Vol 21, No 1 (2019)
- Year: 2019
- Articles: 41
- URL: https://journal-vniispk.ru/1682-7392/issue/view/798
- DOI: https://doi.org/10.17816/brmma.381
Full Issue
Articles
NAUChNAYa ShKOLA S.P. FEDOROVA: ISTORIYa, NASTOYaShchEE, BUDUShchEE
Bulletin of the Russian Military Medical Academy. 2019;21(1):8-11
8-11
ROLE S.P. FEDOROV AND HIS DISCIPLES IN THE FORMATION OF PERM SURGERY AND UROLOGY
Abstract
The work highlights the role of S.P. Fedorov and his students in the formation and development of Perm surgery and urology. Graduate of the Military Medical Academy, Life-surgeon of the royal family VN Derevenko created and organized the work of the clinic of Perm University and the first in the province department of surgery and urology, leading it from 1919 to 1924. From 1925 to 1931 the department and the clinic was headed by an employee of the Military Medical Academy, Professor D.P. Kuznetsky. For the first time, the literature covers the inspection trip of S. P. Fedorov in 1926 to Perm. In 1928, A.V. Lunacharsky called the Perm clinic "the pearl of the Urals."
Bulletin of the Russian Military Medical Academy. 2019;21(1):11-15
11-15
SURGICAL APPROACH AT IATROGENIC INJURIES OF EXTRAHEPATIC BILIARY TRACTS
Abstract
Aim: To study the efficiency of reconstructive operations in “recent” iatrogenic injuries of extrahepatic biliary tracts. Methods. The experiment on surgical treatable of 22 patients with iatrogenic “recent” injuries of extrahepatic biliary tracts is submitted. Primary reparative operation has been performed to 1 patient (suturing of hepaticocholedochus injury after Laparoscopic cholecystectomy). Reparative operations throughout Roux-en-Y biliodigestive anastomosis were performed to 19 patients (Roux-en-Y hepaticojejunostomy - 4, Roux-en-Y bihepaticojejunostomy - 13, Roux-en-Y trihepaticojejunostomy - 2). The external drainage of extrahepatic biliary tracts of the 2nd patient has been the final method of surgical treatable. Results.Post-surgery complaints and mortalities. Among all the 22 patients with iatrogenic injuries of extrahepatic biliary tracts the post-surgery complaints of 4 patients have been registered: failure of stitches of Roux-en-Y bihepaticojejunostomy - 1, acute adhesive small bowel obstruction - 1, stenosis of bihepaticojejunostomy - 1, purulence of surgical wound - 1. Post-surgery mortality is 4,5 %. Conclusion.Roux-en-Y biliodigestive surgery is the main conclusive method in reconstructive treatment of iatrogenic injuries of extrahepatic biliary tracts.
Bulletin of the Russian Military Medical Academy. 2019;21(1):15-18
15-18
EXPERIMENTAL JUSTIFICATION OF MODELING OF THE LIVER ABCESSES
Abstract
Goal. Develop a model of purulent liver abscess (GAP), which corresponds to all the classic signs of a delimited abscess. Material and methods. Simulation of GAP was carried out in an experiment on 60 laboratory animals. Under ultrasound control (UC), a double-lumen Fogerty catheter was inserted into the established portion of the liver, a cystic cavity was formed in 3 days, which was infected and after 3 days GAP was obtained. In the modeling of GAP, clinical, planimetric, microbiological, morphological and instrumental methods of investigation were used. Results. On the third day of the experiment, a round cystic cavity of the liver with a diameter of 1,8 cm3 was formed. Three days after infection, a classic purulent abscess develops, surrounded by a dense wall formed from the liver parenchyma. As a result of the experiment, a clinical, microbiological, morphological and instrumental justification for modeling GAP with all its classic features was obtained. The conclusion. The proposed method for modeling purulent liver abscess is economically and technically profitable, minimally traumatic, provides guaranteed formation of classical GAP in the shortest possible time.
Bulletin of the Russian Military Medical Academy. 2019;21(1):18-21
18-21
COMBINED SURGICAL TREATMENT LIVER ABCESSES IN EXPERIMENT
Abstract
The results of surgical antibacterial rehabilitation and drainage of liver abscess largely depend on the effectiveness of local action of drugs. A promising direction in experimental liver abscess surgery is the local application of laser and nanotechnology. - The goal is to experimentally substantiate the effectiveness of the combined use of low-intensity laser radiation and copper nanoparticles in the surgical treatment of liver abscesses. Material and methods. In an experiment on 80 laboratory rabbits, a classic liver abscess was modeled. According to the variant of local two-week treatment, the animals were divided into 4 groups of 20 each. Animals of the first group were given daily standard sanitation of the cavity with an antiseptic solution; in the second group, low-intensity laser irradiation was locally administered; animals of the third group, the cavity of the abscess was washed with a suspension of copper nanoparticles; in the fourth group of animals, treatment with a suspension of copper nanoparticles in combination with low-intensity laser irradiation was applied. Clinical, planimetric, microbiological, morphological and instrumental research methods were used to evaluate the results of treatment. Results and discussion. The best clinical indicators of general condition by the 9th day were observed in the treatment of animals of the fourth group. Due to the active stimulation of reparative processes, by the 7th day of treatment of animals of this group, no aspirate cultures from the growth abscess cavity were given, which made it possible to speed up the closure of the purulent cavity, which by the 21st day according to ultrasound planimetry, the abscess cavity of the liver was completely obliterated. Conclusion. Used clinical and instrumental methods of research are effective ways to assess the results of treatment of simulated purulent cavity of the liver. The combined surgical treatment of simulated liver abscesses with topical application of uniformly scattered LLLT and copper nanoparticles provides accelerated cleansing of the abscess cavity causative agent and complete obliteration of the abscess cavity.
Bulletin of the Russian Military Medical Academy. 2019;21(1):21-25
21-25
TRANSFISTULAR NANOELECTROIMPULSE LITHOTRIPSY IN THE TREATMENT OF CHOLEDOCHOLITHIASIS
Abstract
In 2003, Russian developers proposed a new method of crushing stones by electric impulses of nanosecond duration, which has several advantages over contact electrohydraulic lithotripsy. The aim of the study was to evaluate the possibilities of transfistular nanoelectroimpulse lithotripsy (NEIL) in the treatment of choledocholithiasis. A nanoelectroimpulse lithotriptor "Urolit", manufactured by Medline Ltd. (Tomsk, Russia), was used to break down the gallstones. 66 patients with large and/or unmovable bile duct stones and bile ducts drains were performed transfistular NEIL. It was successful in 63 patients (95.5%). NEIL made it possible to perform removal of large and/or unmovable gallstones without destroying the sphincters of the major duodenal papilla in 89% cases. Transfistular NEIL is a new highly effective and safe method of crushing gallstones.
Bulletin of the Russian Military Medical Academy. 2019;21(1):25-28
25-28
ORIGINAL METHOD OF MONOPOLAR GAS PLASMA COAGULATION IN EXPERIMENT AND CLINICAL USING
Abstract
The results of the experimental study and the first results of the clinical use of krypton gas as a propulsive mass for inert-gas-enhanced monopolar plasma coagulation are discussed. A number of materials on preclinical testing of the original method of gas-plasma monopolar coagulation, obtained as a result of chronic experiments on pigs, are given. In the course of chronic experiments, standardized wounds were applied to the pig's liver, hemostasis and cholestasis were performed using gas-plasma monopolar coagulation using various inert gases and their mixtures used as propulsive mass. Interventions, sections of the liver parenchyma were subjected to gas-plasma exposure for various periods - from the first to the thirtieth days from the moment of exposure. The collected material was subjected to a morphological study, according to the results of analysis of which the nature of the course of the wound process was evaluated, the peculiarities of the morphological changes of the liver parenchyma at different time periods depending on the composition of the gas or gas mixture used as a propulsive mass. The results of the clinical use of krypton gas as a propulsive mass for gas-plasma coagulation are presented for the first time. The results of the use of kryptonoplasmic coagulation for hemostasis during laparoscopic cholecystectomy are considered. A comparative analysis of the nearest results of gas-plasma coagulation was performed in two groups of patients: using krypton and argon as the propulsive mass. For the first time, the issues of the possibility and experimental justification of using argot-krypton mixture as a propulsive mass for gas-plasma coagulation with the aim of reducing the cost of using this coagulation technique are considered.
