Russian Journal of Pediatric Surgery, Anesthesia and Intensive CareRussian Journal of Pediatric Surgery, Anesthesia and Intensive CareРоссийский вестник детской хирургии, анестезиологии и реаниматологии2219-40612587-6554Eco-Vector185410.17816/psaic1854Case reportsКлинические случаиResearch ArticleVascular reconstruction in children in the oncology center: A case reportsСосудистая реконструкция у детей в онкологическом центре: клинические наблюдения儿童肿瘤外科中血管重建：大学医院肿瘤中心的临床观察https://orcid.org/0000-0003-0516-96686339-1144GurgenidzeNina N.ГургенидзеНина Н.GurgenidzeNina N.
Russian Federation
nina.n.gurgenidze@gmail.comhttps://orcid.org/0000-0001-6334-74566635-6324PopovGuriy I.ПоповГурий И.PopovGuriy I.
Russian Federation
trek-4300@yandex.ru2328-4920AnanyevAleksey N.АнаньевАлексей Н.AnanyevAleksey N.
Russian Federation
alananyev@yandex.ruhttps://orcid.org/0000-0002-6223-40433374-3401KutenkovAleksey А.КутенковАлексей А.KutenkovАleksey А.
Russian Federation
alexqut@gmail.comhttps://orcid.org/0000-0003-3316-99566734-9145TrushinAnton A.ТрушинАнтон А.TrushinAnton A.
Russian Federation
anton.trushin@rambler.ruhttps://orcid.org/0000-0003-1099-38381806-8780KondrashovMaksim A.КондрашовМаксим А.KondrashovMaksim A.
Russian Federation
kondrashov.maks@gmail.comhttps://orcid.org/0009-0008-9042-8831KulikovEvgeniy A.КуликовЕвгений А.KulikovEvgeniy A.
Russian Federation
drkulikovevgeniy@gmail.comhttps://orcid.org/0000-0001-7173-76732607-4958ShvetsovAleksander N.ШвецовАлександр Н.ShvetsovAleksander N.
Russian Federation
9052557239@mail.ruhttps://orcid.org/0000-0001-5953-89386075-9657ZaytsevaAlena N.ЗайцеваАлена Н.ZaytsevaAlena N.
Russian Federation
m.d.zaytceva@gmail.comhttps://orcid.org/0000-0002-5153-20612140-7011PaltyshevIlya A.ПалтышевИлья А.PaltyshevIlya A.
Russian Federation

MD, Cand. Sci. (Medicine)

канд. мед. наук

MD, Cand. Sci. (Medicine)

eexss@mail.ruhttps://orcid.org/0000-0002-3818-62132673-7370KazantsevIlya V.КазанцевИлья В.KazantsevIlya V.
Russian Federation

MD, Cand. Sci. (Medicine)

канд. мед. наук

MD, Cand. Sci. (Medicine)

Ilya_Kazantsev@inbox.ruhttps://orcid.org/0000-0002-8514-53773209-8677ZakharenkoAlexander A.ЗахаренкоАлександр А.ZakharenkoAleksander A.
Russian Federation

MD, Dr. Sci. (Medicine), Professor

д-р мед. наук, профессор

MD, Dr. Sci. (Medicine), Professor

9516183@mail.ruAcademician I.P. Pavlov First St. Petersburg State Medical UniversityПервый Санкт-Петербургский государственный медицинский университет им. акад. И.П. ПавловаAcademician I.P. Pavlov First St. Petersburg State Medical University07012025191020241445515643110202422112024Copyright ©; 2024, Eco-VectorCopyright ©; 2024, Эко-ВекторCopyright ©; 2024,2024Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0https://rps-journal.ru/jour/article/view/1854

In pediatric oncology, tumors with intimate attachment and involvement of major vessels are common and require surgical treatment. However, most surgical procedures do not require resection and vascular reconstruction. In some cases, radical tumor removal is a significant prognostic factor. In such cases, it becomes necessary to reconstruct the affected vessels which cannot be preserved. This creates a complex task for a surgeon, as there is no one-size-fits-all solution and no extensive clinical experience in pediatric oncology. In our clinic, 3 patients requiring inferior vena cava and renal vein reconstruction were treated between 2020 and 2024: a 9-year-old boy (nephroblastoma), a 4-year-old boy (neuroblastoma), and a 10-year-old boy (paraganglioma). Xenopericardium was used as the graft material in the first two cases and allograft was used in the third case. A child with nephroblastoma was followed for 4 years. Blood flow in the inferior vena cava was satisfactory. A boy with neuroblastoma developed thrombosis in the early postoperative period. A patient with a paraganglioma with satisfactory blood flow and a functioning reimplanted kidney was followed for 2 years. This review of clinical cases demonstrates the potential of using various methods of vascular reconstruction and pediatric plastic surgery in the surgical treatment of tumors.

В детской онкологии нередко встречаются опухоли с интимным прилежанием и вовлечением магистральных сосудов, требующие хирургического лечения. Однако большинство оперативных вмешательств проходит без необходимости выполнения резекции и пластики сосуда. В некоторых случаях радикальность при удалении опухоли — важный фактор дальнейшего прогноза ребенка. В таких ситуациях встает вопрос о реконструктивных вмешательствах на вовлеченных сосудах, сохранить которые не представляется возможным. Это создает сложную задачу для хирурга, решение которой не имеет единого подхода и большого клинического опыта в онкопедиатрии. В нашей клинике в период с 2020 по 2024 г. проходили лечение 3 пациента, которым потребовалась реконструкция нижней полой и почечной вен: мальчик 9 лет (нефробластома), мальчик 4 года (нейробластома), мальчик 10 лет (параганглиома). В качестве имплантируемого материала применяли в первых двух случаях ксеноперикард, в третьем — аллографт. Период наблюдения за ребенком с нефробластомой составил 4 года, кровоток в нижней полой вене удовлетворительный. У мальчика с нейробластомой зарегистрирован тромбоз в раннем послеоперационном периоде. Пациент с параганглиомой с удовлетворительным кровотоком и функционирующей реимплантированной почкой наблюдается в течение 2 лет. Представленный обзор клинических случаев демонстрирует возможности применения различных методов реконструкции и пластики сосудов в детском возрасте при хирургическом лечении опухолей.

在儿童肿瘤学中，肿瘤常紧邻或累及主要血管，需进行手术治疗。然而，大多数手术无需进行血管切除或修复。在某些情况下，为确保肿瘤切除的彻底性，以改善患儿的预后，涉及的血管无法保留，这时需要进行血管重建。血管重建在儿童肿瘤外科中尚无统一方案，也缺乏丰富的临床经验。临床病例2020年至2024年 间，3名患者在我们的临床中接受了下腔静脉和肾静脉的重建：患者1: 9岁男孩，患 肾母细胞瘤，术后随访4年，下腔静脉血流正常；患者2: 4岁男孩，患 神经母细胞瘤，术后早期发生血栓形成；患者3: 10岁男孩，患 副神经节瘤，术后随访2年，下腔静脉血流正常，移植肾功能良好。使用的植入材料:前两例采用 异种心包（牛心包）；第三例采用 同种异体移植材料。通过上述临床病例，我们展示了不同血管重建和修复技术在儿童肿瘤手术中的应用潜力。这些方法为肿瘤外科提供了新的治疗思路。

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