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Commentary on the article “Primary intestinal anastomosis in a child with perforation of Meckel's diverticulum and peritonitis” 《梅克尔憩室穿孔合并腹膜炎患儿一期肠吻合术》一文评论
Pub Date : 2023-05-10 DOI: 10.17816/psaic1504
N. Tsap
Commentary on the article Morozov KD, Sharkov SM, Kozlov MYu, Mordvin PA, Ayrapetyan MI, Morozov DA Primary intestinal anastomosis in a child with perforation of Meckels diverticulum and peritonitis published in the Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2023;13(1):105112. (In Russ.) DOI: https://doi.org/10.17816/psaic1498 After reading the article under discussion, serious doubts were raised about the presence of diffuse peritonitis (there was no typical response of the body to a severe inflammatory process in the abdominal cavity), and the mild course of diffuse peritonitis in surgical practice is unknown. Primary intestinal anastomosis in peritonitis cannot be recommended for pediatric surgeons to present its wide introduction in clinical practice.
Morozov KD, Sharkov SM, Kozlov MYu, Mordvin PA, Ayrapetyan MI, Morozov DA文章评论发表在俄罗斯儿科外科麻醉与重症监护杂志,2023;13(1):105112。(俄国人)。DOI: https://doi.org/10.17816/psaic1498在阅读了讨论中的文章后,对弥漫性腹膜炎的存在提出了严重的怀疑(身体对腹腔严重炎症过程没有典型的反应),并且手术实践中弥漫性腹膜炎的轻度病程尚不清楚。腹膜炎的一期肠吻合术不推荐儿科外科医生在临床实践中广泛应用。
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引用次数: 0
In memory of Alina P. Shapkina-Pilipenko (24.01.1929 – 01.03.2023)
Pub Date : 2023-05-10 DOI: 10.17816/psaic1511
Oleg S. Gorbachev
Information about the life path of the founder of pediatric surgery in the Far East, Professor Alina P. Shapkina-Pilipenko, who died in March 2023.
关于远东儿科外科创始人Alina P. Shapkina-Pilipenko教授的生命历程的信息,他于2023年3月去世。
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引用次数: 0
Commentary on the article “Primary intestinal anastomosis in a child with perforation of Meckel's diverticulum and peritonitis” 《梅克尔憩室穿孔合并腹膜炎患儿一期肠吻合术》一文评论
Pub Date : 2023-05-10 DOI: 10.17816/psaic1507
S. Minaev
Commentary on the article Morozov KD, Sharkov SM, Kozlov MYu, Mordvin PA, Ayrapetyan MI, Morozov DA Primary intestinal anastomosis in a child with perforation of Meckels diverticulum and peritonitis published in the Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2023;13(1):105112. (In Russ.) DOI: https://doi.org/10.17816/psaic1498 Performing a primary anastomosis in a child with Meckels gangrenous-perforative diverticulitis in the presence of peritonitis may be the operation of choice only in the early stages of the development of peritonitis.
Morozov KD, Sharkov SM, Kozlov MYu, Mordvin PA, Ayrapetyan MI, Morozov DA文章评论发表在俄罗斯儿科外科麻醉与重症监护杂志,2023;13(1):105112。(俄国人)。DOI: https://doi.org/10.17816/psaic1498在腹膜炎存在的Meckels坏疽-穿孔性憩室炎患儿中进行初级吻合可能是仅在腹膜炎发展的早期阶段选择的手术。
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引用次数: 0
Primary intestinal anastomosis in a child with perforation of Meckel's diverticulum and peritonitisauthors 梅克尔憩室穿孔及腹膜炎患儿一期肠吻合术
Pub Date : 2023-03-01 DOI: 10.17816/psaic1498
K. Morozov, S. Sharkov, Michail Yurievich Kozlov, P. Mordvin, M. Ayrapetyan, D. Morozov
A case-report of the treatment of a 13-year-old child with Meckel's gangrenous-perforative diverticulitis complicated by diffuse peritonitis is presented. The perforation localized at the base of Meckel's diverticulum, therefore ileal resection was performed. The presence of peritonitis required a difficult choice of further surgical management - the stoma formation or performing a primary intestinal anastomosis. Nowadays, it is considered an enterostomy to be the most reliable and rational surgical option after bowel resection in peritonitis conditions. However, this issue has become increasingly controversial. There are many publications which testify to the success of primary intestinal anastomosis, regardless of the peritonitis severity and the degree of contamination of the abdominal cavity, even noting the advantages of radical treatment and prevention of various stoma-related complications. In the presented clinical observation the child underwent primary intestinal anastomosis, despite the presence of an exudative inflammatory process in the abdominal cavity. This option was chosen because of the stable general condition of the child, satisfactory central and peripheral hemodynamics, and the absence of significant hydrobalance disorders. There were no complications in the postoperative period. The child was discharged on the seventh postoperative day. We aimed to evaluate our experience with the primary anastomosis approach in peritonitis condition.
