Khirurgiya最新文献

Objective: To improve treatment outcomes in patients with blunt liver injuries using modern protocols and minimally invasive technologies in a multi-field hospital.

Material and methods: Treatment outcomes were analyzed in 93 patients with blunt traumatic liver injury between 2019 and 2024. There were 74 (79.6%) men and 19 (20.4%) women. Mean age was 42.8±11.3 years; 87 (93.5%) patients were delivered by ambulance, and 6 (6.5%) ones have gone by themselves. Of these, 36 (38.7%) patients presented within the first hour after injury, 49 (52.7%) - within 6 hours, 8 (8.6%) - later. Fifty-four (58.1%) victims had car accident as a cause of injury, 27 (29.0%) ones had falls and 12 (12.9%) had other domestic accidents. Concomitant injuries were observed in 61 (65.6%) victims. Isolated liver damage occurred in 32 (34.4%) patients. Damage to the liver and ≥ 2 organs in multiple and combined trauma was detected in 42 (68.9%) victims. The WSES grade IV in isolated and combined liver injury was observed in 53.1% and 72.1%, respectively. Traumatic brain injury, chest injury and skeletal trauma were the most common (36.6%) concomitant injuries.

Results: Nonoperative management (NOM) for blunt liver injury was applied in 26 (28.0%) patients. Of these, 12 (12.9%) ones underwent only conservative treatment. Successful angioembolization was performed in 17 (94.4%) patients. Laparoscopy was used in 18 (19.4%) patients. Tamponade for hemostasis within the "damage control surgery" concept was used in 35 (37.6%) patients. The incidence of specific and non-specific complications was 10.4% and 25.1%, respectively. Postoperative mortality in blunt isolated liver injury was 6.8%, in combined injury - 14.8%. Overall postoperative mortality - 11.8%.

Conclusion: Routing patients to multidisciplinary hospitals, evidence based care protocols, minimally invasive endovascular and hybrid technologies, and damage control surgery are the main points for improving the outcomes for patients with blunt liver injuries.

Objective: To evaluate technical feasibility, early clinical outcomes, learning curve, and risk factors affecting native liver preservation after laparoscopic Kasai portoenterostomy in children with biliary atresia in Uzbekistan.

Material and methods: A retrospective single-center study involved 33 patients with BA who underwent laparoscopic Kasai portoenterostomy between July 2022 and January 2025. Demographic data, disease characteristics, native liver survival rates, incidence of cholangitis, mortality, and the need for subsequent transplantation were assessed. Data analysis included logistic regression, CUSUM, and Kaplan-Meier methods.

Results: The median age was 69 (27-148) days. Overall survival with native liver was 54.5%, patient survival - 84.8%. The incidence of postoperative cholangitis was 51.5%, and this event was an independent prognostic factor of native liver loss (odds ratio [OR] 0.035; p=0.010). The learning curve stabilized after 16-17 cases that was accompanied by shorter surgery time and better technical performance. Conversion to open surgery was required in only one case (3%).

Conclusion: Laparoscopic Kasai portoenterostomy is a technically feasible and effective alternative to open Kasai procedure with comparable survival rates with native liver. High incidence of cholangitis remains an important issue requiring optimization of postoperative management. In the absence of pediatric liver transplantation in Uzbekistan, improving surgical techniques and preventing cholangitis are essential to improve long-term outcomes.

Objective: To analyze treatment outcomes in children with chemical burns caused by various agents depending on depth of lesion over the past 5 years.

Material and methods: There were 279 patients aged 0-18 years with complaints of burn wounds sustained from contact with various chemical reagents over last 5 years. The article describes the features of local treatment for superficial (grade I-II) burns with modern wound dressings and surgical strategies for wound repair in patients with deep chemical burns.

Results: Effectiveness of treatment strategy is demonstrated by clinical examples.

Percutaneous coronary and carotid interventions prevail in the treatment of coronary artery and cerebrovascular diseases. However, the risk of iatrogenic lesions and arterial thrombosis remains high. The authors analyze national and foreign literature devoted to iatrogenic injuries and thrombotic complications following emergency endovascular interventions. Various risk factors, causes and mechanisms of iatrogenic lesions and thrombosis of coronary and carotid arteries are considered. Particular attention is paid to perforations of coronary arteries in percutaneous coronary interventions. The incidence and various methods for prevention and treatment of iatrogenic injuries and thrombotic complications are described in detail. Optimal ways for prevention and treatment of these complications are presented.

Objective: To establish the role of oxidative and metabolic disorders in pathogenesis of multiple organ failure following acute peritonitis and to develop appropriate treatment.

Material and methods: The study is based on experimental and clinical results. In a model of peritonitis resulting from acute colonic obstruction with intestinal perforation, we studied functional state of various organs and systems in conjunction with homeostasis disorders. Antibacterial and infusion therapy was prescribed in early stages. The experimental group also included Remaxol. In clinical part, 41 patients with acute purulent-fibrinous diffuse or widespread peritonitis and multiple organ failure were used regarding efficacy of complex therapy, including Remaxol.

