Молодежный инновационный вестник

Учредитель: Федеральное государственное бюджетное образовательное учреждение высшего образования «Воронежский государственный медицинский университет имени Н.Н. Бурденко» Министерства здравоохранения Российской Федерации

Свидетельство о регистрации СМИ ПИ № ТУ 36-00228 от 22 декабря 2011 года
Адрес:
394036, г. Воронеж, ул. Студенческая, 10

Главный редактор: Андреев Александр Алексеевич - доктор медицинских наук, профессор кафедры общей и амбулаторной хирургии

Издается с 2011 г. Периодичность выхода: 2 выпуска в год

ISSN: 2415-7805 (print)

Издатель: ФГБОУ ВО ВГМУ им. Н.Н. Бурденко Минздрава России

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Vol 11, No 2 (2022): Materials of the XV International Surgical Forum "INNOVATIVE TECHNOLOGIES IN SURGERY"

Хирургические дисциплины

THE ROLE OF SELECTIVE CORONARY ANGIOGRAPHY AND MYOCARDIAL REVASCULARIZATION IN THE SURGICAL TREATMENT OF CRITICAL AND CHRONIC LOWER LIMB ISCHEMIA. HOSPITAL RESULTS
Avoyan A.
Abstract

The presented work shows various treatment strategies for patients with critical and chronic lower limb ischemia (KINK and HINK 2b) in combination with coronary heart disease (CHD). As is known, patients with atherosclerosis of the arteries of the lower extremities have a frequency of coronary artery lesions up to 72%. As a consequence, these patients are at high risk of coronary events. This issue is very relevant, because according to data in 2010 alone, there were more than 200 million people with peripheral artery disease.

Молодежный инновационный вестник. 2022;11(2):4-6
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Assessment of abdominal tissues viability
Adamenkov N.A., Sumin D.S., Vetrova A.V.
Abstract

Topicality: Disruption of mesenteric circulation is one of the most severe pathologies in abdominal surgery. Intraoperative assessment of intestinal viability remains an unsolved surgical problem. Application of modern methods of ischemia and tissue necrosis determination is a promising direction in the objective diagnosis of these pathologies.
Purpose of the work. Development and introduction into the surgical practice of the operating field illumination methods improving visualization and objective assessment of microcirculation and intestinal wall viability.
Materials and methods. Clinically healthy laboratory rat of Wistar line was the object of investigation. To estimate the degree of the intestinal wall pathological changes in the midline laparotomy, staged ligation of the small intestine arcade vessels with the time intervals from 15 to 60 minutes was carried out. Tissue condition was assessed using RGB lamp, hyperspectral camera and diffuse reflectance spectroscopy method. An LED surgical illuminator with controllable color parameters was used in the study. Diffuse reflectance spectroscopy was used to assess ischemic changes, showing light absorption by different tissue chromophores. Radiation delivery from a broadband source to the tissue and collection of secondary optical radiation to the spectrometer were performed using an optical probe. An optical hyperspectral imaging system based on the principle of registration of diffuse light reflection from the tissue was used. A halogen source was used as a broadband radiation source, and a Specim hyperspectral camera as a detector. The study was completed by sending intestinal sections for pathomorphological examination.
Results. The obtained data were processed in the Matlab program using the mathematical method of image segmentation. Application of colors in the range of 500 and 593 nm (turquoise + orange) allowed to visualize and evaluate ischemic and necrotic intestinal areas better in comparison with the light repeating the radiation of the surgical lamp that was confirmed by histological study. Based on the data obtained by diffuse reflection spectroscopy and hyperspectral imaging methods, the values of blood flow and tissue saturation were calculated. Significant decrease of saturation and blood-filling in the ischemic regions of the intestine was observed.
Conclusions. Application of RGB lamp improves visualization of ischemic areas. Application of hyperspectral camera and diffuse reflection spectroscopy are objective methods of tissue viability assessment.
The study was supported by the Russian Science Foundation under Project No. 21-15-00325.