一个病例报告的治疗13岁儿童与梅克尔坏疽-穿孔憩室炎合并弥漫性腹膜炎提出。穿孔位于梅克尔憩室底部,因此行回肠切除术。腹膜炎的存在需要一个困难的选择,进一步的手术处理-造口或进行初级肠吻合。目前,肠造口术被认为是腹膜炎患者肠切除术后最可靠、最合理的手术选择。然而,这个问题已经变得越来越有争议。有许多文献证明,无论腹膜炎的严重程度和腹腔的污染程度如何,一期肠吻合术都是成功的,甚至指出了根治性治疗和预防各种口相关并发症的优势。在目前的临床观察,儿童接受了原发性肠吻合,尽管存在渗出性炎症过程在腹腔。选择该方案的原因是患儿一般情况稳定,中央和外周血流动力学令人满意,且无明显的水平衡障碍。术后无并发症发生。患儿术后第7天出院。我们的目的是评价我们在腹膜炎条件下的初级吻合方法的经验。
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引用次数: 2
Сombination of pectus carinatum and Scheuermann-Mau disease in children: an empirical pattern or somite syndrome? Сombination儿童胸突和Scheuermann-Mau病:经验模式还是somite综合征?
Pub Date : 2023-02-28 DOI: 10.17816/psaic1491
E. Vorobyeva, A. Razumovskiy, V. Dubrov, D. Vybornov, I. Krest'yashin, Z. Mitupov, E. Vakhova
BACKGROUND: In recent years, there has been marked a tendency to a sharp increase in the number of children with complaints of pectus carinatum. The literature describes only a few cases report of a combination of keeled chest deformity with a more serious pathology of the spine - Scheuermann-Mau disease.AIMS: The aim of the work is to study the frequency, clinical manifestations and methods of timely diagnosis of combined structural lesions of the thoracic spine in children with keeled chest deformity.MATERIALS AND METHODS: The observational single-center cross-sectional study included patients from 5 to 176 years old with pectus carinatum. Categorical values ​​were described by indicating absolute values ​​and percentages in the sample, quantitative indicators corresponding to the criteria of normal distribution were described by using arithmetic means (M) and standard deviations (SD), boundaries of the 95% confidence interval; quantitative indicators not meeting the criteria for a normal distribution were descrided by using the median and interquartile range (Me, Q1Q3).RESULTS: Scheuermann-Mau disease was detected in 11 (9.3%) of 118 children with pectus carinatum. Pterygoid scapulae noted in 97 (82.2%) children with pectus carinatum, increased cervical lordosis in 93 (79.7%) children, and sloping, anteriorly adducted shoulders in 99 (83.9%) children significantly hampered the clinical assessment of the magnitude of thoracic kyphosis. Rigid thoracic kyphosis at the time of examination was formed in 1 16-year-old boy. In children of the younger age group (514 years old), Scheuermann-Mau disease had no clinical manifestations and was detected only during screening X-ray examination, while in the older age group (1516 years old), 3 out of 4 adolescents complained on the back pain. CONCLUSIONS: The frequency of occurrence of Scheuermann-Mau disease in children with pectus carinatum exceeds the average prevalence in the population. In patients with keeled chest pterygoid scapulae, excess cervical lordosis, and rounded shoulders sloping shoulders are associated with the difficulty of assessment the magnitude of thoracic kyphosis. Asymptomatic progression of Scheuermann-Mau disease is typical for younger children with pectus carinatum, and the complaints of pain syndrome and clinical picture of the disease develop only by the age of 15-16.Thus, all patients with pectus carinatum and posture disturbance should undergo a screening X-ray examination of the thoracic and lumbar spine in order to detect Scheuermann-Mau disease and start treatment in time.