Results: According to experimental data, organ failure in severe urgent diseases is based on tissue lipid metabolism disorders. Their reduction is possible by influencing the main trigger agents of membrane-destabilizing phenomena. When assessing functional status of organs and systems, we found that 94.7% of patents had two or more organ failures (multiple organ failure) in early postoperative period. This predisposed to complications arose that further worsened prognosis of disease. In the main group, inclusion of Remaxol in complex therapy significantly changed postoperative period. The most important manifestation was less number of multiple organ failure (χ²=4.151, p=0.042) and shorter duration of symptoms.

Conclusion: Higher effectiveness of Remaxol therapy in correction (prevention) of multiple organ failure in acute severe peritonitis is associated with rapid positive effect on various parameters of homeostasis and oxidative-metabolic tissue disorders.

Objective: To evaluate early and long-term outcomes of surgical treatment for primary multiple lung cancer (PMLC) in elderly and senile patients and to characterize key aspects of perioperative management.

Material and methods: A retrospective single-center study included 12 patients with verified PMLC who underwent surgery between 2010 and 2022. They were classified as elderly (60-75 years; n=9) or senile (76-85 years; n=3) according to the WHO classification. PMLC was confirmed using the Martini-Melamed criteria modified by Antakli and the Warren-Gates criteria. Patients underwent anatomical (lobectomy, bilobectomy, pneumonectomy) or sublobar (segmentectomy, wedge resection) lung resections, predominantly via video-assisted thoracic surgery. Postoperative complications were assessed using the Clavien-Dindo classification. Disease-free and overall survival after the second surgery were analyzed using the Kaplan-Meier method.

Results: R0 resection was achieved in all patients. After surgery for the second primary lesion, postoperative complications occurred in 75% of cases. The most common events were prolonged air leak, residual pleural cavities, COPD exacerbation, and cardiac arrhythmias. No in-hospital mortality was observed. Mean postoperative hospital-stay was 8.4±2.1 days after the first surgery and 10.2±2.5 days after the second surgery. Following the second resection, 1-, 3- and 5-year disease-free survival rates were 93.9%, 84.4%, and 67.6%, respectively. Overall survival rates were 99.6%, 87.4%, and 76.6%, respectively. No significant differences in survival were found between lobectomy and sublobar resections. These findings should be interpreted as descriptive due to small sample size.

Conclusion: In carefully selected elderly and senile patients, surgical treatment of PMLC provides acceptable rates of postoperative morbidity and 5-year survival comparable to published data. Anatomical resections are preferable in patients with sufficient functional reserves. In those with limited cardiopulmonary function, sublobar resections are an acceptable alternative.

Background: Colorectal cancer is one of the most prevalent oncological diseases, with rectal cancer accounting for a substantial proportion of cases. Surgical intervention remains the cornerstone of treatment, with its success significantly influenced by individual pelvic anatomy. Nevertheless, there is a notable scarcity of studies specifically focused on evaluating surgical complexity based on pelvic MRI pelvimetry.

Objective: To identify the prognostic factors of pelvic MRI pelviometry that affect the complexity of surgical treatment of rectal tumors.

Material and methods: A retrospective analysis was conducted on 28 patients with tumors of the rectum and rectosigmoid junction who underwent surgery at the University Clinic of the MNOI of Lomonosov Moscow State University between 2022 and 2024. Surgical complexity was assessed based on operative time, blood loss, conversion rate, ureteral injury, and anastomotic leakage. Correlations between these parameters and MRI pelvimetry data were analyzed.

Results: The mean operative time was 262±85 minutes, with a mean blood loss of 161±240 mL. Ureteral injuries and conversions were observed in 7.1% of cases (2 each), and anastomotic leakage occurred in 10.7% (3 cases). Significant correlations were found between operative time and intertuberous (r=-0.55; p<0.05) and interspinous distances (r=-0.46; p<0.05), as well as sacrococcygeal distance (r=0.48; p<0.05), anorectal angle (r=0.46; p<0.05), and tumor size (r=0.39; p<0.05).

Conclusion: Several MRI pelvimetry parameters of the pelvis were significantly correlated with surgical complexity in rectal cancer. Preoperative evaluation of these parameters may improve surgical planning and outcomes.

Objective: To evaluate the immediate and long-term results of laparoscopic surgical procedures in patients with recurrent hiatal hernias (rHH).

Material and methods: Thirty-six patients with rHH underwent laparoscopic mesh repair and Nissen fundoplication between 2015 and 2024. Nine patients underwent Collis-Nissen esophagogastroplasty due to intraoperative confirmation of short esophagus.

Results: Mean surgery time was 3 (2-4.5) hours, length of hospital-stay - 7 (5-15) days. Intraoperative revision established cuff and part of the stomach displacement into mediastinum as a cause of rHH in 31 cases, eruption of sutures on diaphragmatic crura - in 22 cases, no primary correction of short esophagus - in 9 cases. In 5 cases, we diagnosed distal displacement of cuff. There were no intraoperative or postoperative complications. Recurrence of HH within 5 (1-10) years was noted in 2 (5.5%) patients.

Conclusion: Diaphragmatic crus repair with their reinforcement by mesh endoprostheses and Collis-Nissen esophagogastroplasty for short esophagus significantly reduce the risk of hiatal hernia recurrence.