Vol 13, No 1 (2024): Материалы XVII Всероссийского форума с международным участием «Инновационные технологии в хирургии»

Хирургические дисциплины

Surgical tactics in nonparasitic cysts of the spleen

Borisyuk T.A., Maslakova N.

Abstract

Introduction. The paper presents own observations and 5 cases of non-parasitic cysts of the spleen. The own tactics of examination and surgical treatment are developed. Objective. To analyze the diagnostic results of laparascopic resection of splenic cysts. Research Methods. This article presents 5 clinical cases on diagnostics and treatment of patients with spleen cysts. The laparoscopic method was used in surgical treatment. When choosing it, a number of profile medical literature was studied and analyzed. 5 patients diagnosed with spleen cysts were treated at the Grodno University Hospital. Of them there were 4 women and 1 man. Results and discussion. As a result of successfully performed surgical treatment the patients managed to save such an important organ as the spleen for maintaining the homeostasis of the organism. Postoperative complications were also avoided.

Conclusion. The therapeutic tactics for nonparasitic cysts of the spleen today implies surgical intervention in the presence of pain or compression of adjacent organs. The size of cysts is not a determining factor for the choice of treatment tactics. The results of the performed operations were positive, no complications were observed. The postoperative period in all patients was smooth. All patients were discharged with satisfactory condition.

 

Молодежный инновационный вестник. 2024;13(1):4-7
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Modern methods of surgical treatment of non-parasitic splenic cysts in children

Burko Y.A., Glushkov A., Virko V.

Abstract

Introduction. There is no reliable and absolutely accurate, scientifically proven method of treating cysts, the opinions of the authors contradict each other, and there is still no unified systematic classification of the disease and a high risk of complications.

Aim. To analyze the main modern methods of treatment of nonparasitic spleen cysts in children.

Materials and methods. A retrospective review of the literature over the past 10 years on the issue of modern surgical methods for the treatment of nonparasitic spleen cysts in children has been conducted.

Results. Over the past ten years, the authors have been increasingly inclined to minimally invasive laparoscopic interventions. But the "gold standard" is a traditional splenectomy. The main methods of choice remain open or laparoscopic cystectomy/partial decapsulation, fenestartion, and marsupialization. Partial splenectomy can provide a better balance between recurrence and spleen preservation.Conclusion. Recently, the surgical approach in the treatment of nonparasitic spleen cysts has been changing towards conservative and minimally invasive methods of treatment in order to preserve the spleen in children for immunological indications.

Молодежный инновационный вестник. 2024;13(1):8-10
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Surgical treatment of echinococcosis of the left lobe of the liver

Denischik A.A., Shyla R.S., Mogilevets E.V.

Abstract

Introduction. Liver echinococcosis is a parasitic disease that requires surgical treatment. At this stage of development of surgery, minimally invasive technologies for performing liver resections are widely used. The goal of this study is to analyze and compare the results of open and laparoscopic operations for echinococcosis of the left lobe of the liver. Materials and methods. The study was conducted within the University Clinic of Grodno among patients from the Department of Surgical Pancreatology, Hepatology and Organ and Tissue Transplantation. Using the method of directed selection, two groups of patients were formed: the first group of three people who underwent open hemihepatectomy and the second group also of three patients who underwent laparoscopic left-sided sectionectomy. The research material was the primary medical documentation of the hospital. Results. The average duration of the operation, the average amount of intraoperative blood loss and bed days in both observation groups were determined. No complications were identified during the operation or in the early postoperative period. Conclusions. The duration of the operation and intraoperative blood loss during laparoscopic and open interventions on the left lobe of the liver do not differ significantly. Minimally invasive surgical techniques promote early activation of patients, which significantly reduces their hospital stay.

Молодежный инновационный вестник. 2024;13(1):11-13
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Using Non-Invasive Abdominal Volume

Kanakhina L.B., Protasov A.V., Mazurova O.I.