背景:近年来,有一个明显的趋势,在数量急剧增加的儿童胸廓的投诉。文献只描述了少数病例报告龙骨胸畸形合并更严重的脊柱病理- Scheuermann-Mau病。目的:研究儿童龙骨胸畸形胸椎合并结构性病变的发生频率、临床表现及及时诊断方法。材料与方法:观察性单中心横断面研究纳入了5 - 176岁的胸突患者。分类值用样本中的绝对值和百分比来描述,定量指标对应于正态分布标准,用算术平均值(M)和标准差(SD)来描述,95%置信区间的边界;不符合正态分布标准的定量指标用中位数和四分位数间距来描述(Me, Q1Q3)。结果:118例胸大症患儿中11例(9.3%)检出Scheuermann-Mau病。97例(82.2%)患有胸凸症的儿童肩胛骨呈翼状,93例(79.7%)儿童颈椎前凸加重,99例(83.9%)儿童肩关节前收斜,严重阻碍了对胸后凸程度的临床评估。检查时刚性胸后凸形成于1名16岁男孩。在年龄较小的儿童(514岁)中,Scheuermann-Mau病没有临床表现,仅在筛查x线检查时发现,而在年龄较大的儿童(1516岁)中,4个青少年中有3个抱怨背部疼痛。结论:胸大症患儿的发病频率高于人群平均患病率。在患有龙骨胸翼状肩胛骨的患者中,过度的颈椎前凸和圆肩斜肩与评估胸后凸程度的困难有关。Scheuermann-Mau病的无症状进展是典型的幼儿胸突,疼痛综合征的主诉和疾病的临床表现只有在15-16岁时才出现。因此,所有患有胸突和姿势障碍的患者都应进行胸椎和腰椎x线筛查检查,以便及时发现Scheuermann-Mau病并开始治疗。
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引用次数: 0
Vascular bypass surgery in the treatment of extrahepatic portal hypertension in children (review) 血管搭桥手术治疗儿童肝外门静脉高压症(综述)
Pub Date : 2023-02-28 DOI: 10.17816/psaic1311
Z. Mitupov, A. Razumovsky, V. Rachkov, N. Kulikova, S. Margaryan
In children with extrahepatic portal hypertension (HSV), the most frequent and life-threatening complication is bleeding from varicose veins of the esophagus and stomach. Therefore, the main task of HSV treatment is to prevent bleeding from the veins of the upper gastrointestinal tract. The most effective treatment is portosystem bypass surgery (PSS), the effectiveness of which reaches 94-97%. However, the use of these operations is limited precisely because of a decrease in portal liver perfusion (PPP) and the development of portosystemic encephalopathy (PSE). The aim is to analyze domestic and foreign publications devoted to the surgical treatment of portal hypertension and the development of portosystemic encephalopathy in the postoperative period. A systematic search was carried out in the databases PubMed, Web of Science, Scopus, MEDLINE, eLibrary, RSCI, Cyberleninka. 345 references were analyzed, 110 articles were reviewed, 97 publications on surgical treatment of portal hypertension were selected for the review. The development of PSE in the postoperative period often occurs after the imposition of total PSS. To reduce the risk of developing PSE, selective shunts have been developed, which to some extent preserve the PPP. With distal splenorenal anastomosis (DSRA), the frequency of PE is less than 10-15%. An intermediate position is occupied by a side-to-side splenorenal anastomosis, which has signs of selective surgery. The results of the analysis of literature sources showed that discussions are still underway regarding the choice of the optimal treatment strategy for patients with HSV, the place and role of endoscopic methods for the prevention of gastrointestinal bleeding, as well as mesoportal shunt (MPSH) in the treatment of patients with extrahepatic PG. Nevertheless, the majority of world experts consider MPSH to be the most optimal operation for primary and secondary prevention of varicose bleeding and other complications of HSV. And if it is impossible to perform it, the operation of selective bypass surgery of the DSRA can serve as an alternative to performing MPSH.
