Stradymov, A E Tyagunov, A V Fedorov, A M Shulutko, G D Shulyak

Acute appendicitis in adults. Clinical guidelines.

成人急性阑尾炎。临床指南。
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引用次数: 0
[Foreign body of the thyroid gland]. [甲状腺异物]
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia2024101102
Yu K Aleksandrov, V I Semikov, G A Baranov, A M Shulutko

A rare case of thyroid foreign body is presented. The swallowed fish bone perforated the pharyngeal wall and migrated to the thyroid gland. The rarity of pathology caused diagnostic difficulties. Despite the correct diagnosis, wait-and-see tactics was initially chosen that delayed surgery and contributed to tissue inflammation. The stages of therapeutic and diagnostic process are analyzed. Endoscopy is not always effective, especially when foreign body migrates from pharyngeal lumen into soft tissues. Ultrasound and CT are necessary for topical diagnosis of migrated foreign body. These methods revealed fish bone migration towards cervical vascular bundle and local complications. Literature data and own experience are analyzed. Early surgical treatment guarantees good results and rapid rehabilitation.

这是一例罕见的甲状腺异物病例。吞下的鱼骨刺穿了咽壁并移至甲状腺。病理的罕见性造成了诊断上的困难。尽管诊断正确,但医生最初还是选择了观望策略,这不仅延误了手术,还导致了组织炎症。本文分析了治疗和诊断过程的各个阶段。内窥镜检查并非总是有效,尤其是当异物从咽腔进入软组织时。要对移入的异物进行局部诊断,必须使用超声波和 CT。这些方法揭示了鱼骨向颈血管束移位和局部并发症。对文献数据和自身经验进行了分析。早期手术治疗可保证良好的效果和快速康复。
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引用次数: 0
[Comment on the article "Successful treatment of severe purulent peritonitis against the background of intra-abdominal hypertension syndrome"]. [评论文章“腹内高压综合征背景下重症化脓性腹膜炎的成功治疗”]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia2024121109
A V Sazhin, T V Nechay, A E Tyagunov

Comment on the article "Successful treatment of severe purulent peritonitis against the background of intra-abdominal hypertension syndrome".

评《腹内高压综合征背景下重症化脓性腹膜炎的成功治疗》一文。
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引用次数: 0
[Adapted scale for analysis of necessary septal myectomy in aortic valve replacement]. [适用于分析主动脉瓣置换术中必要的间隔肌切除术的量表]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia202412235
M A Fomin, E P Evseev, E V Balakin, Ya A Aidamirov, A A Botashev, V A Ivanov, T G Nikityuk

Objective: To develop the adapted scale for analysis of necessary septal myectomy (SME) in aortic valve replacement (AVR) for severe aortic stenosis.

Material and methods: A retrospective and prospective analysis included 180 patients with severe aortic stenosis and interventricular septal hypertrophy ≥1.5 cm who underwent surgery between 2012 and 2024. Age of patients was 64 (61; 67.3) years. There were 96 (53.3%) men and 84 (46.7%) women. Heart failure NYHA class III was observed in 98 patients (54.4%), class II in 54 (30.0%) patients. The AVR+SME group included 100 patients, and the AVR group included 80 patients. Both groups did not differ in preoperative clinical and echocardiography characteristics.

Results: Logistic regression was performed to identify significant predictors. Multivariate analysis provided logistic function including 3 predictors: IVST / PWT, indexed LV myocardial mass and aortic annulus diameter. Regression model included significant factors obtained at the first stage of analysis. The obtained prognostic model was significant (p<0.01). Sensitivity was 77.0%, specificity - 83.8%. IVST/ PWT and indexed LV myocardial mass increase the probability of concomitant SME, while aortic annulus diameter has inverse relationship. The cut-off point for indexed LV myocardial mass is 167.5 g, for IVST/ PWT - 1.15, for aortic annulus diameter - 23.5 mm. Further analysis was performed by assigning a score to each predictor. The total score in two groups was determined. Thus, total score > 83.5 indicates advisability of SME in aortic valve replacement.

Conclusion: The new scale for predicting the need for SME in AVR will improve postoperative results.

目的:探讨重度主动脉瓣狭窄患者行主动脉瓣置换术(AVR)中必要的室间隔肌切除术(SME)的适用量表。材料和方法:回顾性和前瞻性分析纳入2012年至2024年间接受手术治疗的180例重度主动脉瓣狭窄和室间隔肥厚≥1.5 cm的患者。年龄64岁(61岁;67.3)年。男性96例(53.3%),女性84例(46.7%)。心衰NYHA III级98例(54.4%),II级54例(30.0%)。AVR+SME组100例,AVR组80例。两组术前临床及超声心动图特征均无差异。结果:采用Logistic回归确定显著的预测因素。多因素分析提供logistic函数,包括3个预测因子:IVST / PWT、指标左室心肌质量和主动脉环直径。回归模型包含了第一阶段分析得到的显著因子。获得的预后模型具有显著性(p = 83.5),表明SME在主动脉瓣置换术中是可取的。结论:新的预测AVR术后需要SME的量表可改善术后效果。
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引用次数: 0
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Khirurgiya
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