Khirurgiya最新文献

Objective: To assess the effectiveness of Amplatzer Septal Occluder as a palliative approach for temporary TEF occlusion before radical surgery.

Material and methods: The authors present a patient with multifocal post-tracheostomy TEF after mechanical ventilation for COVID-19. Two Amplatzer Septal Occluders were implanted under endoscopic guidance for temporary occlusion. Effectiveness, recurrence rate, and feasibility of radical surgery were evaluated.

Results: TEF occlusion successfully eliminated aspiration and enabled radical repair after four months with minimal postoperative complications. However, device dislocation and fistula enlargement were identified as limitations.

Conclusion: This method appears promising but requires further research to assess complication risks and optimize implantation techniques.

Objective: To study reparative potential (cellular effects and biological characteristics) of platelet-rich plasma (PRP) in patients with acute appendicitis (AA).

Material and methods: PRP was obtained by two-stage centrifugation of blood from patients with AA and healthy donors divided into age groups: group 1 (n=10) - healthy donors aged 30-40 years, group 2 (n=10) - healthy donors aged 60-70 years, group 3 (n=10) - patients with AA aged 30-40 years, group 4 (n=10) - patients with AA aged 60-70 years. The study was performed using hTERT-HDFa (d220) cell line of human dermal fibroblasts (HDF). Activated 10% PRP from donors was added to experimental wells. Samples without PRP were negative control (0 (K)), PRP samples with addition of 10% FBS - positive control. Metabolic activity of cells, viability of samples, ability to generate reactive oxygen species (ROS), migration activity and intensity of cellular aging were assessed. Biological characteristics of PRP were defined by ELISA of IL6, IL10, TGFB1, PAI-1, PDGF, VEGF proteins.

Results: PRP from elderly patients with AA was characterized by elevated IL6 and IL10 relative to young patients with this pathology and increased TGFβ relative to healthy peers. On the first day after HDF stimulation with plasma, the lowest viability was found in samples stimulated with PRP from health elderly donors. There were no significant differences among patients with AA regardless of age. After 3 days, we observed high proliferative and metabolic activity of cells after stimulation with plasma from AA patients regardless of age. Antioxidant reserve of PRP in elderly patients with AA was significantly lower than in young patients with AA. Correlation analysis revealed significant relationships between biological profile of PRP, cellular responses and clinical data of patients with AA of different ages.

Conclusion: When comparing cellular responses with clinical data of patients, we found that significant prognostic markers of PRP in AA were IL6, IL10 and TGFβ. Their levels correlated with postoperative hospital-stay. Moreover, high IL6 and IL10 was associated with prolonged hospital-stay in elderly patients.

Objective: To evaluate the effectiveness of comprehensive treatment of mediastinal germ cell tumor in a child with emphasis on the role of neoadjuvant chemotherapy and total resection.

Material and methods: The authors present a boy with primary mediastinal germ cell tumor.

Results: Treatment of a 17-year-old patient with stage IVA anterior mediastinal choriocarcinoma was followed by complete clinical and laboratory remission. Intensive induction polychemotherapy according to the MAKEI 2005 protocol led to significant tumor shrinkage (~85.5%) for subsequent en bloc resection of tumor and adjacent tissues. Postoperative period and final course of chemotherapy were uneventful; follow-up examinations showed normalization of tumor markers, favorable clinical status and no signs of recurrence.

Conclusion: This case demonstrates that comprehensive treatment, including induction chemotherapy and subsequent total resection, enables complete remission even in aggressive and advanced forms of mediastinal germ cell tumors in adolescents. This confirms high effectiveness of modern therapeutic approaches.

History of thymus surgery spans nearly 130 years, and 114 years have been largely devoted to thymectomy. Symptoms of myasthenia gravis (MG) were first described in 1658, but breakthrough in defining the role of thymus in this pathology occurred in the early 20^th century. Improvements in conservative treatment for MG occurred simultaneously with development of thoracic surgery and anesthesiology. These processes converged in 1936, when Alfred Blalock performed and described in detail thymectomy and perioperative management of a patient with MG using available techniques. Despite modern advances in surgical and therapeutic treatment of MG, there is still no unified strategy based on integrative personalized approach to patient management. The article analyzes history of each component of perioperative support of thymectomy with emphasis on Blalock's systemic approach, and also proposes the concept of MIASTOP covering all stages of management of patients with myasthenia.

Objective: To confirm the effectiveness of new meniscus root suture in experiment.

Material and methods: Experimental work was carried out on 40 biological mannequins with damaged meniscus root in two stages. At the 1^st stage, we measured 20 menisci after previous classical suturing and analyze the force for their rupture. At the 2^nd stage, we measured 20 menisci after previous new suturing (RU Patent No. 2809799).

Results: At the 1^st stage, mean force for meniscus root suture rupture was 14.6 kg, at the 2^nd stage was 21.33 kg.

Conclusion: A new method of surgical treatment for meniscus root damage increases strength and consistency of suture by 146.6%.

Objective: To determine the effectiveness of domestic succinate-containing drugs in correction of homeostasis disorders and early postoperative period after open surgery for acute urgent abdominal diseases.

Material and methods: We examined 162 patients: the first group - 43 (26.5%) patients with acute appendicitis, acute intestinal obstruction complicated by acute peritonitis who underwent laparoscopic procedures, the second group - 38 (23.5%) patients with similar diseases who underwent open surgery, the third group - 81 (59.0%) patients with similar diseases who underwent open surgical procedures followed by complex therapy in early postoperative period: Remaxol (46) or Reamberin (35) for the first two days (800.0 ml each) and 400.0 ml for three days intravenously.