在患有肝外门脉高压(HSV)的儿童中,最常见和危及生命的并发症是食道和胃静脉曲张出血。因此,单纯疱疹病毒治疗的主要任务是防止上消化道静脉出血。最有效的治疗方法是门静脉搭桥手术(PSS),其有效性可达94-97%。然而,正是由于门静脉肝灌注(PPP)减少和门静脉系统性脑病(PSE)的发展,这些手术的使用受到限制。目的是分析国内外关于门静脉高压症手术治疗及门静脉全身性脑病术后发展的文献。系统检索PubMed、Web of Science、Scopus、MEDLINE、library、RSCI、Cyberleninka等数据库,分析文献345篇,复习文献110篇,选择门静脉高压症手术治疗相关文献97篇。术后PSE的发展通常发生在全PSS植入之后。为了降低发生PSE的风险,选择性分流术在一定程度上保护了PPP。远端脾肾吻合(DSRA)的PE发生率小于10-15%。中间位置为侧对侧脾肾吻合,有选择性手术的迹象。文献来源分析的结果显示,关于HSV患者的最佳治疗策略的选择,内镜方法预防胃肠道出血的位置和作用,以及门静脉分流术(MPSH)在肝外PG患者治疗中的作用仍在讨论中。世界上大多数专家认为MPSH是预防静脉曲张出血和其他HSV并发症的一级和二级预防的最佳手术。如果无法完成,可选择DSRA旁路手术作为MPSH的替代方案。
{"title":"Vascular bypass surgery in the treatment of extrahepatic portal hypertension in children (review)","authors":"Z. Mitupov, A. Razumovsky, V. Rachkov, N. Kulikova, S. Margaryan","doi":"10.17816/psaic1311","DOIUrl":"https://doi.org/10.17816/psaic1311","url":null,"abstract":"In children with extrahepatic portal hypertension (HSV), the most frequent and life-threatening complication is bleeding from varicose veins of the esophagus and stomach. Therefore, the main task of HSV treatment is to prevent bleeding from the veins of the upper gastrointestinal tract. The most effective treatment is portosystem bypass surgery (PSS), the effectiveness of which reaches 94-97%. However, the use of these operations is limited precisely because of a decrease in portal liver perfusion (PPP) and the development of portosystemic encephalopathy (PSE). \u0000The aim is to analyze domestic and foreign publications devoted to the surgical treatment of portal hypertension and the development of portosystemic encephalopathy in the postoperative period. \u0000A systematic search was carried out in the databases PubMed, Web of Science, Scopus, MEDLINE, eLibrary, RSCI, Cyberleninka. 345 references were analyzed, 110 articles were reviewed, 97 publications on surgical treatment of portal hypertension were selected for the review. \u0000The development of PSE in the postoperative period often occurs after the imposition of total PSS. To reduce the risk of developing PSE, selective shunts have been developed, which to some extent preserve the PPP. With distal splenorenal anastomosis (DSRA), the frequency of PE is less than 10-15%. An intermediate position is occupied by a side-to-side splenorenal anastomosis, which has signs of selective surgery. \u0000The results of the analysis of literature sources showed that discussions are still underway regarding the choice of the optimal treatment strategy for patients with HSV, the place and role of endoscopic methods for the prevention of gastrointestinal bleeding, as well as mesoportal shunt (MPSH) in the treatment of patients with extrahepatic PG. \u0000Nevertheless, the majority of world experts consider MPSH to be the most optimal operation for primary and secondary prevention of varicose bleeding and other complications of HSV. And if it is impossible to perform it, the operation of selective bypass surgery of the DSRA can serve as an alternative to performing MPSH.","PeriodicalId":437552,"journal":{"name":"Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130843140","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
Use of indocyanine green in resection of renal cysts in children 吲哚菁绿在儿童肾囊肿切除术中的应用
Pub Date : 2023-02-28 DOI: 10.17816/psaic1494
Y. Kozlov, S. Poloyan, A. A. Marchuk, A. Rozhanski, A. A. Byrgazov, K. Kovalkov, V. Kapuller, A. Narkevich, Sergey S. Muravev