Bulletin of the Russian Military Medical Academy. 2019;21(1):28-32
28-32
SURGICAL MANAGEMENT OF MIRIZZI’S SYNDROME
Abstract
Complicated gallstone disease causes operative difficulties despite surgeon’s experience and patient’s examination. We have an experience of surgical management in patients with Mirizzi’s syndrome (MS) that made3,2% from a total number of operated patients with cholelithiasis (women 74%, men 26%). Patient’s age was from 28 to93years old.We want to stress that the final form of MS is defined only during surgery. We distinguish only 2 forms of MS without sharing according to involvement of common bile duct into destructive-and-inflammatory process.In 45% of patients I form of MS was registered, in 55% - II form. In MS-I the preferable surgery is cholecystectomy with outer bile ducts draining. Plasty of hepatocholedochus in MS-I is indicated for proved duct stricture. MS-II is the indication for performing different restorative or reconstructive surgery dependent on intraoperative data (application of primary suture on common bile duct, plasty of hepatocholedochus with the gallbladder wall, choleedochoduodenostomy, hepaticocholedochostomy, hepaticojejunostomy).
Bulletin of the Russian Military Medical Academy. 2019;21(1):32-36
32-36
YATROGENIC BILE DUCT INJURIES (BASED OF THE TVER REGION DATA)
Abstract
Laparoscopic cholecystectomy (LC) is one of the most frequent operations. The significance of the problem with iatrogenic unwitting bile duct injuries (BDI) remains extremely actual up to the present. Our aim was to analyze the situation in the Tver region associated with this complication. From 1994 to 2017, 11280 cholecystectomies were performed in the surgical department of the regional hospital in Tver, while LC was performed in 10396 (92.9%) patients. Patients with "severe" unwitting BDI (42) from the whole region were concentrated in this clinic; we analyzed their treatment. Intraoperatively unwitting BDI were diagnosed only in 8 (19.0%) patients. The most frequent mechanism of trauma was “carving out” of bile duct fragment. In some cases, the cause of iatrogenic was the unjustifiably hasty intersection of tubular structures in the zone of the Calot triangle without their proper identification. In 15 (35.7%) patients, surgical correction of this complication was carried out in two stages. All patients eventually formed an end-to-side hepatico-, hepato- or bihepato- jejuno Roux-en-Y anastomosis, while in 36 (85.7%) patients - with replaceable transhepatic drains according to Saypol-Kurian. All patients recovered, there was no hospital mortality. In our opinion, the problem of continuous training and improvement of operational techniques (including simulation ones) for both young and “mature” surgeons remains relevant. It is necessary to use a typical tactic for the management of patients with unwitting BDI and concentrate them in a specialized hospital.
Bulletin of the Russian Military Medical Academy. 2019;21(1):36-40
36-40
DIAGNOSTICCRITERIAANDMANAGMENTOF ACUTE CHOLANGITIS AND BILIARY SEPSIS: THE MODERN VIEW ON THE PROBLEM
Abstract
Theproblemofcholangitisandbiliarysepsisbecomemoreandmoreactual.Developingdiagnosticcriteriaforpatientswithinflammationofbiliarytractisoneofunsolvedquestionsofbiliarysurgery. Accordingtonewclassificationofgeneralizedformofinfections (Sepsis 3) it’sadvisabletoclassifiedpatients with biliary obstruction to three groups: mechanical jaundice, acute cholangitis and biliary sepsis with defying appropriate diagnostic criteria for each of them.Theaimofourworkistoimprovetreatmentresultsforpatientswithhyperbilirubinemia, biliary hypertension and system inflammation response syndrome (SIRS) by dividing them on groups and determining diagnostic criteria for each of them. Intheperiodfrom 2014 to 2018 wehavetreated 208 patientswithbiliaryobstruction. Accordingtodevelopeddiagnosticcriteriaallpatients was divided on three groups: mechanical jaundice, acute cholangitis and biliary sepsis.Afterthetreatmentthenextvalueswereanalyzed: timefromadmissiontohospitaltooperation, thetimeofoperation, thefrequencyofpostoperativecomplications, mortality, the duration of hospital stay, economic efficiency.Toassesstheeffectivesofdevelopedcriteriacomparativeanalysiswithretrospectivegroup, whichcontained 182 patients with hyperbilirubinemia, biliary hypertension and SIRS treated in a period from 2010 to 2014, was performed. Accordingtoobtainedresultswecanconcludethatdividingpatientswithhyperbilirubinemia, biliary hypertension and SIRS on groups and developeddiagnosticcriteria, routing and manage tactics let us to improve treatment results in this category of patients, about what we can judge by such figures as timefromadmissiontohospitaltooperation, thefrequencyofpostoperativecomplications, mortality, the duration of hospital stay, economic efficiency.
Bulletin of the Russian Military Medical Academy. 2019;21(1):40-43
40-43
FIBROCHOLODOSCOPY IN DIAGNOSTICS AND TREATMENT OF COMPLEX FORMS OF CHOLEDOCHOLITHIASIS
Abstract
Relevance of the topic: endoscopic intraoperative choledochoscopy with traditional surgical procedures is a highly informative research in the diagnosis and treatment of choledocholithiasis. Objective: to evaluate the effectiveness of intraoperative use of fibrocholedochoscopy in the diagnosis and treatment of "complex" forms of choledocholithiasis. Materials and methods: Between 2011 and 2017, 88 patients underwent treatment for "complicated" forms of choledocholithiasis using intraoperative fibrocholedochoscopy. Results: after dissection of the choledochal wall and extraction of large concrements from the lumen, a fibrocholedochoscopy was performed. The fibrocholedochoscope was inserted into the lumen of the common bile duct through a formed opening with examination of the biliary tract. An obligatory condition for assessing the permeability of the distal sections of the bile ducts was the carrying out of an endoscope through the OBD zone. The remaining remaining calculi were recovered with the help of Dormia baskets (15 (17%) cases). In 86 (97.7%) patients, the operation is completed by the imposition of a hollow stitch of choledoch (priority reference No. 2018122530, 2018). Conclusion: fibrocholedochoscopy in the treatment of complex forms of choledocholithiasis allows to methodically evaluate the biliary tract, perform lithoextraction from the proximal and distal sections.
Bulletin of the Russian Military Medical Academy. 2019;21(1):43-46
43-46
OBSTRUCTION OF BILE DUCTS IN CHRONIC PANCREATITIS AND POSSIBILITIES OF ITS SURGICAL CORRECTION
Abstract
Purpose of the study: optimize surgical tactics for bile duct obstruction in patients with various forms of chronic pancreatitis (CP). Materials and methods: The results of the examination and treatment of 503 patients with CP, 354 of whom were operated on, were analyzed. Mechanical jaundice was detected in 76 (21.5%) patients. The main type of relief of symptoms of biliary tract obstruction were transpapillary endoscopic and laparoscopic techniques or their combinations, which in 37 (47.4%) patients were the final treatment option, and in 35 (46.1%) - a preliminary stage before performing traditional surgical interventions. Traditional interventions were the only treatment method in 4 (6.4%) patients. Results: Based on the modified Marseille-Rome classification of CP (1988), a systematic approach was developed to assist this category of patients. It has been established that the use of endoscopic techniques in patients with obstructive CP allows not only to stop the symptoms of biliary hypertension, but also to influence the course of the underlying disease, by ensuring adequate drainage of both the bile and pancreatic ducts. The use of transduodenal and laparoscopic techniques for the relief of obstructive jaundice in patients with inflammatory CP, calcifying CP is best justified as a preliminary stage of treatment. The preferred option of surgical correction in patients with inflammatory and calcific CP with primary lesions of the pancreas head should be resection of the pancreas head according to Beger or Frey. Conclusion: The optimal combination of minimally invasive surgical treatment options and traditional surgical interventions, taking into account the shape and variation of CP, complicated by the development of obstructive jaundice, allows for maximum correction of the course of the disease in the near term and in the long term.