Translated with www.DeepL.com/Translator (free version)

Молодежный инновационный вестник. 2022;11(2):7-9
pages 7-9 views
INJURIES OF SOFT TISSUE STRUCTURES OF THE KNEE JOINT AND ULTRASONIC EXAMINATION
Asimova A.A., Malikov J.I.
Abstract

The data of ultrasound examination of patients with a history of traumatic injuries of soft-tissue structures of the knee joint, in which bone damage was excluded by radiography, were studied. The most common triad of symptoms was manifested by pain, restriction of movement and swelling of the knee joint. The data on the diagnostic effectiveness of the ultrasound method of examination for injuries of soft-tissue structures of the knee joint are clarified and detailed. An ultrasonographic study of the relationship between the thickness of the site of degenerative changes of the meniscus and the frequency of its ruptures was carried out. In the diagnosis of traumatic injuries of soft-tissue structures of the knee joint, the method made it possible to clearly identify the presence of damage, differentiate ruptures and degenerative changes in these structures.

Молодежный инновационный вестник. 2022;11(2):10-13
pages 10-13 views
The formation mechanism of the gastrointestinal fistulas in infected pancreatic necrosis
Anorev N.I., Ivanov S.A.
Abstract

Abstract

Among all the complications of infected pancreatic necrosis, the leading place is occupied by severe gastrointestinal fistulas that occur in 6-20% of patients.

The aim of the study is to determine the mechanism of formation of gastrointestinal fistulas in infected pancreatic necrosis in order to choose the optimal treatment tactics.

Materials and methods

In 18 out of 142 patients with infected pancreatic necrosis (12.7%), the course of the disease was complicated by the formation of fistulas of the gastrointestinal tract. All patients were examined according to a single method, including laboratory tests of blood, urine, ultrasound of the abdominal cavity, overview radiography of the chest organs. CT of the abdominal cavity was performed to determine the degree of damage to the pancreas and retroperitoneal tissue. The diagnosis of "infected pancreatic necrosis" was established on the basis of the results of microbiological examination of the punctate of acute fluid accumulations and necrotic tissue from the necrosis zone.

 

Results

From all 18 patients with gastrointestinal fistulas that complicated the course of infected pancreatic necrosis, conservative treatment was performed in 3 (16.7%) and surgical treatment in 15 (83.3%) patients. Conservative therapy was performed in patients with fistulas that arose after puncture under ultrasound control of infected fluid accumulations. From  the 15 operated patients, 11 were diagnosed with colon fistulas. Gastrointestinal fistulas in 8 (53.3%) of the operated patients led to severe sepsis, multiple organ failure and death. The overall mortality rate among patients with infected pancreatic necrosis complicated by gastrointestinal fistulas was 44.5%.

Conclusions

The study showed that most gastrointestinal fistulas in infected pancreatic necrosis are associated with prolonged inflammation of the peripancreatic zone and infection. The mechanism of formation of the most severe colonic fistulas is necrosis of the mesentery and the wall of the colon, associated with anatomical features of its blood supply. It also follows from the results that with a minimally invasive approach, conditions are created for the successful treatment of emerging gastrointestinal fistulas.

Молодежный инновационный вестник. 2022;11(2):14-20
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Comparative analysis of surgical methods of intervention for varicocele in adolescents of the Voronezh region
Bakaeva N.
Abstract

Relevance. Varicocele is a varicose vein of the pampiniform plexus of the spermatic cord, the surgical treatment of which is widespread in pediatric surgery. In addition to the pathology of the reproductive function, the disease causes a violation of the physical and psycho-emotional well-being of the patient.
Progress in the surgical treatment of this disease does not stand still. Discussions and disputes continue in the scientific world about the feasibility and advantages of choosing one method or another, and there is no consensus in the leadership of a particular method.
Target. To compare the statistical data of surgical treatment of varicocele in adolescents using the Palomo technique and laparoscopic varicocelectomy. To study the data of relapses and complications of the disease after surgery, to identify the most effective technique of surgical treatment of varicocele in adolescents from the compared surgical techniques.
Materials and methods. Using the statistical data of the Voronezh region (on the basis of ODKB No. 2, 2016-2021) of surgical treatment of varicocele using the Palomo method and laparoscopic varicocelectomy, a qualitative and quantitative analysis of the effectiveness of surgical interventions performed on adolescents from 12 to 17 years old was carried out.
Results. The study included an assessment of the course and duration of operations, complications and relapses. Both operations have completely different techniques, and laparoscopic varicocelectomy requires the use of special equipment. The execution time varies and is often in direct correlation with the experience and skills of the surgeon, on average the Palomo technique takes 7-10 minutes, laparoscopic varicocelectomy - 10-15 minutes. Varicocele recurrence was observed only in 15% of adolescents operated on using the Palomo technique. Laparoscopy revealed a complete absence of complications and relapses, which emphasizes the preferential choice of this technique. In addition, patients who underwent laparoscopic varicocelectomy rehabilitated much faster than the other group.
Conclusion. Based on the studies, it was found that in the practice of pediatric surgery, the most effective and successful surgical treatment of varicocele is laparoscopic varicocelectomy.