Introduction. The study presents the experience of using ICG imaging to assess the margin of resection of a kidney cyst after intravenous administration of indocyanine green. Case reports. In the present study, we present a case report of laparoscopic treatment of simple renal cysts in two male patients aged 10 and 12 years. For this purpose, resection of the extrarenal portion of the kidney cyst was performed using fluoroscopic control by intravenous administration of indocyanine green. The intrarenal residue was subjected to argon-plasma coagulation. Treatment outcomes were assessed over a follow-up period of 6 and 12 months. The size of the cysts measured before surgery using ultrasound and computed tomography was 50 and 70 mm. Both cysts were located in the lower pole of the right kidney. The duration of the operation was 40 and 45 minutes, respectively. During the surgical intervention, there were no complications in the form of bleeding from the kidney parenchyma or damage to neighboring organs. The content of the cyst was in all cases a clear liquid without pathological impurities. Cytological examination revealed a low content of cells, which were represented by single macrophages and urothelial cells. Histological analysis revealed that the lining of the cyst wall was represented by transitional epithelium without signs of malignancy. The length of stay of patients in the hospital was 3 days. According to the ultrasound examination performed 1, 3, 6 and 12 months after the operation, there were no signs of recurrence of the disease. Conclusion. Thus, based on the presented clinical case, it can be assumed that the main advantage of using fluorescent technology during resection of kidney cysts include a clear definition of the demarcation line between the avascular wall of the cyst and the perfused kidney tissue, which helps prevent bleeding from the renal parenchyma.
介绍。本研究介绍了应用ICG成像评估静脉注射吲哚菁绿后肾囊肿切除边缘的经验。案例报告。在本研究中,我们提出了一个病例报告腹腔镜治疗单纯性肾囊肿的两名男性患者,年龄分别为10岁和12岁。为此目的,通过静脉注射吲哚菁绿,在透视控制下切除肾囊肿的肾外部分。肾内残留物经氩-血浆凝固处理。在6个月和12个月的随访期间评估治疗结果。术前使用超声和计算机断层扫描测量的囊肿大小分别为50和70毫米。两个囊肿均位于右肾的下极。手术时间分别为40分钟和45分钟。在手术过程中,没有出现肾实质出血或损害邻近器官的并发症。所有病例的囊肿内容物均为无病理杂质的透明液体。细胞学检查显示细胞含量低,以单个巨噬细胞和尿路上皮细胞为代表。组织学分析显示,囊肿壁内衬为移行上皮,无恶性肿瘤征象。患者住院时间为3天。术后1、3、6、12个月超声检查均未见疾病复发迹象。结论。因此,根据本临床病例,可以认为,在肾囊肿切除术中使用荧光技术的主要优点包括明确囊肿无血管壁与灌注肾组织之间的分界线,有助于防止肾实质出血。
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引用次数: 0
Robot-assisted bladder diverticulectomy in a 9-year-old boy 机器人辅助膀胱憩室切除术1例9岁男童
Pub Date : 2023-02-26 DOI: 10.17816/psaic1305
M. S. Mosoyan, D. Fedorov, I. Osipov, Viktor V. Burkhanov, T. Pervunina, I. Kagantsov
Bladder diverticulum in children is rarely encountered in the practice of a pediatric urologist. If the bladder diverticulum has clinical manifestations (pain, urinary tract infection, hematuria, voiding dysfunction, vesicoureteral reflux, or obstruction of the ureterovesical anastomosis), then surgical treatment is indicated. Recently, more and more publications began to appear on the removal of the bladder diverticulum using laparoscopic or vesicoscopic access. Several foreign publications report on the removal of a bladder diverticulum in children using a robotic approach. A 9-year-old boy with a diagnosis of bladder diverticulum underwent surgical intervention in the volume of robot-assisted bladder diverticulectomy in January 2020 at the Almazov National Medical Research Centre. Ports da Vinci 12 and two 8 mm were used, as well as an assistant 5 mm port, which were installed in typical places for lower abdominal surgery. The duration of the operation was 135 minutes. Console time - 75 minutes. The volume of blood loss is 20 ml. The patient was in the intensive care unit for a day. The urethral catheter was removed on the 7th day after the operation. Urination independent, free; phenomena of delay, incontinence were not noted. The patient was discharged on the 9th postoperative day in a satisfactory condition. At the control examination after a year at the place of residence, she does not complain, urination is not disturbed, there are no pathological changes in the ultrasound of the kidneys and bladder. Robot-assisted bladder diverticulectomy in children is a feasible, effective and safe treatment option in expert centers with extensive experience in robotic surgery. The described clinical case of bladder diverticulectomy is the first in Russia performed using a robotic system in pediatric practice.