Bulletin of the Russian Military Medical Academy. 2019;21(1):46-50
46-50
UNPREMEDITATED INJURIES OF THE BILE DUCTS AND SYSTEMATED APPROACH TO THEIR ELIMINATION
Abstract
Purpose of the study: To present the program of diagnosis and treatment of patients with injuries of the bile ducts, corresponding to modern requirements of medical care. Materials and methods: The results of examination and treatment of 77 patients with bile ducts injuries (BDI) are analyzed. The analysis of the main surgical interventions for the elimination of BDI is given: reconstructive operations in 44.3% of patients, recovery operations - in 36.7% and external drainage - in 19%. Results: A program approach was developed to provide care to patients with BDI. The implementation of this program will provide timely diagnostics of BDI and minimize the number of postoperative complications. A rational approach to reducing the number of injuries is the prevention and prevention of the occurrence of BDI. Conclusion:The choice of a rational option for surgical intervention, taking into account modern classification positions that take into account the integral assessment of the leading criteria: the patient’s general somatic condition, the presence of infectious purulent complications, the scale of damage, the diameter of the crossed main bile duct, the damage mechanism (thermal or mechanical), makes it possible to justify the choice of a rational surgical option interventions and significantly reduce the number of complications, mortality and improve the quality of life of patients with BDI.
Bulletin of the Russian Military Medical Academy. 2019;21(1):50-54
50-54
TRANSPAPILLARY ENDOSCOPIC SURGERY: COMPLICATIONS AND PREVENTION OF THEIR DEVELOPMENT
Abstract
Improvement of endoscopic techniques and tools, minimal invasiveness of transpapillary endoscopic surgery (TES), accumulated experience, as well as the introduction of preventive measures, do not always avoid the development of life-threatening complications (6.8 - 10,2% of patients) and deaths (1,7 - 3%). The purpose of the study is to assess the practical significance of the proposed predictors of TES complications in the treatment of patients with impaired patency of the ductal systems of the liver and pancreas, to propose program measures for the prevention of complications. The results of TES in 3305 patients performed in the planned and emergency order with various diseases of the hepatopancreatobiliary region are analyzed. Based on multivariate analysis, statistically significant (p <0.05) predictors of major life-threatening complications of TES were distinguished: 1) post-operative pancreatitis (female (78.2%), difficult cannulation (54.6%), multiple cannulation, fast / tight contrasting pancreatic duct (49.4%)); 2) bleeding (current mode (52.1%), presence of cholangitis (43.5%), coagulopathy in the presence of jaundice (65.2%)); 3) duodenum perforation (elderly and senile age (68.2%), difficult cannulation (66.7%)); 4) acute cholangitis (inadequate drainage of the bile ducts (83.3%), unsuccessful attempt to drain the bile ducts (48.6%)). We are supplemented prophylactic measures for postoperative complications in case of TES. A personalized record of the main predictors of complications of the feasibility study and the use of a program of preventive measures will allow an adequate choice of tactical approaches and technical options for operations, which will lead to improved treatment outcomes, minimizing the frequency of complications and mortality.
Bulletin of the Russian Military Medical Academy. 2019;21(1):54-58
54-58
IMPORTANCE OF NODE SIZE IN HIGH-DIFFERENTIATED THYROID CANCERSURGERY
Abstract
Биологическое поведение раковых узлов щитовидной железы (ЩЖ) различно в зависимости от их размеров. Цель исследования: определить|опознать| отличия в исходах для больных |следствии|дифференцированными раками (ДР) ЩЖ,|разграничивает||кельей|| сгруппированными согласно|сгруппировывают| диаметру|соответственно| опухоли.| Изучение включало ретроспективный анализ 97 пациентов с ДРЩЖ|разграничил|, отнесенными к |T1| и T2| согласно|соответственно| Пятой редакции классификации TNM. М:Ж=13:86Rjynbyutyn||больного|. У 64|больного| выявлен папиллярный рак, у 33 - |больногофолликулярный рак. Больные|больного| были разделены на 3 группы: |утверждаетсяI - диаметр опухоли до 10 мм|, II - 11-20 мм|, III - 21-40 мм|. Критериями оценки считали| характер метастазирования и 5-летнюю выживаемость после операции. Средний срок наблюдения составил|больной| 8,6 лет. Мы не видим оснований относить все раки размером до 20 мм| к микрокарциономам||, т.к. раковые узлы размером 11-20 мм требуют иных лечебно-тактических подходов, а данные, подтверждающие адекватность гемитиреоидэктомии для всех ДРЩЖ размером до 20 мм на сегодняшний день отсутствуют|. Мы считаем правильным считать микрокарциномами опухоли до 10 мм, пока не будет накоплено достаточно данных для обоснованного пересмотра этой точки зрения.
Bulletin of the Russian Military Medical Academy. 2019;21(1):58-60
58-60
URGENT OPERATIONS IN PATIONS WITH DISEASES OF THYROID GLAND COMPLICATED BY COMPRESSION OF NECK AND MEDIASTINUM
Abstract
Reports of immediately and urgent interventions on the thyroid gland are rare. The aim of the study was to develop and put into practice the optimal tactics of treating patients with nodular tumors of the thyroid gland, which caused compression of the organs of the neck and mediastinum. From 1974 to 2015, 97 patients with thyroid disease were operated in the Endocrine Surgery Center, they was 0.57% of 29325 patients. All patients had symptoms of compression syndrome. All patients were divided into 2 groups. I group consist of 52 (31.1%) patient who underwent immediately surgical interventions. The second group included 115 (68.9%) patients operated for urgent indications. The mean age of patients operated for immediately reasons was 73.0 ± 1.39 year.The mean age of patients operated for urgent indications was 63.8 ± 1.51 year. Among the reasons that caused the compression syndrome, the differentiated cancer of the thyroid gland was observed in 79 (47.3%) cases. Benign thyroid diseases caused urgent surgical interventions in 88 (52.7%) patients. In our work, we first used the definition of the degree of tracheal constriction with spirography in 135 (80.84%) patients to identify the timing of surgery. In the course of emergency surgical interventions, radical operations were performed on 8 (22.9%) patients with differentiatedcancer of the thyroid gland, in cases of urgent interventions, this figure is 2 times more - 23 (52.3%) patients. The performance of urgent operations increases the possibility of radical surgical interventions, reducing the frequency of postoperative complications.
Bulletin of the Russian Military Medical Academy. 2019;21(1):60-63
60-63
THE STRUCTURE OF THYROID NODULES IN CHILDREN SUBJECTED TO SURGICAL TREATMENT
Abstract
The article provides the literary information and the results of our own research on the structure of the thyroid nodules in operated children.The clinical significance of nodular neoplasms of the thyroid gland is determined by the relatively high risk of carcinomas. Along with this, the relevance of this research is due to the increasing of surgical interventions and the fact that the features of nodules in children and tactics of management of patients remain debatable.The aim of the work was to study the structure of thyroid nodules in childrenin various age groups. The case histories of 225 operated childrenfrom 4 to 17 years oldfrom 2007 to 2017 were analyzed. Nodular neoplasms of the thyroid in children were more common. Tumor-like diseases - colloid nodes in childhood were rare, only in 2.2% of cases. The high incidence of thyroid cancer (35.6%) under the mask of nodal goiter determines active surgical tactics in patients with nodal neoplasms in childhood.