Abstract

Introduction. Due to the direct relationship between abdominal volume (abdominal volume) and the likelihood of developing intraabdominal hypertension (IAH), the measurement of intra-abdominal volume before and after surgery is an important aspect for predicting the development of abdominal compartment syndrome (ACS). Purpose. Study of the possibility of using computed tomography (CT) to predict the development of AKS in patients with large and giant ventral hernias. Materials and methods. The study involved 10 patients without ventral hernias, who underwent CT of the chest, abdominal and pelvic organs with intravenous contrast. Abdominal volume (abdominal volume) was measured using the manual method, as well as according to the methods of E.Y. Tanaka and N.S. Nikityaeva. Data processing was carried out using the Python language and the statistical packages pandas, sklearn, matplotlib and scipy. Results. The use of the E.Y. Tanaka method is statistically closer to the conditionally true volume (p-value: 0.3). The determination of the muscle area of ​ ​ the anterolateral wall of the abdominal cavity and its effect on the abdominal cavity has a higher statistical value than the determination of the length of muscle fibers on the right and left. Conclusions. Methods for measuring OBP and muscle fiber lengths are presented as a clinical example in a patient with a giant hernia. The use of conditional boundaries for determination of cranio-caudal, anteroposterior and transverse size by the method of E.Y. Tanaka et al. Is more rational (p-value: 0.3), since the results are closer to conditionally true sizes. It is also important to note that the standard CT examination does not always capture the lower branches of the pubic bone necessary for determining cranio-caudal size according to method No. 2, and the use of bone landmarks to measure anterior-posterior size excludes subjectivity.

Молодежный инновационный вестник. 2024;13(1):14-20
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Analysis of the development of complications after surgical treatment of purulent-inflammatory diseases of the hand in children

Kiseleva A.S., Baranov D.A.

Abstract

Introduction. The hand is involved in all kinds of human activities, so it is most often subjected to injuries of various types. Despite the new methods of treatment, the problem of combating purulent-inflammatory diseases of the hand in children remains at a high level. 

Objective. To evaluate the development of complications after surgical treatment of purulent-inflammatory diseases of the hand.
Materials and methods. The study was conducted on the basis of  BOOZ VO ODKB 2 in Voronezh in the purulent-septic department. A retrospective analysis of 156 case histories of patients treated in the clinic from 2005 to 2023 was carried out. The age of the patients at the moment of treatment was from 1 to 17 years, 33 patients were treated with the diagnosis of phlegmon, 123 patients were treated with the diagnosis of panaricium. The development of complications after surgical treatment of pustular diseases was assessed by collecting anamnestic data from the parents of the patients.

Results. The results of the study showed that the majority of patients with the diagnosis of panaricitis had no motor disorders of the operated hand, the scar did not cause psychological and physical discomfort in the patients - 80.5%. Motor disorders were detected in 9% of patients diagnosed with phlegmon, in 54.7% - the scar causes physical and psychological discomfort, no disorders of the hand function were detected.

Conclusions. The frequency of purulent-inflammatory diseases of the hand and fingers today remains high, in this connection the treatment tactics requires annual revision and introduction of new methods and technologies.

Молодежный инновационный вестник. 2024;13(1):21-24
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Features of the clinical course and treatment tactics of acute appendicitis in modern conditions

Matvienko M.D., Boev S.N.

Abstract

Introduction. Acute appendicitis is one of the most common surgical diseases. Aim: to study the features of the course and tactics of treatment of acute appendicitis at present. Materials and methods. The analysis of the case histories of 134 patients admitted with a diagnosis of acute appendicitis was carried out. Results. The average age of the patients was 36,7±1,5 years, more than a third were under 25 years of age. The course was characterized by subfebrile body temperature, absence of dyspeptic disorders, moderate leukocytosis, positive Volkovich-Kocher symptom, and predominance of destructive forms. The average time from the onset of the first symptoms to admission to the hospital was 31,8±3,3 hours. In 6% of cases other pathology was detected; in 1.5% of cases acute appendicitis was diagnosed intraoperatively. Laparoscopic and laparoscopically assisted appendectomy prevailed (81,6% of cases); open surgeries were used for treatment of patients with a disease duration of more than 72 hours. The frequency of complicated forms was 27,8%. Conclusions. Young patients prevailed among patients with acute appendicitis. The absence of fever, pronounced leukocytosis and a number of appendicular symptoms made diagnosis difficult; there was a late call for medical help. Laparoscopic interventions predominate in the treatments. The tactics, frequency of complications depend on the time of seeking medical help.