儿童膀胱憩室在儿科泌尿科医生的实践中很少遇到。如果膀胱憩室有临床表现(疼痛、尿路感染、血尿、排尿功能障碍、膀胱输尿管反流或输尿管膀胱吻合口梗阻),则需要手术治疗。近年来,关于腹腔镜或膀胱镜下入路切除膀胱憩室的报道越来越多。一些国外出版物报道了使用机器人方法切除儿童膀胱憩室。2020年1月,一名被诊断为膀胱憩室的9岁男孩在阿尔马佐夫国家医学研究中心接受了机器人辅助膀胱憩室切除术的手术干预。使用了达芬奇12端口和两个8mm端口,以及一个辅助5mm端口,安装在下腹部手术的典型位置。手术时间为135分钟。控制台时间- 75分钟。失血量20毫升。患者在重症监护室住了一天。术后第7天拔除导尿管。排尿独立、自由;未发现延迟、尿失禁等现象。患者于术后第9天出院,病情满意。在一年后的居住地对照检查中,她没有抱怨,排尿不受干扰,肾脏和膀胱超声检查未见病理改变。机器人辅助儿童膀胱憩室切除术是一种可行、有效和安全的治疗选择,专家中心在机器人手术方面有丰富的经验。所描述的膀胱憩室切除术的临床病例是俄罗斯第一个在儿科实践中使用机器人系统的病例。
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引用次数: 1
Endoscopic ultasound guided cystogastrostomy in treatment of complicated form of acute pancreatitis in children 超声内镜引导下囊胃造口术治疗儿童复杂形式的急性胰腺炎
Pub Date : 2023-02-26 DOI: 10.17816/psaic1486
P. Pavlushin, A. Gramzin, Eugeniy Drobyazgin, S. Dobrov, A. Okhotina, A. Nikulina, D. Arkhipov, Nikolay Krivosheenko, Y. Koinov, V. Tsyganok, Y. Chikinev
Acute pancreatitis in children is relatively rare, about 3-13 cases per 100,000 population annually, and complicated forms are three times less common than in the adult cohort of patients. However, recently there has been an increase in the number of acute pancreatitis in the pediatric group, which entails a relatively higher incidence of complicated forms of acute pancreatitis, including the formation of parapancreatic acute fluid accumulations, and determines the relevance of this problem for pediatric surgeons. In this article, using the example of 2 observations, the technology of puncture of a parapancreatic pseudocyst under ultrasound and X-ray control is presented, followed by the introduction of a conductor string into the cavity of the pseudocyst and further stenting of this anastomosis with two plastic double-pigtail stents. In the first case, a 12-year-old boy was operated on with idiopathic pancreatitis and the formation of an acute parapancreatic fluid accumulation in the tail of the pancreas. In the second observation, in a 10-year-old girl, the formation of a parapancreatic pseudocyst occurred as a result of drug-induced pancreatitis (a complication of long-term use of the antiepileptic drug - valproic acid). Both children were operated on using this technique. Antisecretory therapy was carried out in the postoperative period. Catamnesis after 1 year and 6 months: children do not complain, ultrasound and x-ray studies did not reveal any pathology. Conclusion. Endoscopic cystogastrostomy under ultrasound guidance is a method that has found wide application in the complicated course of pancreatitis in adult patients. These observations show its effectiveness in pediatric practice. But the relatively short period of observation of treatment results requires additional research on a much larger number of outcomes of these surgical interventions in children.