Bulletin of the Russian Military Medical Academy. 2019;21(1):63-66
63-66
THE CHARACTERISTICS OF PREVALENCE AND ANALYSIS OF RESULTS OF TREATMENT OF DIABETIC FOOT SYNDROME
Abstract
Diabetic foot syndrome (SDS) is one of the most severe complications of diabetes mellitus (DM), and the treatment of such patients is one of the difficult tasks. Purpose: to present the epidemiological characteristics of SDS on the basis of the state register of SDS of the Perm region and to analyze the results of treatment of this category of patients in different departments of surgical profile. Evaluation of results of treatment was given on the basis of expert analysis of 150 case histories of the patients Patients were performed General clinical examination, microbiological examination of the wound content, rheovasography, angiography, duplex scanning, x-ray examination of the feet, the survey for the assessment of the risk of developing VTS. According to the register, SDS was registered in patients older than 18 years with type 2 diabetes in 4.4 % of cases. The prevalence of SDS and amputations correlated with the duration of type 2 diabetes. The average age of SDS development was 64.3±0.5 years. Inpatients belonged to the older age group, had long-term disease poorly compensated diabetes in combination with associated diseases. The average duration of the purulent-necrotic process was 1 month. Patients had an average risk of SDS according to the survey. In the specialized Department of vascular surgery, the effectiveness of treatment was higher, due to the level of diagnosis and the use of innovative surgical technologies. All of the above is a significant argument in favor of the development of specialized care for patients with diabetic foot syndrome.
Bulletin of the Russian Military Medical Academy. 2019;21(1):66-69
66-69
MODERN SURGICAL INTERVENTIONS IN PATIENTS WITH THYROID DISEASES
Abstract
The study is based on the analysis of the results of surgical treatment of 298 patients with various diseases of the thyroid gland, who were examined and treated in the department of endocrine surgery of the City Clinical Hospital named after S. P. Botkin from 2012 to 2016. 147 (49.3%) patients of the I group were operated on using extrafascial technique with intersection of the prelaryngeal muscles and visualization of the recurrent laryngeal nerve. 151 (51.7%) patients of group II underwent extrafascial surgical interventions from reduced migratory approaches using modern, including original, methodological approaches. For the prevention of paresis of the larynx in the allocation of recurrent laryngeal nerves, microsurgical instruments and magnifying devices were used. For the prevention of postoperative hypoparathyroidism, in addition to carefully accounting for anatomical and topographic-anatomical features, a «stress-test» and a method of double visual-instrumental recording of the parathyroid gland-induced fluorescence were used. In the first group of patients with surgical treatment, the following complications were recorded: in 2 (1.4%) patients developed permanent, in 8 (5.4%) transient postoperative hypoparathyroidism, and in 3 (2.0%) - temporary unilateral laryngeal paresis. The overall incidence of operative complications was 8.8% (13 patients). In the postoperative period, the following complications were recorded in group II: 2 (1.3%) patients developed transient hypocalcemia, and 1 (0.7%) patient had unilateral laryngeal paresis. The overall incidence of operative complications was 1.99% (3 patients). Analysis of the cosmetic result of the intervention, assessed on the POSAS scale, showed that cosmetic effect was better in group II (p << 0.05). Thus, modern surgical interventions in patients with thyroid diseases, including new methodological approaches, have improved the results of surgical treatment with a decrease of the number of complications and achieving a better cosmetic effect of the surgical intervention.
Bulletin of the Russian Military Medical Academy. 2019;21(1):69-72
69-72
SHORT-TERM OUTCOMES OF SURGICAL TREATMENT OF PANCREATIC NEUROENDOCRINE TUMORS ASSOCIATED WITH THE SYNDROME OF MULTIPLEENDOCRINE NEOPLASIA TYPE 1
Abstract
Background: pancreaticneuroendocrine tumors occur in almost all patients with multiple endocrine neoplasia type 1 (MEN1) and are a major cause of death. Surgical resection is the only potentially curative therapy for pNETs, otherwise various endocrine syndromesdevelop threatening the patient's life. Aim: to evaluate the short-term results of surgical management of patients with pancreatic neuroendocrine tumors with MEN1. Materials and methods: by last 20 years, 40 patients with pancreatic neuroendocrine tumors within MEN1 were operated. Results: in the early postoperative period,according to the classification of Clavien-Dindo, complications occurred in 12 (26%) patients. The following types of complications were diagnosed: IIIa in 6 patients; IIIb - in 2; type V in 4 patients. Complications of types I, II and IV were not identified. Conclusion: less percentage of postoperative complications is achieved by performing organ-preserving operations, after precise imaging diagnose, due to minimal intraoperative pancreatic injury.
Bulletin of the Russian Military Medical Academy. 2019;21(1):72-75
72-75
LAPAROSCOPIC ADRENALECTOMY IN SURGICAL TREATMENT OF ADRENANOCORTICAL CARCINOMA
Abstract
Relevance of research: аdrenalectomy remains the only method of potentially radical treatment of adrenocortical carcinoma (AСС), and the complete resection is considered one of the leading factors in the prognosis of disease. The question of the possibility and feasibility of using video- endoscopic technologies in the treatment of patients with ACC is still being discussed. Objective: the purpose of our study was to evaluate the effectiveness of laparoscopic adrenalectomy in the treatment of ACC patients. Material and methods: the study is based on the analysis of the results of diagnostics and surgical treatment of 12 patients who underwent laparoscopic adrenalectomy and verified ACC during histological and immunohistochemical studies. Results: stage I were verified (according to the ENSAT) in 4 cases, in 4 - II stage, and in 4 - III stage. The median of tumor size was 4.9 cm. Intraoperative and postoperative complications did not occur. In all cases, the R0-resection was confirmed by morphological examination. The median patient follow-up was 71 months (1; 141), during this period 11 patients were alive, 1 patient, who had surgery in stage III died of disease progression (distant metastases) 49 months after surgery. During the follow-up period tumor recurrence did not occur. Overall 5-year survival was 75% (95% CI; 30-95%). Conclusion: despite the small number of patients included in this study, satisfactory immediate results (absence of complications, R0-resection) and long-term results allow us to consider video- endoscopic surgery as an effective treatment for patients with ACC.
Bulletin of the Russian Military Medical Academy. 2019;21(1):75-78
75-78
QUALITY OF LIFE AFTER SURGICAL TREATMENT OF INSULIN-PRODUCTION TUMORS OF THE PANCREAS
Abstract
Background: insulinoma is a neuroendocrine tumor characterized by hyperproduction of insulin and hypoglycemia that decrease patient's quality of life. The only curative method of treatment is surgery. Aim: studying the quality of life of patients after various options for surgical treatment of insulin-producing pancreatic tumors. Materials and methods: 48 patients operated in the First Moscow State Medical University were included in the quality of life study. Patients were divided into two groups: those who underwent tumor enucleation (n 28), and patients who underwent resection of the pancreas (n 20). The study was performed using the questionnaire SF-36, not earlier than 3 months after surgery. Results: in the study of quality of life, a significant difference was only in a scale of role-physical functioning, which was higher in patients that underwent tumor enucleation, as opposed to patients after resection procedures. Conclusion: the quality of life in both groups remained at a high level; the differences were noted only in the scale of role-physical functioning, which was higher in patients after tumor enucleation.