Results: Complex early postoperative therapy in patients with acute surgical abdominal diseases, including drugs with antioxidant, antihypoxant, phospholipase-inhibiting effects (Reambirin, Remaxol), significantly improved postoperative clinical and laboratory data (lower incidence of complications by 18.4-27.8%, p<0.05; shorter hospital-stay by 2.34-3.17 days, p<0.05). This therapy affects the main pathogenetic components of urgent abdominal pathologies, course of early postoperative period and complications. Thus, we observe significantly lower endogenous intoxication, intensity of lipid peroxidation and phospholipase activity, as well as structural restoration of the main membrane-forming lipids.

Conclusion: Effectiveness of complex therapy, including Reambirin and Remaxol, is based on its ability to affect key pathogenetic oxidative-toxic components that directly affects early postoperative period and incidence of complications. Positive effects appear early after surgery. The undoubted result of studies in urgent abdominal pathology is establishment of possible approximating the results of open traumatic surgical interventions to laparoscopic ones.

Objective: To evaluate whether heart rate variability (HRV) is a predictive of severity of acute appendicitis.

Material and methods: A cross-sectional and prospective study was conducted in 144 patients who underwent appendectomy. The sample included 111 patients with complicated appendicitis and 33 ones with uncomplicated appendicitis. Clinical data, HRV parameters and their predictive capacity for complicated appendicitis were evaluated. HRV was measured as the difference between minimum and maximum heart rate over three minutes before anesthetic induction. The student's t-test and the ROC curve were used for statistical analysis.

Results: Patients with complicated appendicitis had longer duration of illness (2.05±0.71 vs. 1.15±0.36 days, p=0.001) and higher leukocyte count (15.696.63±4.530.74 vs. 13.465.52±3.375.71, p=0.010). HRV was significantly lower in complicated cases (10.24±4.72 vs. 14.58±4.78, p=0.001). The area under the ROC curve was 0.750 (95% CI: 0.665-0.834) that indicated moderate predictive capacity of HRV for complicated appendicitis.

Conclusion: Heart rate variability was associated with severity of acute appendicitis, and HRV was lower in complicated cases. ROC curve suggests that HRV may be moderate predictor for identifying complicated appendicitis.

The authors analyzed evolution of therapeutic approaches for acute peritonitis with accent on abdominal drainage. A systematic review enrolled the PubMed, Scopus, Web of Science, eLibrary and Cochrane Library databases for the period 1980-2024. Methods of abdominal sanitation in acute peritonitis underwent through a long way of evolution from simple passive drainage to complex programmed interventions. Historically, various approaches have been used (from closed systems to open abdominal management with laparostomy). The middle of the 20^th century was marked by revolution of programmed relaparotomies, which made it possible to carry out scheduled revisions regardless of clinical status. Modern techniques include vacuum-assisted therapy, peritoneal lavage dialysis with antibacterial drugs, minimally invasive laparoscopic sanitation. Clinical studies demonstrate the advantages of a programmed approach over "on-demand" relaparotomies. Active drainage with cyclic washing provides not only mechanical cleansing, but also systemic detoxification. Choice of optimal tactics should be based on severity of peritonitis, clinical status of patients and capabilities of a particular hospital. Evolution of treatment for peritonitis is a bright example of triumph (victory) of scientific medicine over seemingly invincible disease. Words of G. Wegner are now perceived as evidence of the past era. Modern surgeons with appropriate knowledge, technologies and effective medicines successfully manage disease that inspired sacred fear a century and a half ago. However, peritonitis is still a serious challenge requiring high professionalism and multidisciplinary approach.

Colorectal cancer is a malignant tumor arising from mucosa of large intestine (colon, rectosigmoid part and rectum). Currently, surgery is the primary treatment for colorectal cancer regarding oncological perspective. However, it is associated with high risk of postoperative complications, and one of these is anastomotic leakage (AL). According to various data, the incidence of AL can reach 35%. One of the main factors for AL is impairment of perfusion in anastomotic area. We hypothesize that preserving the left colic artery in rectosigmoid and rectal surgeries, as well as the first sigmoid artery in rectal surgeries will reduce the incidence of AL. Modern technologies, including CT perfusion, indocyanine green dye, photoplethysmography, perfusion flowmetry, and MASP (marginal artery stump pressure) allow us to assess perfusion preoperatively and intraoperatively. This review analyzes the main causes of AL from physiological and metabolic-biochemical perspective. It presents statistical data reflecting the relevance of intestinal perfusion assessment and proposes hypotheses that could significantly reduce the incidence of anastomotic leakage. Study objective was to select the optimal method for assessing intestinal perfusion. We analyzed the articles published in PubMed and Sci-Hub databases.

Objective: To identify key clinical, laboratory, and instrumental predictors and develop a prognostic scale for acute mesenteric ischemia (AMI) to optimize early diagnosis.

Material and methods: A prospective, cross-sectional, single-center study was performed between 2016 and 2024. Inclusion criteria: age ≥ 18 years, suspected or diagnosed AMI during surgery or autopsy.

Results: Prognostic scale is based on relative contribution of predictors. The model demonstrates very good discriminatory ability with AUC 0.832.

Conclusion: Thus, the proposed diagnostic algorithm brings us closer to solving the problem of patient selection for in-depth radiological diagnosis in resource-limited emergency hospitals. Implementation of this algorithm in clinical practice will standardize diagnostic process for acute mesenteric ischemia, reduce the time to diagnosis, and initiate timely treatment. This is critical for improving the outcomes of this life-threatening condition.