Молодежный инновационный вестник. 2022;11(2):21-26
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COMPARATIVE ANALYSIS OF MODERN METHODS OF MEASURING THE AREA OF THE WOUND SURFACE
Bokov D.A., Mikhailov N.O.
Abstract

Relevance. Modern technologies are replacing traditional methods in clinical medicine. This trend is also observed in surgery – at the moment, a large number of computer programs and mobile applications have been developed to help a practicing specialist.
Goal. To conduct a comparative analysis of modern methods of measuring the area of the wound surface.
Materials and methods. The experiment was conducted on the basis of the Research Institute of Experimental Biology and Medicine of the Burdenko State Medical University of the Ministry of Health of Russia. Over 500 wound surfaces have been analyzed by various methods of measuring wounds. Traditional methods of measuring wounds according to J.I. Kundin, H.N.Mayrovitz and L.N. Popova were used for the study. From computer programs, ImageJ, Universal Desktop Rule were used, from mobile applications - +WoundDesk, V2F, ImitoWounds. To standardize the results, the method of measuring the area of the wound by L.N.Popova was chosen.
Results. In comparison with the selected standard, when calculated by the J.I.Kudin method, the average deviation was – 23.18%, when calculated by the H.N. Meyrovitz method – 30.37%. The deviation when using ImageJ was 12.23%, Universal Desktop Ruler - 13.8%. Mobile applications showed the best results – the average deviation when using +WoundDesk was 9.16%, V2F - 11.04%, ImitoWound - 7.49%.
Conclusion. The programs used for planimetric studies can serve as a substitute for traditional methods, since they are quite accurate. The use of these technologies can significantly reduce the time used to measure the area, increase the accuracy of measurement, and better display the dynamics of the wound process. Technologies allow you to remove the contact of materials with the wound, and therefore reduce the likelihood of infection of the wound.

Молодежный инновационный вестник. 2022;11(2):27-31
pages 27-31 views
Intraoperative prevention of silent sinus formation after extranasal operations on the maxillary sinus
Bushneva E.V.
Abstract

Relevance:
Among the entire pathology of the ENT organs, chronic inflammation of the maxillary sinus is one of the most common and accounts for 7-12% of all diseases related to surgical infection. The problem of treatment of this pathology remains relevant to the present day.
The most important problem in the treatment of chronic rhinogenic maxillary sinusitis is the restoration of bone tissue and ciliated epithelium after extranasal operations on the maxillary sinus.
Purpose: to study the possibility of using platelet-rich fibrin to close a postoperative bone defect in the anterior wall of the sinus and stimulate regenerative processes in the mucous membrane of the affected sinus.
Methods:
The objects of the study were 8 patients with a diagnosis of chronic recurrent purulent-polypous maxillary sinusitis in the period from 09/21/21 to 01/28/2022 on the basis of VOKB No. 1 of the Otorhinolaryngology Department. The study plan included the study of case histories, analysis of the course of the operation, as well as observation of patients in the postoperative period. To evaluate the results of treatment, patients were divided into two clinical groups of 4 people each. According to the treatment plan, all patients underwent radical maxillary sinus otomy according to Caldwell and Luke, however, in patients of the first (main) group, the surgical intervention was completed by inserting a platelet-rich fibrin clot (PFC) into the burr hole of the anterior wall of the sinus.
Results:
Relief of the main manifestations of chronic inflammation and postoperative changes in the wound against the background of the use of OTP occurred quite quickly. So collateral edema disappeared on average 3 days after surgery, infiltration - on the 2nd day. Soreness on palpation significantly decreased on days 2-3 in patients after the use of OTP. In the comparison group, all these changes lasted more time and took place on average for 4-5 days.
Conclusion:
The use of platelet-rich fibrin in the complex treatment program for chronic maxillary rhinosinusitis is a clinically effective, easily reproducible method that optimizes the course of the wound process in the regeneration phase.