Bulletin of the Russian Military Medical Academy. 2019;21(1):78-81
78-81
3D- SIMULATION AS THE METHOD OF TOPICAL DIAGNOSTICS IN THE SURGICAL TREATMENT OF GIPERPARATIREOZA
Abstract
Urgency of theme. Morbidity by primary giperparatireozom (PGPT) varies from 0,4 to 18,8 the cases for 10000 the populations. Defeat the parathyroid glands in patients with second (VGPT) and tertiary (TGPT) giperparatireozom, who are found on program hemodialysis reaches 32-34%. The only method of treatment is surgical. The effectiveness of operational interference in many respects depends on verification and visualization of all the pathologically changed parathyroid glands. Purpose. To improve topical diagnostics of parathyroid adenomas by constructing the personified preoperation 3d-model of the anatomical formations of neck on basis MRT. Materials and methods. Preoperation 3d-simulation is executed 10 to the patients: 3 by patient with PGPT, 7 patient with TGPT. For obtaining the personified 3d-model were used results MRT and special software (priority information №2018122324, also, 2018122326 from 18.06.2018). In the regime of preoperation planning were built the three-dimensional models of neck with the designation of trachea, the thyroid gland, the parathyroid glands, gullet, collar bones. Obtained results. With the use of preoperation 3d-simulation it was possible to avoid diagnostic eksploratsii of neck in search of not less 4th parathyroid glands, was reduced the time of the fulfillment of operational interference on the average on 30±15 minutes, was possible to avoid the postoperative complications, connected with the damage of recurrent guttural nerves. Conclusion. The method proposed is the reliable method of pre-operation topical diagnostics of pathologically changed parathyroid glands. With the use of 3d-simulation the operation time decreases, is reduced the need for traumatic and expensive on the time eksploratsii of neck, necessary for the search for changed parathyroid glands, and, correspondingly, the probability of the development of postoperative complications. This method can serve as the objective criterion of visualization parathyroid glands and also as the criterion of effectiveness of the carried out treatment
Bulletin of the Russian Military Medical Academy. 2019;21(1):81-84
81-84
VIRIATION OF THE EXTERNAL BRANCH OF THE SUPERIOR LARYNGEAL NERVE
Abstract
Till now, there is no universal clinical classification about variations of the external branch of the superior laryngeal nerve despite the multiple classifications that was proposed. The aim of this research is identification and systematization of topographic types of the external branch of the superior laryngeal nerve. The study is based on the autopsy material (21 complexes organs of the neck) and on identification of variations of 40 external branches of the superior laryngeal nerve. We identify two permanent landmark that are located at the minimum distance from nerve and on which we made metrical calculations: oblique line of thyroid cartilage, tendinous arch of the inferior pharyngeal constrictor muscle. The “entry” point of the nerve is always located on the inferior pharyngeal constrictor muscle,and not protruding beyond the oblique line of thyroid cartilage superiorly and tendinous arch of the inferior pharyngeal constrictor muscle anteriorly. The proposed topographic classification of the location of the external branch of the superior laryngeal nerve is based on localization of point of pierced of the nerve relating to the length of the oblique line of thyroid cartilage. In 64.2% of cases, the external branch of the superior laryngeal nerve was in close proximity to the upper pole of the thyroid gland, which could lead to its damage during surgery (type I and II). In type III and IV (35.8%) - the point of "entry" in the muscle was located as far as possible from the upper pole of the thyroid gland, and most of the nerve was covered by the fibers of the inferior pharyngeal constrictor muscle.
Bulletin of the Russian Military Medical Academy. 2019;21(1):84-88
84-88
LOW-INVASIVE PARATHYRЕOIDECTOMY UNDER ULTRASOUND-GUIDED WITH THE USE OF PERCUTANEOUS LASER ABLATION
Abstract
Assessment of efficiency of low-invasive parathyroidectomy executed by us under ultrasonic navigation with use of the percutaneous laser ablation (PLA) at 49 patients with laboratory proved PHPT is carried out. Assessment of efficiency was carried out by ultrasonic criteria to which decrease of volume of PTG belongs. At patients essential decrease of volume of the enlarged PTG and lack of signs of a cicatrical tissue on the place of earlier existing PTG in 1 year after completion of treatment is taped. The decrease of volume of PTG calculated according to ultrasonography indicates efficiency of the applied low-invasive option of a parathyrеoidectomy. Ultrasonic criteria of efficiency were fundamental in definition of further tactics of maintaining the patient in the postoperative period.
Bulletin of the Russian Military Medical Academy. 2019;21(1):88-91
88-91
REHABILITATION OF PATIENTS AFTER OPERATIONS ON THE THYROID
Abstract
Scientists and specialists, who works in the field of treatment thyroid gland diseases, identify and eliminate the effects of surgical interventions with nodular, multinodular and recurrent goiter with symptoms of compression of the organs of the neck and upper mediastinum. In total, the study included 119 patients who underwent extirpation of the thyroid gland (43), resection of the thyroid gland (33) and hemithyroidectomy (43). Comparisons were made on the basis of the volume of the preoperative examination, the immediate surgical intervention and the features of the intraoperative technique. It was established that the severity of local pain, postoperative complications such as neck edema during hematoma and gray formation reliably depended on the size of the skin incision, dissection of the short neck muscles, mobilization of the nodding muscles and removal of the tissue from the lymph nodes. 6 months after the surgical treatment, the patients had no complaints. If hypocalcemia occurs (in 14 cases), patients undergo a comprehensive treatment according to the original scheme. As a result of the treatment in all cases, the action of hypocalcemia was stopped. The study shows that the effectiveness of surgical treatment, the postoperative period, complications, cosmetic results and quality of life, as well as rehabilitation studies aimed at reducing the effectiveness of preoperative examination, increasing the amount of operational benefits and late statement of complications.
Bulletin of the Russian Military Medical Academy. 2019;21(1):91-94
91-94
PROBABILITY OF CANCER DETECTION DURING REPEATED OPERATIONS IN PATIENTS WITH BENIGN THYROID DISEASES
Abstract
Introduction. Suspected malignant growth in patients with recurrent goiter is one of the main causes of repeated operations. Focuses of carcinoma can be detected in patients operated on for multinodular goiter with compression of the organs of the neck, recurrent diffuse toxic goiter. Objective of investigation is to assess the risk of a malignant lesion of the thyroid remnant in patients with recurrent goiter, to justify the surgical tactics in this group of patients. Material and methods. In the St. Petersburg Center of Endocrine Surgery and Oncology 28138 patients with various thyroid diseases were operated on for the period from 1973 till 2016. Results. In a retrospective analysis of the group consisting of 1106 patients with recurrent goiter, a new thyroid disease was detected in 156 (14.1%) cases. Thyroid cancer in thyroid remnant was detected in 57 (36.5%) cases or 5.2% of all the patients with recurrent goiter. The work describes the risk of malignant lesion of the thyroid remnant in patients with recurrent goiter and surgical tactics in this group of patients. Conclusion. Cancer of the thyroid gland, as a new disease of the thyroid remnant, in patients previously operated on for benign thyroid pathology, is found in 5.2% of observations. The possibilities of fine-needle aspiration biopsy in this group are reduced. Active surgical tactics in cases of multinodular transformation of the thyroid remnant is justified. The operation of choice is reresection up to thyroidectomy. Careful intraoperative study of removed tissue and close cooperation with the morphological service helps to reduce the number of diagnostic and tactical errors in patients with both recurrent and ordinary multi-node goiter.