Молодежный инновационный вестник. 2024;13(1):25-31
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Modern methods of liver resection

Makhin V.A., Лаптиёва A.Y., Ostroushko A.P., Andreev A.A.

Abstract

Relevance. To date, the incidence of injuries, neoplasms and parasitic liver diseases continues to grow, but resection remains one of the main methods of surgical treatment for its pathology. Liver resection, even with the use of modern technologies, remains a highly traumatic operation, leading to disruption of metabolic, hemostatic, detoxification and other functions, leading to the development of complications in 4.1–47.7%, fatal outcomes in 0.24–9.7% of cases.
Goal. To study modern surgical approaches to liver resection.
Materials and methods. The data presented in PubMed, Elibrary and Cyberleninka are reviewed. The search was conducted using the keywords "liver resection", "liver". Criteria for exclusion from the analysis: description of individual clinical cases; books and documents; comparison of treatment results of individual patients.
Results. To date, atypical and anatomical liver resections are performed, i.e. taking into account the internal structure of the organ. The choice of surgery technique is also important. In addition to open methods, there are minimally invasive techniques, which include laparoscopic and robot-assisted resections. It is proposed to divide minimally invasive liver resections into three main options with different technical features – laparoscopic resection using laparoscopic ports, hand-assisted surgery, and hybrid surgery.
Conclusion. Liver resection, even with the use of modern technologies, remains a highly traumatic operation, which is why the choice of surgical intervention technique is a key point in the treatment of patients with liver pathology requiring surgical treatment.

Молодежный инновационный вестник. 2024;13(1):32-36
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Issues in using predictive gradient bousting models to predict complications in patients with surgical peritonitis

Polidanov M.A., Volkov K.A., Sukhoy D.V., Maslyakov V.V., Barulina M.A.

Abstract

Introduction. With the development of technology, computational capabilities, and artificial intelligence, it has become possible to create a medical decision aid system for predicting the occurrence of complications in peritonitis. The aim of the study was to use predictive models of gradient bousting to predict complications in patients with surgical peritonitis. Materials and Methods. The study involved data from 1192 patients hospitalized with the diagnosis of peritonitis. The methods of classical statistics - Pearson's pair correlation and machine learning methods - gradient bousting on decision trees - were used to investigate the importance of signs (indicators of clinical-diagnostic and instrumental investigations) on the occurrence of complications. Precision, recall and F1-metrics were used to assess the quality of the resulting model. Results. One of the ways to improve the results of abscess treatment is the possibility to detect and predict the occurrence of complications at an early stage, which, undoubtedly, can greatly simplify the construction and strategy of treatment. Conclusions. The paper shows the principal possibility of using artificial intelligence methods to predict the probability of complications occurrence in peritonitis.

Молодежный инновационный вестник. 2024;13(1):37-39
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Assessment of the microvasculature with a non-contact sensor: development and application methods

Rakhmanova A.A., Faradzhev D.M., Tsibin A.Y.

Abstract

Introduction. The limited applicability of contemporary techniques for evaluating the microvasculature stems from the requirement for intrusive research and inadequate outcome reliability. Only mucosal membranes or exposed organ regions can be treated intraoperatively with these techniques. Promising is the suggested non-contact technique for measuring the microvasculature, which is based on evaluating the local myogenic response of venules and arterioles to a cold substance. Aim of the study. Assessing the microvasculature and investigating local reserves of temperature regulation of microcirculatory in volunteers aged 20-45, stratified by gender, age, ethnicity, and existence of negative habits, using a non-contact sensor. Materials and methods. Microcirculation was assessed with a non-contact sensor at a distance of 3-5 cm from the skin on the foot, lower leg and the back of the brush. The technique consisted of continuously alternately assessing the base temperature, the temperature at the moment of supply of the refrigerant (within 30 seconds) and monitoring the rate of recovery of the base temperature. The duration of the technique (no more than 1 minute per measurement), is universal for any part of the body and is safe, because the device does not require invasive monitoring. Results. With normal blood supply, temperature recovery occurred within 2 minutes. Such data were obtained from people who did not have vascular pathology or smoke burden. A slower reaction was observed in smokers. In patients in the traumatology department, after undergoing spinal anesthesia, the line was fluctuating, and recovery of the microvasculature took longer (3 or more minutes). Conclusions. The technique of non-contact monitoring of the microvasculature response is a promising method for assessing ischemia during emergency surgery, determining the boundaries of resection of an ischemic organ, addressing the issue of tissue viability, and identifying the type of tissue based on blood supply levels in the context of cancer vigilance.