Молодежный инновационный вестник. 2022;11(2):32-37
pages 32-37 views
Multidisciplinary approach in a patient with multifocal atherosclerosis
Galstyan A.
Abstract

The most common comorbidity in patients with chronic lower limb ischemia (CLLI) is coronary artery disease (CHD). According to the recommendations of the ESC from 2017. in patients with lower limb artery disease (ANK), the probability of having clinically significant CAD ranges from 25% to 72%. This highlights the importance of a thorough preoperative evaluation of patients with multifocal atherosclerosis (MFA) who may have significant lesions in multiple arterial beds. This thesis presents a clinical case of the treatment of a patient with clinically significant lesions in several arterial beds, for whom a multidisciplinary team determined the optimal treatment strategy.

Молодежный инновационный вестник. 2022;11(2):38-40
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Influence of arterial anatomy of the pancreas on the development of postoperative complications after pancreaticoduodenectomy
Dvukhzhilov M.V., Stashkiv V.I., Struchkov V.J.
Abstract

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Молодежный инновационный вестник. 2022;11(2):41-46
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Improving the provision of surgical care to newborns with peritonitis
Dedov A.С.
Abstract

Relevance: The most formidable problem in newborns and premature infants, leading to a fatal outcome, is peritonitis.

Objective: to study the tactics of treatment, preoperative preparation for the development of peritonitis in newborns and premature infants in order to improve it.

Methods: The study was conducted from 2012 to 2021 on the basis of the BUZ in VRCCH №1, in the department "Surgery of newborns".

All children underwent laboratory examination (general blood test, acid-base state, blood electrolytes), and abdominal X-rays.

Results: Over the past 10 years, 38 children with clinical manifestations of peritonitis have been in the hospital.

Gastrointestinal perforations were postnatal in most (92%) cases and were accompanied by fibrinous (31%), serous (31%) and fecal (38%) peritonitis.

The study revealed that necrotizing enterocolitis was the cause of perforating peritonitis in 65.7% of cases (IIIA - 48%, III B - 52%), in 10.5% of cases - atresia of the small intestine with perforation, short bowel syndrome with intestinal necrosis and gastroschisis occurred in 10.4% of cases. 8.1% of children had intestinal malrotation with necrosis. 5.2% of newborns had intrauterine fecal peritonitis and stomach rupture.

All children with perforations were operated on. The tactics of surgical intervention differed depending on the type and level of perforation, the length of the process and the condition of the newborn. Laparocentesis followed by peritoneal drainage was performed in 25.7% of children.

Conclusions: The most common cause of peritonitis in newborns is necrotic enterocolitis, which has the most unfavorable prognosis of treatment. The mortality rate of newborns with perforated peritonitis decreased from 40% to 5%.

Молодежный инновационный вестник. 2022;11(2):47-52
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INDICATORS OF THE EFFECTIVENESS OF THE TREATMENT OF FALSE CYSTS
Jamolova F.N.
Abstract

Objective: to compare the results of treatment of patients with pseudocysts of the pancreas operated by the traditional laparotomy method and using minimally invasive technologies.
Materials and methods of research. A retrospective analysis of the results of treatment of 47 patients with pseudocysts of the pancreas was carried out. Punctures and drainage of pancreatic pseudocysts on the background of pancreatitis, under the control of ultrasound, were performed in 24 patients (main group). 23 patients were subjected to the cavity method of treatment (control group). Indications for laparotomic methods of treatment were considered to be the preservation of clinical manifestations of the disease, purulent discharge from the cyst for 3-4 days after drainage under ultrasound control, the presence of sequesters in the cystic cavity. These patients underwent laparotomy, external cyst drainage, and sequestectomy. The indication for puncture or drainage under ultrasound control was a false pancreatic cyst more than 6 cm in diameter in the absence of signs of sequestration. All patients underwent cytological and bacteriological examination of the fluid evacuated from the cyst, the level of amylase content in it was examined.
Results. The positive effect of treatment was noted in 82.7% of patients using minimally invasive percutaneous techniques (elimination of cysts was achieved in 52.3% of patients, reduction of cyst size - in 30.7%) and in 65.6% of patients treated with traditional laparotomy methods. The average hospital stay in patients of the main group decreased by 12.3 days compared to the control. Intraoperative and postoperative complications were noted in 17.3% of patients in the main group and 34.4% in the control group. The most frequent complications were suppuration (25% of all patients with pseudocysts), bleeding and recurrence of pseudocysts (1.3% and 10.2%, respectively). At the same time, in 96.7% of patients with recurrent pseudocysts in the early postoperative period, the level of intracystic fluid amylase exceeded normal values by 5 or more times.
Conclusions. The effectiveness of the compared minimally invasive surgical methods can be compared with laparotomy methods, while some of the complications in the early postoperative period and the average length of hospital stay with the use of minimally invasive interventions are significantly less (p<0.05). The level of intracystic fluid amylase can serve as a prognostic sign for two-stage treatment.