Bulletin of the Russian Military Medical Academy. 2019;21(1):94-98
94-98
CLINICAL MANIFESTATIONS OF PARATHYROID CANCER IN 29 YEARS OLD MAN
Abstract
Parathyroid cancer is an extremely rare cause of primary hyperparathyroidism, accounting less than 1% of cases. The neoplasm is detected in people 40-50 years old. Ratio of men and women is 1: 1, in contrast to hyperparathyroidism caused by adenoma of epithelial bodies, when there are 3-4 times more women than men among the patients. Due to the rarity of this disease, surgeons and morphologists may have difficulties in verification of the tumor. Distinctive features of the course of the disease include the extremely rapid progression of bone changes, the development of hypercalcemic crises with a high level of blood calcium and serum parathyroid hormone. Radical surgery involves the removal of malignant parathyroid tumor in a single block with the ipsilateral thyroid gland, as well as paratracheal lymph nodes. The aim of investigation is to show a rare observation of bone manifestations of parathyroid cancer. Material and methods. Parathyroid cancer was diagnosed in 2 (0.7%) of 283 patients with primary hyperparathyroidism, operated in the Center of Endocrine Surgery. Male 29 years old was operated on in January 2016. Disease duration was about 2 years. The clinical picture was characterized by multiple bone fractures, generalized cystic osteodistorofy, renal failure, severe electrolyte disorders, cachexia. The diagnosis was confirmed by high values of total calcium and blood parathyroid hormone. The patient underwent removal of the parathyroid tumor, during the histological and immunohistochemical study of which parathyroid cancer was verified. The patient was able to sit on his own after 3 months, get up with support after 6 months and walk with the help 10 months later after the operation. In May 2017 an increase of parathyroid hormone to 1900 pg / ml was detected with a normal value of blood calcium, which indicates recurrence of parathyroid cancer. Findings. The high grade of the disease is due to both the aggressive course of parathyroid cancer and the late diagnosis.
Bulletin of the Russian Military Medical Academy. 2019;21(1):98-101
98-101
MODERN DIAGNOSTIC AND MINIMALLY INVASIVE TECHNOLOGY IN THYROID SURGERY
Abstract
Purpose of the study: to evaluate the role of the main instrumental methods of diagnostics and to determine the criteria for selecting patients with surgical diseases of the thyroid gland (TG) for the reasonable implementation of optimal minimally invasive surgical interventions. Materials and methods: the results of the examination and treatment of 340 patients with surgical diseases of the TG, who underwent variety of minimally invasive techniques were analyzed. Results: we compared the sensitivity, specificity, accuracy, positive and negative predictive values of the multiparametric neck ultrasonography, 99mTc-MIBI scintigraphy TG and fine-needle cytology. Minimally invasive video-assisted procedure was performed in 29,4% patients, nonendoscopic - in 38,2%, endoscopic - in 32,4%. Postoperative specific complications were revealed in 4,4% who underwent surgery: transitory recurrent laryngeal nerve palsy - in 1,5%, transient hypoparathyroidism - in 1,6%, hematoma - in 0,8%. It was stated that the main criteria that determine the rationale for minimally invasive interventions on the TG are: the nodule size and the TG volume; hyperfunctioning thyroid and clinical thyroiditis; substernal extension; extrathyroid extension and the necessity of implementation of central neck dissection due to central and laterocervical lymph node metastases. Conclusion: the application of the determined criteria based on the integrated use of modern diagnostic techniques for patients with surgical diseases of the TG can justify the selection of optimal minimally invasive surgical interventions, avoid unreasonable operations, to avoid increasing of the frequency of specific complications, reduces surgical trauma and duration of stay in hospital, improves cosmetic outcome and enhances the quality of life of the patients.
Bulletin of the Russian Military Medical Academy. 2019;21(1):101-105
101-105
CT-PLANNING ACCESS FOR ADRENALECTOMY
Abstract
Aim: to determine the possibilities of modern multislice computed tomography in the preoperative planning of a rational variant of surgical access to the adrenal gland with a tumor. Materials and methods: the results of the examination and treatment of 1196 patients with surgical diseases of the adrenal glands (AG) were studied. The virtual-figurative design of a rational variant of surgical access to AG with a tumor was carried out in 362 patients after evaluating the features of their topographic-anatomical location according to CT-scan. The criterion for the inclusion of patients in the study was the ability to perform after 2013 multislice computed tomography (MSCT) with intravenous contrast on the modern installation Aquillion 64 (Toshiba, Japan) and subsequent post-processing of images with the construction of multiplane and 3D reconstructions. Results: studying the features of the topographic-anatomical location of AGs with a tumor using MSCT allowed us to form a virtual-figurative perception of their syntopy in 362 patients and to design options for access to perform adrenalectomy (AE): retroperitoneoscopic (n = 303), laparoscopic (n = 25), thoracophrenotomy ( n = 30), thoracophrenolaparotomic (n = 5). 363 surgical interventions were performed for 362 patients. A single-sided retroperitoneoscopic AE for pheochromocytoma was performed in 1 patient. Reliable CT criteria were determined that affect the duration and safety of the above-mentioned accesses performed by AEs. It has been established that when designing access to the right AG, it is necessary to consider: the diameter of the neoplasm; the location of the AG with a tumor relative to the inferior vena cava and the lower right hepatic vein; contact with vessels in the gate of the kidney, as well as the presence of additional central veins AG. The determining factors in planning access to the left AG are: neoplasm diameter, contact with vessels in the gate of the kidney and splenic vessels, location in the aorto-renal vascular triangle. It was established that retroperitoneoscopic AE, performed in 83.7% of patients with AG tumors with a diameter of ≤ 8 cm, is an operation of choice. Laparoscopic access remains relevant only when the right-sided localization of an AG tumor with a diameter of up to 8 cm and planning simultaneous surgical interventions on the abdominal organs in individuals of a brachymorphic physique (8.3%). Open approaches are shown in benign lesions of the AG more than 8 cm in diameter, generalized forms of adrenocortical cancer (ACC) (T3-4N0-2M0-1), malignant paragangliomas with signs of invasion or distant metastasis (n = 9.7%). Conclusions: multispiral computed tomography allows, before the operation, to carry out adequate planning of the safest surgical access for adrenalectomy, avoiding the development of intra- and postoperative complications, minimizing operative trauma, shortening the operating time, and speeding up the medical and social rehabilitation of patients.
Bulletin of the Russian Military Medical Academy. 2019;21(1):105-109
105-109
ANALYSIS OF OUTCOMES SURGICAL TREATMENT OF PATIENTS WITH NEUROENDOCRINE TUMORS
Abstract
The aim of the study: evaluate the possibility of surgical method in the treatment of patients with neuroendocrine tumors of the gastrointestinal tract and pancreas. Materials and methods. The results of treatment of 283 patients with neuroendocrine tumors of the gastrointestinal tract (GI NET) and pancreas (PNET) were studied. Women were 60.8 %, the average age - 55.8 years. Examination of patients was carried out using laboratory (chromogranin-A, serotonin, 5-GIUK, insulin, gastrin), instrumental (ultrasound, CT, MRI, EGD, FCS, PET 68Ga-DOTATOC) and morphological (histology, immunohistochemistry) diagnostic methods. Results. Surgical treatment was performed in 233 (82.3 %) cases. Endoscopic tumor removal was performed in 56.7% of patients with localized GI NET. Postoperative complications in localized and locally advanced GI NET developed in 8.1 % and 9.5% of cases. Patients localized PNET enucleation was performed in 54.7 % of cases, median resection - 3.1 %, head resection - 4.7%, distal resection - 26.6%, pancreatoduodenal resection (PD) - 10.9 %. In cases of locally advanced PNET surgical treatment was performed distal resection in 58.3 % of patients, PD - 16.7 %, head resection - 25 %. There were no significant differences in the frequency of postoperative complications in patients with localized (37.9 %) and locally advanced (41.7 %) PNET (p > 0.05). In generalized NET cytoreduction was performed in 13.7 % of patients, removal of the primary tumor - 32.6 %. Median survival of patients after cytoreduction, primary tumor removal, drug therapy in an isolated version was 43.4 months., 38.9 months. and 24 months. (p < 0.05). The 5-year survival rate of patients with localized NET was 81.9%, locally advanced - 57.1%, generalized - 27.6%. Conclusion. The surgical method is the main in the treatment of patients with localized and locally advanced NET. In cases of generalized NET, multidisciplinary assessment of the possibility of surgical treatment of patients is necessary in all cases.