Keywords: microcirculation; microvasculature; ischemia; non-contact measurement; restoration of microcirculation

Молодежный инновационный вестник. 2024;13(1):40-42
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Antegrade choledochoscopy in laparoscopic cholecystectomy is a method of diagnosis and treatment of papillostenosis

Sakhabetdinov B.A., Abdullina D.D., Garifullova A.R., Kurbangaleev A.I.

Abstract

Annotation.

In the last 30-40 years, there has been a negative trend in the incidence of cholelithiasis, which is complicated by the development of papillostenosis of various degrees. Now widely used in the diagnosis and treatment of papillostenosis: ERHPG and EPST, but these types of surgical correction of the pathology of BDS have disadvantages. In this connection, antegrade choledochoscopy with subsequent augmentation is an option for the diagnosis and correction of papillostenosis narrowing of varying degrees. The purpose of the study is to evaluate the effectiveness of endoscopic antegrade choledochoscopy (EAC) in papillostenosis of various degrees. Materials and methods: 31 case histories of a patient who was hospitalized in the surgery department from 2013 to 2022 with BDS stenosis complicated by mechanical jaundice, who underwent EAC followed by BDS augmentation, were analyzed. Of 100% of patients – 3,2% (1 patient) - had a history of BDS restenosis after undergoing LHE, antegrade choledoscopy and BDS augmentation (4,5 years after the first intervention), he underwent CPG, EPST. This technique for the diagnosis and treatment of papillostenosis has a large 5-year effectiveness (96,8%).

Молодежный инновационный вестник. 2024;13(1):43-47
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Intracerebral hematoma of the frontal lobe and subarachnoid hemorrhage due to arterial aneurysms and structural abnormalities of the anterior cerebral artery. A clinical case. The course of the operation

Sviridov D.V., Mikulich H.V.

Abstract

Abstract. Relevance. An intracerebral hematoma is a limited space localized in the substance of the brain and filled with liquid blood, cerebral detritus or blood clots. This type of hematoma is very rare and most often the main causes are hypertension, aneurysms or arteriovenous malformations. The purpose of the work. Description of a clinical case of intracerebral hematoma and subarachnoid hemorrhage resulting from an arterial aneurysm and an anomaly in the structure of the anterior cerebral artery, which increases doctors' awareness of this disease and helps to diagnose it in a timely manner, as well as fully prescribe the necessary treatment or perform surgery. Materials and methods. As the research material, a clinical case is presented, which was studied on the basis of medical documentation of the neurosurgical department of the VOKB No. 1. The research method used in this work is descriptive. The results and their discussion. A 59-year-old man was admitted to the neurosurgery department complaining of acute headaches and nausea. The patient's consciousness is moderately stunned, as well as the patient was adynamic upon admission and, therefore, speech contact is somewhat limited. During CT scan, intracerebral hemorrhage in the frontal lobe on the right was verified, and a subarachnoid hemorrhage of unknown origin was also detected. The necessary laboratory tests and preparation of the patient for surgery were also carried out. Against the background of medical and surgical treatment, the patient's condition improved. Conclusion. Due to the fact that this pathology occurs in neurosurgical practice, the analysis of clinical cases demonstrates the importance of the doctor's knowledge and allows for a full examination and surgical intervention to eliminate the threat to the patient's life.

Молодежный инновационный вестник. 2024;13(1):48-55
pages 48-55 views

The use of endovascular selective arterial embolization of the gastroduodenal, pancreatoduodenal and left gastric arteries in abdominal surgery for gastric and duodenal ulcers complicated by recurrent bleeding

Semenova V.A., Glotov D.A.

