卷 7, 编号 3 (2017)

The short bowel syndrome (SBS) is a severe disorder caused by a significant loss of absorption capacities of the intestine due to its resection manifested as pronounced chronic intestinal insufficiency. We aimed at the investigation of the SBS causes at different intervals. The study was conducted in collaboration with the department of pediatric surgery of the RCCH (Republican Children’s Clinical Hospital) and Mannheim clinics of pediatric surgery at Heidelberg University (Germany). The most frequent causes of SBS in children are necrotizing enterocolitis, gastroschisis, small intestine atresia, twisted bowel, etc. According to our studies, gastroschisis was the most frequently occurred cause whereas necrotizing enterocolitis occupied the 2nd position on the list. Atresia and twisted bowel held the 3rd and 4th positions. However, it should be mentioned that the share of patients with SBS following necrotizing enterocolitis has increased considerably lately.

Background. In this study we reported our experience with repair of esophageal atresia using open surgery and thoracoscopy The aim of scientific work was to evaluate the effect of minimally invasive surgery for treatment of this congenital disease.
Methods. We reported the data of 114 neonates who underwent standard thoracotomy (44patients – Group I) and video-assisted thoracoscopic surgery for esophageal atresia repair (70 patients – Group II). The two groups were compared for patients demographics, operative report and postoperative parameters.
Results. The compared groups were similar in terms of demographics and preoperative parameters. There was significant difference in mean operative time between open and thoracoscopic procedure (111,14 min vs 77,00 min; p<0,05). Duration of care in neonatal intensive unit and length of hospital stay were significantly shorter in the Group II (12,39 d vs 8,13 d; p<0,05 and 31,80 d vs 22,81 d; p<0,05). Rates of early complications were diferent between groups (36,36 % – group I vs 11,43 % – group II; p<0,05). Rate of long-term complications was dominated in the thoracotomy group (20,45 % vs 0 %; p<0,05).
Conclusion. Thoracoscopic repair of the esophageal atresia gave results better than open surgery.

Introduction. An isolated open arterial duct (OAD) is one of the most common congenital heart disorders. According to literature, every 1 child out of 2,000 children has OAD at birth.
It accounts for 5–10% of all the congenital heart disorders [1].
Material and methods. The article analyzes the results obtained during the minimally invasive surgical treatment of an open arterial duct (OAD) in children. The following two types of surgeries were performed: OAD clipping via an extra pleural mini thoracotomy approach and thoracoscopic clipping. A treatment method is chosen depending on the patient’s severity degree.
Results. Treatment resulted in 100% blood flow termination via the arterial duct in the lack of intraand postoperative lethality and any serious complications in the postoperative period.
Conclusions. It is better to perform OAD clipping in premature children right at the resuscitation unit without transportation of the patients to the operating theater and using the extra pleural minimal thoracic approach.
In elder stable children, thoracoscopic OAD clipping is an effective and reliable treatment method that terminates the pathological blood flow from the open arterial duct irrespective of its form and size.

The purpose of the work was to improve the results of open surgical operations in complicated nephrolythisis in children.
Materials and methods of investigations. 121 patient with complicated nephrolythisis aged 1 to 15 years were observed by the authors. In 87.1% of cases the somatic background was due to concomitant diseases (ARVI, hypertrophy, pneumonia, rickets, etc.).
Results. The calculus deposit was removed using nephrolithotomy in 42.1%, pyelolithotomy in 46.3% and clicolithotomy in 11.6% patients. In obstructive purulent and calculous pyelonephritis, calculus was cured with primary nephrolithotomy and nephrostomy. Corrective surgeries were performed in 37% patients with renal defects. Correct management of the postoperative period and methods of the calices-pelvis system drainage were paid a great attention.
Conclusion. Conservative therapy of concurrent diseases and inflammation in the kidneys was followed by the surgery. Indications for various types of surgeries were developed depending on the type of nephrolithiasis.

The purpose of the study was to examine the way the prolonged epidural block influences the post-operative course of necrotizing enterocolitis in newborns.
Materials and methods. We analyzed treatment results of 77 newborns with NEC at the Omsk Regional Center of Newborn Surgery in 2009–2014.
The main group included 47 patients who underwent the prolonged epidural block following the surgery. The control group of 30 patients included newborns without the block.
Results. Comparison of two clinical groups revealed a positive effect produced by the prolonged caudal block on the duration of artificial ventilation and initial functioning of the GIT. This resulted in statistically significant improvement of survival of newborns with necrotizing enterocolitis.
Conclusion. The extended caudal epidural block following the surgeries for NEC in newborns is an affordable, safe and effective method of treatment that optimizes the course of the postoperative period.

Purpose of the study: to examine and develop the best variant of formation of the intestinal anastomosis.
Materials and methods: the experimental work analyzes the processes of regeneration in the area of the interintestinal anastomosis formed with a one-row continuous perforated, one-row continuous serous-muscular, two-row precision intestinal suture when performing surgeries on the Wistar white rats (n=45).
Results and discussion: histological investigations of the anastomosis area carried out on the 1, 3, 7, 14, 21 days of the experiment showed a difference in the course of reparative processes in the anastomosis area depending on the method of application of intestinal sutures.
Conclusions: Depending on the conducted morphological studies, the priority of application of two-row precision intestinal suture and feasibility of its application in the clinical practice among newborn children are proven.

Short bowel syndrome (SBS) continue to be important clinical problem in pediatric population due to high mortality and morbidity rates, as well as their devastating socioeconomic effects. In this paper, the etiology of SBS, its pathophysiology, the cellular and molecular mechanisms of intestinal adaptation, are reviewed. The most common complications of SBS are outlined with strategies to reduce them. The medical management and nutritional support of a patient with SBS is complex and requires a multidisciplinary. A review of the pharmacologic agents and growth factors that have been studied experimentally and administered clinically for the management of short bowel syndrome is presented.
Surgical procedures to promote intestinal adaptation and intestinal lengthening have largely changed the available options for non-transplant interventions.