Bulletin of the Russian Military Medical Academy. 2019;21(1):109-113
109-113
EXTRAPERITONEAL ACCESS FOR THE TREATMENT OF INGUINAL HERNIA
Abstract
Introduction. Inguinal hernia is one of the most common diseases and occurs mainly in men of working age. The development of surgery and endoscopic technology made it possible to look at this pathology from the other side and move on to pathogenetically substantiated minimally invasive methods of treatment. The aim of the study. To improve the results of the endohernioplasty in inguinal hernias by improving the techniques and determining the advantages and disadvantages of various options for positioning mesh. Materials and methods. The paper reflects the experience of 203 endovideosurgical allohernioplasty in 161 patients using transabdominal preperitoneal (TAPP) and extraperitoneal techniques (TEP, e-TEP). Results. Intraoperative damage to the sigmoid colon occurred twice with sliding inguinal hernias on the left at the beginning of TAPP, one injury required a laparotomy, the other was eliminated laparoscopically. When performing 55 extraperitoneal hernia repair, there were no complications. Long-term results were traced from 6 to 36 months; no relapses were identified. Conclusion. Due to its advantages, the endovideosurgical technique for the treatment of inguinal hernias is a priority, e-TEP access are easier to learn and can be used even in difficult cases, expanding the surgeon’s capabilities and is the first step to master extraperitoneal approaches to other abdominal hernias.
Bulletin of the Russian Military Medical Academy. 2019;21(1):113-117
113-117
RADIOFREQUENCY ABLATION IN TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE WITH BARRETT’S ESOPHAGUS
Abstract
OBJECTIVE: To evaluate results of treatment of patients with Barrett’s esophagus, including radiofrequency ablation of columnar epithelium with antireflux surgery. METHODS: We treated82 patients with gastroesophageal reflux disease withBarrett’s esophagus between 2011 and 2018. 4 patients had low-grade dysplasia, 63 patients had hiatal hernia. We performed laparoscopic Toupet 2700 fundoplication in 58 of these patients.This allowedto perform radiofrequency ablation (RFA) procedure 2-3 months later in 27 of these patients. In 12 patients without radiological signs of hiatal hernia we performed RFA as the first treatment step. Follow-up endoscopy was performed 3,6 and 12 months after RFA. RESULTS: Metaplasia eradication wasachieved in 97,5% after 1 procedure and in 100% after 2 procedures. 6 months after treatment recurrence of metaplasia was registered in 2,4% patients. CONCLUSIONS: Changing security profile of new endoscopic treatment methods indicates the need for new strategies for Barrett’s esophagus. The most effective scheme is two-step treatment including antireflux surgery and radiofrequency ablation in combination with drug therapy.
Bulletin of the Russian Military Medical Academy. 2019;21(1):117-122
117-122
THE USE OF MESH ENDOPROSTHESIS IN SURGICAL TREATMENT OF VENTRAL HERNIA
Abstract
Surgical treatment of patients with ventral hernias remains an urgent problem in abdominal surgery. More than 20 million operations are performed annually in the world for hernias. The urgency and complexity of the problem is based on the fact that inadequately performed surgery leads to a recurrence of the disease in 14-54% of cases. The aim of the work is to study the results of surgical treatment of patients with ventral hernias using mesh endoprostheses. The results of a retrospective analysis of 437 hernioplasty performed with hernias of various localizations for the period from 2010 to 2014 were used. Patients were classified by hernia localization and divided into groups depending on the methods of alloplasty. The duration of observation of patients operated by using polypropylene mesh ranged from 6 month to 3 years. An analysis of the complications that developed after alloplasty of the inguinal, postoperative, umbilical hernias and hernias of the linea alba was carried out. Our clinical experience confirms that the operation of Liechtenstein is rightly considered to be the “gold standart” for the treatment of inguinal hernias. However, the use of polypropylene mesh in the treatment of inguinal hernias leads to the development of postsurgical wound complications. Placed next to the polypropylene mesh peritoneum flap plays the role of internal drainage, prevents the development of seromas in the wound. The use of a new inguinal alloplasty technique reduced the number of postoperative complications. Also, the best immediate and long-term results are obtained by alloplasty using a sublay method. In patients with postoperative hernias operated by sublay method, no recurrences were observed and they showed the best quality of life.
Bulletin of the Russian Military Medical Academy. 2019;21(1):122-125
122-125
JUSTIFICATION AND DIRECT RESULTS OF ENDOSCOPIC GYNRYOPLASTICS WITH TAPP AND TEP TECHNIQUES
Abstract
Inguinal hernioplasty is one of the most common planned surgical interventions. With the advent of minimally invasive technologies in herniology, a new page in the field of inguinal hernia surgery has opened. The emergence of laparoscopic techniques (TAPP) and fully pre-peritoneal surgery using the TEP method allowed us to achieve good long-term results. However, there remain unresolved questions of justifying the choice of a particular method of minimally invasive intervention in patients with inguinal hernias, as well as minimal information about the comparison of long-term results of treatment of this category of patients. As a result of the study, the results of treatment of 987 patients with inguinal hernias, operated from 2014 to 2018, were evaluated. in the clinic by the endoscopic method (319 by the laparoscopic method TAPP and 668 patients operated by the TEP method). The criteria for the comparison of endoscopic techniques of hernioplasty were: the duration of the operation, the intensity of the pain syndrome, the postoperative bed-day, the economic costs for one treated herniological patient. It was established that in the absence of significant contraindications, the operation of choice was hernioplasty according to the TER method due to the lower risk of damage to internal organs and its greater economic efficiency, while maintaining all the positive qualities of minimally invasive intervention. The average bed-day after surgery according to the TAPP method was 3.8 ± 0.2, and according to the TEP method - 2.6 ± 0.3. The complications, the frequency and the cause of relapses after endoscopic hernioplasty were studied. Analyzing long-term results, in 3 cases (0.9%) after laparoscopic hernioplasty, a relapse of the disease was diagnosed. After hernioplasty using the TEP method, relapse was diagnosed in 2 cases (0.3%). In 2 patients, the hernia recurred was due to the small size of the established mesh prosthesis (less than 10x15 cm), in 3 patients it was caused by turning the lower edge of the mesh prosthesis and was observed at the stage of mastering the technique. As a result of the study, it was found that the TEP technique, in contrast to laparoscopic hernioplasty TAPP, leads to a reduction in the postoperative hospital bed, is accompanied by a significantly lower pain syndrome and recurrence rate of the disease, and also has greater economic efficiency.
Bulletin of the Russian Military Medical Academy. 2019;21(1):125-129
125-129
APPLICATION OF MODIFIED NICKELIDE TITANIUM IMPLANTS TO REPLACE ABDOMINAL WII DEFECTS IN EXPERIMENT
Abstract
An important step towards the development of reticular endorotesis was the introduction and use of modern super-elastic material based on nickel-titanium. The article is devoted to a new way to solve one of the urgent problems of surgery. The experiment proved the possibility of an intraperitoneal method of disposing of a nickel-mesh titanium implant based on titanium nickelide modified by auto-coupling tissue in artificially created defects of the anterior abdominal wall, and anti-adhesive properties of the combined mesh material are shown. In the experiment, performed a series of experiments on 33 rabbits of the Chinchilla breed. Animals were divided into 3 groups of 11 animals each. The experiment included 2 stages. In the first part, netting of nickelide titanium implant was performed in the posterior pelvic limb of the animal. The second stage was carried out by replacing the artificially created defect of the anterior abdominal wall with a mesh implant based on titanium nickelide modified with connective tissue. The experiment proved the possibility of an intraperitoneal method of disposing of a nickel-mesh titanium implant based on titanium nickelide modified by auto-coupling tissue in artificially created defects of the anterior abdominal wall, and anti-adhesive properties of the combined mesh material are shown. The use of super-elastic reticular nickel-titanium implants in combination with an auto-connecting tissue will, with a high degree of effectiveness, replace the lost structures of the anterior abdominal wall in patients with postoperative ventral hernias.