Abstract

Introduction. Acute upper gastrointestinal bleeding from ulcerative etiology remains a challenging problem due to significant morbidity and mortality rates, and selective transcatheter arterial embolization (TAE) is considered a safer alternative because it avoids open surgery, especially in high-risk patients. Target. To study the use of transcatheter selective embolization of the left gastric artery, gastroduodenal artery and pancreaticoduodenal arteries for ongoing gastrointestinal bleeding in abdominal surgery. Materials and methods. During the study, 30 medical records of patients who underwent TAE from January 2023 to January 2024 at the City Clinical Emergency Hospital were analyzed. 30 successful operations were performed, the 30-day survival rate was 86.7%. In 22 patients, TAE was performed with ongoing bleeding due to the ineffectiveness or impossibility of endoscopic hemostasis, in 4 patients with recurrent bleeding. Results. The clinical success rate was 70%. The technical success rate was 100%. After embolization, 9 patients experienced rebleeding and 2 patients died. Conclusions. 1.TAE is an effective way to treat gastrointestinal bleeding, as well as to prevent it. 2. Endovascular occlusion of the branches of the celiac trunk during acute gastrointestinal bleeding allows you to achieve direct hemostasis and gain time to stabilize the patient before planned surgical treatment. 3. TAE is the operation of choice in patients with high surgical risks with ongoing and recurrent bleeding.

Молодежный инновационный вестник. 2024;13(1):56-62
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The results of surgical treatment of tricuspid valve atresia in children

Semikova D., Bykov S.E., Kovalev S. .

Abstract

Introduction. Tricuspid valve atresia (ТVA) is a congenital defect characterized by a lack of communication between the right atrium and the right ventricle. The prevalence of the defect ranges from 1.6 - 3% of all CHD and ranks third among the defects of the blue type. In the case of ductus-dependent pulmonary blood flow, the tactic of applying a systemic pulmonary shunt or stenting an open arterial duct (OAD) is adopted. Goal. To give a comparative assessment of the immediate and long-term results of surgical treatment of ATC in children on the basis of the VOKB No. 1 medical school. Materials and methods. From 2014 to 2016, 4 children with TVA underwent surgical treatment in the Department of Cardiac Surgery №1 of the VOKB №1 Medical Center. Surgical treatment consisted of OAD stenting. Results. The assessment of the immediate and long-term results of the stages of surgical treatment was carried out. The effectiveness and safety of this method of correction of congenital malformation as an alternative to the modified Blackock–Taussig shunt is substantiated. Conclusions. OAD stenting, as a stage of surgical correction in newborns with TVA, is an effective method of surgical treatment.

Молодежный инновационный вестник. 2024;13(1):63-68
pages 63-68 views

Comparative evaluation of pain scales

Sitnova V.А., Smyslov A.Y., Morozov A.М.

Abstract

Abstract.Introduction. Pain is a subjective sensation. The correct and accurate definition of pain plays a key role in the diagnosis and treatment of various diseases. Scales and questionnaires are considered to be the most reliable and generally accepted tools in the world practice for assessing the qualitative and quantitative characteristics of pain. Goal. Compilation of a comparative assessment of the most common pain syndrome scales and questionnaires. Materials and methods. A search for pain intensity scales was carried out and the most correct scales were selected in relation to pain intensity assessment (a trial survey of 20 patients was conducted for this purpose), after the sample there were 10 scales left, with the help of which 42 patients of the surgical department of the GBUZ GKB No. 7 in Tver were interviewed. The distribution of respondents by gender was: 21 women and 21 men. The average age of the respondents was 52 years. Results. When determining the percentage difference between the scales and the average percentage of pain of each respondent, it turned out that some scales overestimate pain indicators, while others underestimate the turnover, so the Abby scale had the largest deviation (-46%). Conclusion. When assessing pain, it is very important to take into account the nature, localization, intensity and duration of pain and its impact on the patient's daily life. It is equally important to pay attention to the factors that can influence the change in the perception of pain syndrome.

Молодежный инновационный вестник. 2024;13(1):69-73
pages 69-73 views

On the effectiveness of functional tests in the determination of obliterating atherosclerosis of the arteries of the lower extremities

Utkina V.A., Filich A.S., Morozov A.М.