儿童急性胰腺炎相对罕见,每年每10万人中约有3-13例,复杂形式的患者比成人患者少三倍。然而,最近儿科组的急性胰腺炎数量有所增加,这导致复杂形式的急性胰腺炎的发病率相对较高,包括胰腺旁急性液体积聚的形成,这决定了儿科外科医生对这一问题的相关性。本文以2例观察为例,介绍了在超声和x射线控制下穿刺胰腺旁假性囊肿的技术,随后将导体串引入假性囊肿腔内,并进一步用两个塑料双尾支架置入该吻合口。在第一个病例中,一名12岁的男孩因特发性胰腺炎和胰腺尾部急性胰旁积液的形成而接受手术。在第二个观察中,一名10岁的女孩,由于药物性胰腺炎(长期使用抗癫痫药物丙戊酸的并发症)而形成胰腺旁假囊肿。两个孩子都用这种技术做了手术。术后给予抗分泌治疗。1年零6个月后失忆:儿童无主诉,超声和x线检查未发现任何病理。结论。超声引导下的内镜胆囊胃造口术是一种在成人复杂病程胰腺炎患者中得到广泛应用的方法。这些观察结果表明其在儿科实践中的有效性。但是治疗结果的观察期相对较短,需要对这些手术干预在儿童中的更多结果进行额外的研究。
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引用次数: 0
Cross-fused dystopia of the right kidney with cystic dysplasia of the non-functioning left kidney associated with ureterocele 右肾交叉融合异位伴左肾囊性发育不良伴输尿管膨出
Pub Date : 2023-02-26 DOI: 10.17816/psaic1488
G. I. Kuzovleva, Veronika V. Rogozhina, O. Staroverov, E. Ayryan, N. Кhvatynets, V. V. Rostovskaya
Cross-dystopia is a rare type of congenital anomaly, characterized by a displacement of the kidney to the opposite side, as a result of which both of them are located on the same side and in about 85% of such cases, a fusion of the parenchyma of two kidneys can be observed. We have not found descriptions of cases from practice when an orthotopic cystic dysplastic kidney with a lack of function associated with the pathology of the ureterovesical segment (ureterocele) was fused with the lower pole of a cross-dystopian normally formed kidney in literature.The patient, 8 d.o., a preliminary diagnosis - agenesis of the right kidney, doubling of the left kidney, cystic dysplasia, doubled left kidney whiyh ureterohydronephrosis lower half and ureterocele. In order to restore the outflow of urine and function of the lower half of the presumably doubled left kidney, a cystourethroscopy was performed. In a typical place on the right there is a correctly formed ureteral orifice, ureterocele on the left, which occupies half volume of bladder. With a holmium laser, an artificial orifice was formed in the ureterocele in order to restore the urine passage. At 9 m.o., tomography urinary tract was performed - cross-dystopia of the right kidney with fusion of the lower pole with a cystic dysplastic orthotopic left kidney.Laparoscopic nephrureterectomy of a non-functioning orthotopic kidney was performed.The control examination indicate complete clinical remission and social adaptation of the patient after discharge. Cross-dystopia of the kidney with fusion with cystic dysplastic kidney and a formed ureterocele is a rare congenital anomaly that requires timely examination in a specialized clinic and drawing up an individual treatment plan. The surgical manual should be focused on a symptomatic urological problem with an emphasis on preserving kidney function.
交叉异位是一种罕见的先天性异常,其特征是肾脏向另一侧移位,因此两个肾脏位于同一侧,在约85%的此类病例中,可以观察到两个肾脏的实质融合。我们没有在文献中发现与输尿管膀胱段(输尿管精索细胞)病理相关的功能缺失的原位囊性发育不良肾与正常形成的跨反乌托邦肾的下极融合的病例描述。患者8岁,初步诊断为右肾发育不全,左肾加倍,囊性发育不良,左肾加倍,下半部分输尿管积水和输尿管膨出。为了恢复尿液的流出和左肾下半部分的功能,进行了膀胱输尿管镜检查。在典型的右侧,有一个正确形成的输尿管口,左侧是输尿管膨出,占膀胱体积的一半。利用钬激光,在输尿管囊肿中形成一个人工孔口,以恢复尿液通道。上午9点,行尿路断层扫描-右肾交叉异位伴下极囊性发育不良左肾融合。腹腔镜下肾输尿管切除术的功能不正常的原位肾。对照检查显示患者出院后临床完全缓解,社会适应能力较好。肾交叉异位合并囊性发育不良肾并形成输尿管囊肿是一种罕见的先天性异常,需要及时到专科诊所检查并制定个体化治疗方案。手术手册应侧重于有症状的泌尿系统问题,并强调保留肾功能。
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Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care
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