Bulletin of the Russian Military Medical Academy. 2019;21(1):129-132
129-132
PROCALCITONIN OF EYACULATE AS A MARKER OF DISORDERS OF SPERMATOGENESIS
Abstract
The study of the protein composition of the ejaculate is devoted to a significantly smaller number of studies than the characterization of the cellular composition of sperm and the characterization of spermatozoa. Objective: to investigate the concentration of procalcitonin (PCT) in seminal plasma and serum in normal conditions and with oligozoospermia. Materials and methods. 88 men were examined (the main group - 40 men with oligozoostantenospermia, the comparison group - 48 men with a normal concentration of spermatozoa). Results and discussion. The concentration of PCT in seminal plasma in the examined patients (n = 88) was almost 10 times higher than its serum content and amounted to 0.349 ± 0.370 ng/ml versus 0.037 ± 0.027 ng/ml (p<0.000001). In patients with oligozoospermia the contents of the PC has exceeded the value of the comparison group (p = 0,0095). Serum PCT concentrations in blood serum did not differ between groups (p = 0.605). There were no statistically significant correlations between the level of PCT and other indicators of sperm (sperm concentration, their total content and volume of ejaculate). Summary. The content of PCT in seminal plasma does not depend on its level in blood serum. A higher content of PCT in the ejaculate compared to serum indicates its local production in the reproductive system. The increased procalcitonin level in seminal plasma may indicate decreased fertility of the ejaculate.
Bulletin of the Russian Military Medical Academy. 2019;21(1):132-136
132-136
PSYCHEMICAL STATE OF PATIENTS UNDER NITROGEN MONOXIDE THERAPY FOR PREVENTION OF PURULENT-INFLAMMATORY POSTOPERATIVE COMPLICATIONS IN UROLOGY
Abstract
На базе урологических отделений ФГБУ «3 ЦВКГ им. А.А. Вишневского» Минобороны РФ была проведена клиническая часть работы по разработке и внедрению новой комбинированной терапии урологическим пациентам для профилактики гнойно-воспалительных послеоперационных осложнений. Комбинированная терапия включала в себя лимфотропную антибиотикопрофилактику и терапию монооксидом азота. Во время проведения исследования важным является зависимость удовлетворенности результатом у пациентов от разных характеристик. Диагностика личностных особенностей пациентов в медицинской практике усложняется дефицитом времени и отсутствием специальной подготовки у врача. Исходя из этого, возможность определения психоэмоционального состояния пациента и качества его жизни во время лечения крайне ограничена. Таким образом, целью моего исследования явилось определение изменения психоэмоционального статуса пациентов под влиянием комбинированной NO-терапии. В данной работе комплексному обследованию были подвергнуты 130 больных, 67 из которых получали традиционное лечение, и 63 - комбинированную терапию. Для оценки состояния пациентов использовали личностные опросники: Методика «Шкала реактивной и личностной тревожности» и тест дифференциальной самооценки функционального состояния. Полученные в ходе исследования результаты позволяют подтвердить наличие достоверных изменений параметров психологического статуса пациентов после проведения комплекса терапий. Данные параметры полностью подтверждают клинические показатели пациентов, что еще раз доказывает эффективность предложенной комбинированной терапии.
Bulletin of the Russian Military Medical Academy. 2019;21(1):136-140
136-140
EXTRAPERITONEOSCOPIC PROSTATEСTOMY: SURGICAL TECHNIQUES PRESERVING THE QUALITY OF LIFE OF THE PATIENT
Abstract
Objective.Radical prostatectomy (RPE) performed without preserving the neurovascular bundles and the pubovesical complex has a great risk of developing urinary incontinence and erectile dysfunction, which significantly impairs the quality of life of patients with prostate cancer in the postoperative period. Methods. The effectiveness of surgical treatment was assessed in 22 patients (mean age 57.6 ± 6.4 years) with a diagnosis of prostate cancer, who underwent extraperitoneoscopic intrafascial nerve-saving radical prostatectomy with preservation of the pubovesical complex. The criteria for the effectiveness of this technique of surgical treatment were considered the preservation of erectile function and the absence of urinary incontinence in the early and late postoperative period. Results. In the postoperative period, all patients were continent; in 3-4 months, erectile function was restored without additional stimulation by phosphodiesterase-5 inhibitors. Conclusions.The described technique demands detailed understanding by the surgeon of the surgical anatomy of the prostate and the basic surgical principles of nerve preservation in order to significantly improve the quality of life of patients in the postoperative period.
Bulletin of the Russian Military Medical Academy. 2019;21(1):140-143
140-143
PNEUMATIC CONTACT TRANSURETHRAL ureterOLITHOTRIPSY in emergency urological practice
Abstract
Relevance. Minimally invasive methods of removing the ureteral calculus in urological practice have steadily taken the leading position. According to the Russian clinical recommendations the indications for endoscopic correction of ureteral calculus are concrements with a low probable passage, constant pain symptomatic on the background of adequate analgesia, the varying degrees of obstruction severity and impaired renal function. The purpose of the work is to assess the efficacy of transurethral pneumatic contact lithotripsy of ureteral calculus in emergency urological practice. The research tasks included the refinement of the endoscopic lithotripsy results, depending on the localization level among men and women. Materials and methods. The results of endoscopic treatment of ureteral calculus among 360 patients of both sexes, hospitalized in a urological hospital with emergency indications of a renal colic diagnosis, are presented. Results. The efficiency of retrograde pneumatic contact ureterolithotripsy reached 91.8 %. The most optimal this method is with the localization of calculus in the lower third of the ureter, regardless of the concrement size and sex. The percentage of the calculus fragmentation of the middle third of the ureter among men and women was 91.6 and 93.4 respectively. The lithotripsy in the upper part of the ureter was 23.6 % more effective among women. Operational complications were registered in 7.5 % cases.
Bulletin of the Russian Military Medical Academy. 2019;21(1):143-147
143-147
IMPLEMENTATION OF LAPAROSCOPIC APPROACH IN A KIDNEY CANCER SURGERY - A SINGLE CANCER’S CENTER EXPERIENCE
Abstract
Renal cell cancer or renal cell carcinoma (RCC) is the most common type of kidney cancer in adults. In Russia (2017 year) it accounts for approximately 3.7% of adult malignancies.Laparoscopic radical nephrectomy (LRN) now is a gold standard in treatment of renal cell carcinoma (RCC) in the world. In Russia laparoscopic nephrectomy (radical and partial) have been commonly performed at a large multicenter hospitals with the large number of patients and relatively rare at single regional cancer centers. Implementation of laparoscopic approach in a renal cell cancer surgery in a safe and timely manner will improve quality and accessibility of minimally invasive surgery in a regional cancer centers. Aims: evaluate complication rate, surgical operation time, mortality rate implementing minimally invasive surgical technique in renal cell cancer surgery - a single cancer’s center experience. Summary: 174 patients underwent surgery using laparoscopic technique for renal cell cancer. All patients were divided on 2 equal groups, depending on the time required to master laparoscopic technique. Outcome measures included operation time, conversion rate, blood loss, mortality rate, readmission and postoperative complication rates and time of impatient care. Result: Main outcome variables(operation time, conversion rate, time of impatient care, mortality rates, postoperative complication rates) reach a plateau in the learning curve after 94 operation. It is important to mention that during the whole period of implementing laparoscopic technique for renal cell cancer postoperative complication rates, mortality rates and operation time were comparable with the data available in the literature. Conclusion: It is shown that the introduction of minimally invasive technologies into a renal cell cancer surgery is relatively safe and possible under the given conditions, while the time of mastering laparoscopic technique in regional cancer center is comparable with the data available in the literature.
Bulletin of the Russian Military Medical Academy. 2019;21(1):147-150
147-150