卷 8, 编号 3 (2018)

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The purpose is to present morphological and morphometric changes in the histoarchitecture of the intestinal wall in newborns with necrotizing enterocolitis considering the outcomes of the disease. Materials and methods. The PRMU clinics carried out a morphological study of histological intestinal sections of 99 operated patients with NEC from 2003 to 2017. The patients were divided into the following groups: 72 survived newborns from group I (favourable outcome) and 27 dead newborns from group II (unfavourable outcome). The object under study was surgical specimen of the ileum and large intestine. Result. The disease outcome can be predicted using morphological changes in the intestinal wall in NEC. The leading role of the drainage function of the lymphatic apparatus is established in the article. It is completely restructured in the operational specimen of patients with the unfavourable course. Changes in the cellular composition in the form of insufficient number of fibroblast cells and isolated epithelial and stromal cells enabled subsequent destruction of the bowel wall with progression of the exudative processes.

The purpose of the study: evaluation of the results of surgical treatment of children with bezoars of the gastrointestinal tract.

Materials and methods. Over the past 18 years, we have observed 6 children with bezoaris (girls-4, boys-2). Of these, 5 children with trichobezoirs of the stomach and intestines and one child with polybezoar – rags, bandages. Age fluctuated from 8 to 13 years. Only one girl was at the age of 3 years. With careful collection of anamnesis, it was found that everyone had a bad habit of chewing the ends of the hair. Only one child suffering from a severe CNS lesion had a polybekoar. It is difficult to determine the exact period of existence of trihobezoars. Children were registered with pediatricians for gastritis 2–3 years; perhaps these were the first signs of the formation of trichobezoara in the stomach.

Results. Of the six children operated 5 (3 girls and 2 boys). At one girl of 12 years the tri-chaser in the size of 4 sm was in a stomach, and its tail descended in duodenum. This bezoar removes endoscopically. The remaining 5 children were operated. All the children recovered.

Conclusions. With trihobezoare stomach possible endoscopic removal. However, the main method of treating children with bezoars of the gastrointestinal tract is surgical. 

Just like any surgery, a surgical operation pertaining to the eye and its appendages is a common cause of stress that changes the functions of all organs and systems. Numerous previous studies have shown this. The task of anesthesia is to protect a body from stress.

The purpose of the study was to estimate the severity of a stress reaction when using different methods of anesthesia during eye surgeries in children.

Material and methods. Plasma concentrations of glucose, lactate and cortisol were measured in children aged 4 to 18 years old at three surgical stages. Various methods of anesthesia were used in 5 groups. The patients were distributed at random with 20 children in every group. Results. All estimated values were within the age-specific reference range. Glucose and cortisol levels tended to increase, whereas lactate level was decreasing.

Conclusion. The suggested anesthesia types can sufficiently protect patients during eye surgeries and be applied in the practice. 

Purpose. To analyze the results of treatment of children with keel-shaped deformity of the chest using various methods.

Materials and methods. The work is based on the retrospective analysis of treatment outcomes for 28 children who obtained treatment for KSDC at pediatric surgical departments of Regional Clinical Hospital No. 2 in Tyumen and Children’s Regional Clinical Hospital in Kirov. These are clinical bases of pediatric surgery departments of Tyumen and Kirov State Medical Universities. Various treatment methods were applied including chest constant pressure devices and thoracoplasties.

Results and discussion. The Ravich procedure was done in 14 children. The patients stayed at the hospital for 18±3 days and required prolonged anesthesia and long-term antibacterial therapy; discharge was followed by long-term immobilization with a plaster or polymer corset. 6 children had surgeries using smallinvasive thoracoplasty based on the method offered by H. Abramson. The hospital treatment stage was 7 to 11 days. 8 children had therapy using orthosis.

Conclusion. The authors believe that mental traumas caused by a keel-shaped deformity require minimally invasive techniques for correction that eliminate the deformity considering esthetic requirements of a patient.

The article starts with a summary of the international experience in making medical care both accessible and high quality for children with surgical conditions and trauma by concentrating patients in specialized trans-regional centers. The authors give results of the retrospective analysis of the reasons for failure when implementing the concept of trans-regional specialized medical care in the Russian healthcare system. The paper lists problems with legislative control over these aspects: supplying the centers with resources, medical evacuation processes, distribution of responsibility by areas, and the information exchange with local medical institutions (hospitals, clinics, etc). The article also illustrates similarities and differences on how the trans-regional centers for pediatric surgical care function inRussiaand in other countries. The authors outline high priority measures for creating trans-regional centers for specialized medical assistance for children inRussia. The systematic review includes 16 domestic and 28 foreign literature sources, 8 references to Russian laws and regulations. 

Total deep facial burns represent one of the most complex clinical tasks for a surgeon. A child’s quality of life and complexity of subsequent treatment stages depends on effective surgical tactics used during the acute period of a burn trauma. The article describes the use of full-thickness graft preliminarily stretched with an endoexpander when treating deep facial burns in a child with the total burns involving 60% of body surface and thermoinhalation lesion. The surgery was done on the 36th day of staying at the hospital in spite of the patient’s severe condition. 

The article describes a clinical case of a child with hepatic focal nodular hyperplasia. The obtained good result is confirmed with clinical data and instrumental studies. This allows us to assume safely that radical surgery is possible in these patients. 

The article is devoted to the history of establishing the Department of Pediatric Surgery and UrologyAndrology of theSechenovUniversity. The role of the first PD of the EmperorMoscowUniversity and founder of pediatric surgery as a science Leonty P. Aleksandrov was described. He organized a course devoted to pediatric surgical diseases in 1893 and was the head physician of Saint Olga’sPediatricHospital. He also founded the Society of Pediatric Surgeons inMoscow, and was an initiator of the meeting of Russian surgeons conducting serious work on the organization of meetings of Russian surgeons in memory of N. I. Pirogov. In 2008, he founded a Department of Pediatric Surgery and Urology-Andrology of theFirstMoscowStateUniversitynamed after I. M. Sechenov. The article describes therapeutic, research, organizational and pedagogical work of the department since its establishment till now. 

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The review of literature deals with the current classification of the biliary atresia, presents the authors’ opinion considering a technique of theKasaiprocedure, and displays modern modifications of portoenteroanastomosis estimating their effectiveness. PubMed database and Google Scholar search system were used to search for primary terms. Survival of children with this pathology was analyzed depending on theKasaitechnique, anatomical form, terms of portoenteroanastomosis and importance of early diagnosis of this pathology.