Молодежный инновационный вестник. 2022;11(2):53-55
pages 53-55 views
Morphological picture of osteomyelitis with the use of tizol and amikacin
Zolotukhin v.O., Elfimov A.D.
Abstract

Relevance: Osteomyelitis is one of the most difficult options for the development of surgical infection. Relapses of the disease occur in 20-30% of patients, and the frequency of amputations and dysfunctions of the affected limb can reach 10.3-56.8% of cases.
Materials and methods: the experimental study was conducted on the basis of the EBM Research Institute. "Voronezh State Medical University named after N. N. Burdenko." Experiments were conducted on 180 animals with chronic osteomyelitis in 5 groups: 2 control and 3 experimental groups. In the 1st control group, no treatment was carried out. In the 2nd control group, as in all the others, two-stage surgical rehabilitation was carried out using hydro-pulse and micromotor installations. In the 1st experimental group, amikacin was injected into the bone cavity at a dose of 15 mg / kg after surgical rehabilitation; in the 2nd experimental group, an aquacomplex of titanium glycerosolvate was injected before filling the cavity. In the 3rd experimental group, the sequential use of tizol and laser radiation was used.
Results of the study: the effectiveness of the approaches was determined on the basis of the histological picture of the pathological process on 7., 14., 28., 60., 90. and 120. The best indicators were recorded in the 3rd experimental group (combined use of tizol and amikacin).

Молодежный инновационный вестник. 2022;11(2):56-59
pages 56-59 views
Clinical case report of Endoprosthetic replacement of the acetabulum in the tumor involvement of the sciatic bone
Ivanova A.
Abstract

Relevance: The rarity of tumor lesions of the pelvic bones and paraacetabular region, the low percentage of detectability at the initial stage of the tumor process, the adjacent position of vital organs and major neurovascular structures in the pelvic cavity, as well as the important role of the pelvic ring in ensuring the function of human movement determine the complexity of performing organ-preserving operations and the high incidence of postoperative complications in this category of patients.

Objective: demonstration of the possibility of modern treatment of osteosarcoma of the paraacetabular region.

Subjects and methods: the clinical case of a patient with osteosarcoma of the right sciatic bone ypT1N0M0 G2 IIA art., who was undergoing step-program  treatment in the Department of Bone Pathology No. 6 of the "NMRC for Traumatology and Orthopedics named after N.N. Priorov" of the Ministry of Health of the Russian Federation.

Results: the presented clinical case is indicative due to the excellent results achieved: Orthopedic status (MSTS) - 92%.

Conclusion: Early diagnosis of a pathological focus without a pronounced soft tissue component, combined treatment in full and the use of modern surgical techniques led to the achievement of excellent functional results.

Молодежный инновационный вестник. 2022;11(2):60-63
pages 60-63 views
Biochemical aspects of prevention of chronic liver failure after liver resection
Laptiyova A.Y., Antakova L.N., Ostroushko A.P.
Abstract

Goal. Improving the results of the prevention of chronic liver failure by intraoperative administration of cyanocobalamin in an experiment.