Abstract

Abstract.Introduction. Currently, diseases of the cardiovascular system are recognized as the main cause of death in the world. One of the reasons for the development of pathologies in the cardiovascular system is the processes of atherogenesis and the formation of atherosclerotic plaques. Regardless of the level of development of modern diagnostic methods, primary diagnostics is of great importance, which, in addition to the usual collection of anamnesis, physical examination, and necessary laboratory and instrumental studies, includes specific functional tests. Goal. To determine the effectiveness of functional tests for obliterating atherosclerosis of the arteries of the lower extremities in the conditions of initial examination of the patient. Materials and methods. To identify the trigger factors for the development of atherosclerosis and determine the effectiveness of functional tests for obliterating atherosclerosis of the lower extremities, an initial examination was performed taking into account the above methods. 100 people participated in the study. Of which 58% are women, 42% are men. Results. Based on individual risk factors for the occurrence of obliterating atherosclerosis of the arteries of the lower extremities, it is possible to assume the risk of the occurrence or progression of atherosclerosis without complex laboratory studies. Conclusion. The use of only functional tests for the early diagnosis of atherosclerosis of the arteries is not suitable, since the samples are positive only in people with terminal stages of the disease.

Молодежный инновационный вестник. 2024;13(1):74-80
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Microbial environment of surgical patients

Utkina A.A., Fisyuk E.A., Uzhov M.A., Morozov A.М.

Abstract

Abstract. Introduction. Purulent inflammatory diseases are one of the most common problems in modern surgery. Various methods are used for the diagnosis and analysis of purulent processes in surgery, including clinical examination, visual assessment of the lesion, laboratory and microbiological studies. In the course of the current study, pathogens of purulent-inflammatory diseases were identified, and their sensitivity to antibacterial drugs was determined. Goal. To study the microflora of pathological excretion in persons suffering from purulent-inflammatory processes, taking into account the sensitivity of pathogens to antimicrobial drugs. Materials and method. In the course of this study, the identification of causative agents of purulent-inflammatory diseases was carried out by separating material from wounds, as well as determining their sensitivity to antibacterial drugs using the disco-diffusion method. The research was conducted during 2019-2022 on the basis of the surgical department of GBUZ GKB No. 7 in the city of Tver. Results. Staphylococcus aureus, Klebsiella pneumoniae and Escherichia coli occupy leading positions in the surgical department under study. Conclusion. The use of antibiotics should be carefully monitored to minimize the risk of developing resistance to them. Limiting the use of antibiotics, prescribing the correct dosages and duration of treatment, as well as using combinations of various antibacterial drugs to increase their effectiveness leads to a decrease in the likelihood of developing resistance.

Молодежный инновационный вестник. 2024;13(1):81-86
pages 81-86 views

Wound closure options after excision of the coccygeal pilonidal sinus

Chotchaev M.K., Vladimirovich S.S., Kelin Y.D., Astezheva A.Y., Korablina S.

Abstract

The relevance of this pathology is determined by the frequency of the disease, the young age of the patient, and the results of treatment that do not satisfy the doctors of coloproctology today. With the use of mass medical examination, 3% of the examinees have shown signs of a pilonidal sinus being present. This particular pathology represents 1-2% of all the surgeries that are currently being performed, while also yielding to the 12% of all the coloproctology surgeries being administered. The aim of the study. To develop new methods of surgical treatment of coccygeal pilonidal sinus, allowing to significantly improve the immediate and long-term outcomes of diseases. Materials and methods. Were examined and operated on 230 patients with coccygeal pilonidal sinus. The control group included 102 patients. The main group consisted of 128 patients, who took a differentiated approach to the choice of operation method. Results. In the control group 19 (18.6%) complications were observed: wound suppuration in 8 (7.8%), development of inflammatory infiltrate in the wound in 5 (4.9%), marginal necrosis of the skin in the area of the wound edges in 6 (5.9%) operated patients with subsequent edge detachment in 3 patients. In the main group complications were noted in 6 (4,7%) patients: wound suppuration in 2 (1,6%), development of inflammatory infiltrate in the wound in 4 (3,1%). The long-term results were traced within the period from 1 to 8 years. Recurrence of the disease occurred in 11 (10.8%) patients in the control group. There were no recurrences in the main group. Conclusion: our proposed method of surgical treatment of coccygeal pilonidal sinus, taking into account the intensity and prevalence of the inflammatory process, topographic-anatomic structure of the gluteal-sacrococcygeal region, using intradermal sutures allowed to improve the immediate and long-term outcomes of the disease.

Молодежный инновационный вестник. 2024;13(1):87-91
pages 87-91 views

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