Materials and methods. The experiments were performed on 96 Wistar rats. All animals underwent liver resection according to the method of G. Higgins and R.Anderson. In the 1st control group, prevention of liver failure was not carried out, in the 2nd control group, 0.9% NaCl was intrahepally administered; in the 1st experimental group, cyanocobalamin; in the 2nd experimental group, cyanocobalamin was administered intraperitoneally. On the 14th day, blood was taken for biochemical examination. Statistical processing was performed using the Statistica 6.0 program.

Results. On the 14th day of the study, normalization of cytolysis syndrome indicators was observed in the 1st experimental group in 97.5 ± 3.1% of animals; in the 2nd experimental group - in 71.0 ± 3.1%, in the 1st control group - in 68.2 ± 4.1%, in the 2nd control group – in 84.6± 2.6% of animals. Indicators of hepatic cell insufficiency syndrome normalized in 100% of animals in the 1st experimental group, 88.4±4.1% - in the 1st control group, 84.3±2.2% - in the 2nd control group, 91.1±2.4% – in the 2nd experimental group. Indicators of cholestatic syndrome were normalized only in the 1st experimental group in 68.4 ± 5.2% of animals.

Conclusion. Intraoperative administration of cyanocobalamin during liver resection significantly contributes to the relief of cytolysis, cholestasis and hepatic cell insufficiency syndromes.

Молодежный инновационный вестник. 2022;11(2):64-66
pages 64-66 views
Analysis of the prevalence of venous thromboembolic complications at the present time
Muhamadeeva M., Ibragimov D.R., Arapova A.V.
Abstract

Relevance. Venous thromboembolic (VTE) complications are often a concomitant aggravating condition of the underlying disease in patients. VTE complications includes deep vein thrombosis (DVT), superficial thrombophlebitis and pulmonary embolism (PE). The main factors of VTE complications development are well known, including oncological diseases, thrombophilia, and injuries. Perhaps an additional factor is patients with severe coronavirus infection, may be at risk of developing thrombosis.
Objectives. To assess the impact of the COVID-19 pandemic on the development of VTE in patients.
Materials and methods. For the analysis, the data of appeals and cases of hospitalization of patients with VTE complications for 2018-2021 in the Republic of Bashkortostan of the vascular surgery department of the Ufa City Clinical Hospital No. 21 were selected, according to the information and analytical subsystem of RIAMS "Promed".
Results. The study analyzed 512 cases of thrombosis of the lower extremities. Among the patients, 271 (52.9%) women, 241 (47.1%) men, the age of the patients was 59.7±15.1.
A comparative analysis of the last four years revealed an increase in the number of hospitalizations of patients with phlebothrombosis, which, apparently, is due to changes in the conditions of the COVID-19 epidemic. In 2021, the incidence of thrombotic complications increased significantly. However, in 2019-2020, the ratio of occurrence of thrombosis in the veins of the lower extremities among men and women varied slightly. The figures for 2018 indicate a higher number of thrombosis in women 65 (67%) compared to men 32 (33%). It was revealed that during the analyzed period, deep vein thrombosis is predominant.
Conclusion. The number of patients admitted to the hospital during the COVID-19 pandemic has increased. This trend has been observed since the end of 2021. To date, statistics on VTE complications are heterogeneous and changing due to the adaptation and improvement of anti-epidemic measures, the presence of COVID-19 convalescents and vaccinated patients.

Молодежный инновационный вестник. 2022;11(2):67-72
pages 67-72 views
THE FIRST EXPERIENCE OF USING IMPACT SOLID-STATE LASER WITH ULTRAVIOLET RADIATION ON AN ATHEROSCLEROTIC PLAQUE HUMAN CADAVERIC VESSELS
Noschenko N., Perova A.A.
Abstract

Annotation
Objective: to evaluate the effectiveness of the effect of a solid-state laser with ultraviolet radiation on the atherosclerotically altered arterial wall of human cadaveric vessels. Materials and methods: the object of the study were samples of human cadaveric vessels (carotid, femoral arteries, brachiocephalic trunk, aorta). The laser exposure was carried out with the specified technical parameters the same for all samples. The samples were subjected to laser exposure with fixation of the time required to overcome the inner and middle layer of the arterial wall, then histomorphological examination of the samples was carried out. Results: it was revealed that the use of laser exposure to a solid-state laser with ultraviolet radiation UL-02/213 "Olimp" is a safe technique, since the time required for wall perforation exceeds 30 seconds, respectively, the technique with these technical parameters is operator controlled. According to the results of histomorphological analysis, all samples exposed to laser exposure had smooth edges, no signs of necrotic lesion were found in nearby structures, the plaque was removed evenly. Conclusion: the use of a solid-state laser with ultraviolet radiation UL-02/213 "Olimp" is a safe and effective technique.
Keywords: cardiovascular surgery, laser angioplasty, excimer laser angioplasty, solid-state laser.

Молодежный инновационный вестник. 2022;11(2):73-76
pages 73-76 views
RESULTS OF SURGICAL TREATMENT OF THE BRACHIOCEPHAL TRUNK
Polyansky D.
Abstract

Intrathoracic reconstructions for atherosclerotic lesions of the brachiocephalic trunk have proven to be interventions that provide long-term patency and freedom from neurological deficits and, today, are considered the operation of choice for such lesions.

Purpose: to evaluate the hospital results of surgical treatment of brachiocephalic trunk.

Materials and methods. The study included 79 patients with atherosclerotic lesion of the brachiocephalic trunk. who were treated at the Vishnevsky National Medical Research Center for Surgery in the period from 1983 to 2020.

Results. Hospital results: stroke - 4 (5.06%), prosthesis thrombosis - 3 (3.9%), bleeding - 4 (5%), mediastinitis - 6 (7.5%), AMI - 4 (5%), lethality - 3 (3.9%).

Thrombosis of the prosthesis during the hospital period was observed in patients who underwent closed endarterectomy from the bifurcation of the brachiocephalic trunk: with linear prosthetics in two cases (2.6%), with double bifurcation prosthetics in one case (1.3%). Bleeding in all 4 cases (5%) was observed from the sternum and soft tissues, eliminated after resternotomy and revision of the p/o wound. Hospital mortality was 3.9%: in one case (1.3%) due to mediastinitis, and in two (2.6%) due to stroke. Only the development of prosthesis thrombosis (p=0.006) significantly influenced the occurrence of neurological deficit in the n/o period - in 2 out of 3 cases of prosthesis thrombosis, a stroke occurred in the right hemisphere.

It should be noted that since 2001, there have been no cases of thrombosis, AMI and mediastinitis. In the first case, in our opinion, this is due to the refusal of endarterectomy from the bifurcation of the brachiocephalic trunk with linear prosthetics. In the second - an assessment of cardiac risk based on the results of coronary angiography or stress echocardiography. If necessary, the first step was myocardial revascularization, and then intrathoracic reconstruction. And, finally, we associate the absence of cases of mediastinitis with the transition from complete median sternotomy to partial, which provides optimal visualization and exposure in the surgical wound, and also, due to low trauma, reduces the risk of postoperative complications.

Conclusion. Thus, to date, brachiocephalic trunk prosthetics has proven itself in the practice of cardiovascular surgery as a safe and reliable technique that provides acceptable hospital results, as well as long-term patency and freedom from neurological deficits.

Молодежный инновационный вестник. 2022;11(2):77-79
pages 77-79 views
Modern treatment of liver alveococcosis
Yurkovskaya A., Zhao A.V., Stepanova Y.A.
Abstract

Alveolar echinococcosis of the liver (AE) occurs as a result of infection with larval forms of E. multilocularis. The only radical method of treating liver alveococcosis is surgery. However, the use and introduction of new methods of treatment (antegrade and retrograde stenting, cryodestruction of the remaining alveolar tissue), in addition, long-term use of albendazole can improve the results of treatment of such patients, as well as their quality of life.

The aim of the study: to improve the results of treatment, as well as the quality of life of patients with liver alveococcosis.
Materials and methods. The study included 150 patients with liver alveococcosis treated at the Vishnevsky National Research Medical Center of Surgery in the period from 2009 to 2021. There were 66 men (44%), 84 women (56%), the average age was 54 years (18-78 years). Scope of examination of patients: ultrasound + MSCT+MRI.
The results of the study. 140 (93%) patients underwent surgery, 21 (16.5%) patients underwent palliative interventions, the rest (n = 119) underwent liver resection in various volumes: radical (in volume R0) – 64 (53.8%); cytoreductive (in volume R 1-2) - 55 (46.2%). All patients were prescribed chemotherapy after surgery.
In 10 (7%) patients, the prevalence of the process did not allow surgical intervention (antiparasitic therapy with albendazole was prescribed).
At the time of admission, 21 (15%) hospitalized patients had mechanical jaundice. In order to resolve it, before surgery on the liver, he performed the following minimally invasive interventions: Bile duct stenting - 15; bile duct stenting - 7. In 18 cases, in the presence of a massive alveococcal lesion with a decay cavity in the center, external drainage of this cavity was performed.
Since 2012, we have been using cryodestruction (CD) of the remaining parasitic tissue using the Russian CRYO-01 apparatus and porous permeable cryoapplicators made of titanium nickelide. According to this method, 31 (26%) patients were operated on. Cryolysis was performed on the remaining/suspicious part of the pathological tissue on the right dome of the diaphragm (4), in the liver gate (7), on the remaining parenchyma of the left lobe after PGGE (10), on the remaining segments of the right lobe after resection (6), in the paraaortic tissue (3), along the right ureter (1).
The nature and frequency of complications in the postoperative period is presented
as follows: fluid accumulation – 4 (3.4%); biloma 10 (8.4%); failure
of biliodigestive anastomosis - 1 (0.8%); biliary peritonitis - 2 (1.7%); biliary fistula –
12 (10.1%); residual alveococcosis with the formation of bile duct stricture -
5 (4.2%); purulent cholangitis - 1 (0.8%); bleeding - 1 (0.8%); liver failure -3 (2.5%); suppuration of postoperative wound - 2 (1.7%). The postoperative period in 12 patients was complicated by the formation of a complete
external biliary fistula, which required the performance of CHCS, external-internal
drainage of the ducts of the right and left lobes of the liver (n = 8); ERPG, EPST, stenting
of the bile ducts (n=4). Stricture against the background of residual alveococcal lesion
developed in 5 patients, which required endoscopic intervention.
4 (4.8%) deaths were noted. One fatal outcome after RPPGE, supplemented by resection of segment 1 and NSAIDs with cryodestruction along the edge of liver resection along the right ureter. The reason is progressive multiple organ failure.
Conclusions. The use of combined treatment (radical resection; liver resection, supplemented by cryodestruction of the remaining parasitic tissue), minimally invasive methods of treatment under the control of radiation examination methods can be considered the most optimal and modern methods of treating liver AE. The decision on the choice of treatment method for such patients should be strictly individual, and the use of chemotherapy (taking albendazole) must be carried out in the postoperative period. These methods make it possible to correct complications in the n\o period, as well as to improve the quality of life of patients with liver alveococcosis.

Молодежный инновационный вестник. 2022;11(2):83-86
pages 83-86 views
Morphological aspects of prevention of postoperative hepatic insufficiency with cyanocobalamin solution
Shishkina V.V., Laptiyova A.Y., Ostroushko A.P., Yashkova M.A.
Abstract

Goal. Improving the results of prevention of postoperative hepatic insufficiency by activating the reparative potential of the liver with cyanocobalamin administration.

Materials and methods. The study was performed on 36 Wistar rats. In 3 experimental groups, resection was performed in the amount of 70% of the initial liver mass: in the 1st - prevention of postoperative liver failure was not carried out, in the 2nd - after resection, 0.9% NaCl solution was injected into the preserved liver lobes, in the 3rd - cyanocobalamin. Liver resection was not performed in the 1st control group. The result was evaluated 2 weeks after surgery. The MS Excel package was used for statistical processing.

Results. Histological and immunohistochemical studies 2 weeks after surgery showed the best results in the 3rd experimental group: the number of binucleated hepatocytes was 19.31±3.68%, ki67-positive hepatocyte nuclei 6.22± 0.54%. When studying liver sections stained with silver impregnation, the number of reticular fibers in the 3rd experimental group was more than 90% of the indicators of the 1st control group, in the 1st and 2nd experimental groups – less than 80%.

Conclusion. The proposed method of activating the reparative potential of the liver by the introduction of cyanocobalamin allows to increase the proliferative activity of hepatocytes, contributes to an increase in the number of cells entering the mitotic cycle, ensures the restoration of the structural organization of the liver, its anatomical and functional integrity.

Молодежный инновационный вестник. 2022;11(2):80-82
pages 80-82 views

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