卷 9, 编号 1 (2019)

The article describes clinical observation of treatment of a premature infant with chyloperitoneum. Accumulation of fluid in the abdominal cavity was diagnosed prenatally at 31–32 weeks of gestation. Premature surgical delivery was performed at 34– 35 weeks due to the high risk of antenatal fetal death. Paracentesis with fluid analysis was done; chylous exudate was confirmed. Total parenteral nutrition, octreotide and drainage of the abdominal cavity were used during conservative treatment. It was decided to perform a surgery as the therapy was ineffective. At the age of 2 months and 7 days laparotomy was conducted, abdominal organs were revised, lymph ducts were ligated, and abdominal cavity was drained producing a positive effect. The fluid outflow was terminated and the child was discharged in a satisfactory condition.

Purpose: to report a case of a giant stomach trichobezoar successfully treated with a laparoscopic technique. Methods. A 14-year-old girl with signs of partial upper gastrointestinal obstruction was admitted to the hospital. Stomach trichobezoar was found during an endoscopic examination. The child was discharged following conservative therapy, as her parents gave no consent to surgery. In 2 months, she was admitted to the hospital again for planned surgery. Result. Gastrotomy was performed laparoscopically. Giant bezoar was removed from the stomach, placed in an endosac and then removed from the abdominal cavity through a Pfannenstiel incision. No postoperative general or wound complications were found. The patient recovered and was discharged. Conclusion. Treatment of stomach trichobezoars should be surgical. The method depends on a certain case. We believe that laparoscopy is more useful as compared to open surgeries and recommend it in uncomplicated forms of stomach trichobezoars.

Introduction. Russia needs to reform the stepwise model for delivering medical aid to children with surgical diseases and traumas mobilizing patients and those injured at specialized Interregional Centers (IRC). Purpose. To substantiate profiles and dislocation of IRC providing surgical aid to children in Russia. Material and methods. 103 specialists from 85 territorial entities of the Russian Federation presented their expert reviews concerning profiles and dislocation of IRC that provide surgical aid to children in accordance with the nomenclature of professions and administrative structure of the country. The expert reviews were analyzed using the methods of descriptive statistics to rate IRC profiles, their territorial dislocation, and focus on interaction of those surveyed with certain medical organizations. Consistency of expert opinions was estimated using Kendall’s coefficient of concordance. Results. Experts indicated 14 activity profiles of IRC providing surgical aid to children. According to rating results, more than a half of positive estimates belonged to five priority profiles including surgery of neonates, neurosurgery, oncology, thoracic surgery and combustiolgy. As far as IRC dislocation is concerned, experts mainly considered medical organizations within a federal district of territorial entities of the Russian Federation. Total number (287) of references (by priority profiles) to hospitals within territorial entities of Russia was 4 times more than the respective estimate (66) for federally governed healthcare providers. Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology that served as a base for potential IRC (oncology) was the most in-demand (19 requests) federal structure. Conclusion. Community of professionals has come to a consolidated opinion according to which buildup of IRC providing care in neonatal surgery, neurosurgery, oncology, thoracic surgery, and combustiology at children’s hospitals in territorial entities of the Russian Federation and 13 federally governed clinical research centers is a significant factor of providing affordable and qualitative medical aid.

Introduction. Surgical treatment of intestinal atresia with distal tracheoesophageal fistula involves resection of fistula and intestinal primary anastomosis. However, premature children often have complications associated with delayed anastomosis. Thus, an optimal surgical approach is not determined. Purpose. Analyzing treatment results in newborns with intestinal atresia and very low weight. Materials and methods. Treatments outcomes in infants with intestinal atresia and very low weight (less than 1500 g) from 2008 to 2017 were assessed retrospectively. The patients were divided into 2 groups: (1) fistula dressing and crossing with subsequent delayed anastomosis reconstruction and (2) primary anastomosis. Demographic, surgical and postoperative complications were compared. Results. 23 preterm children with IA/TEF were operated. Twelve patients (52%) underwent primary anastomosis, whereas 11 (48%) of them had a stepwise surgery. Anastomotic leak confirmed by esophagram was similar in both groups (17% and 18%). Stenosis was more common in step-wise surgery (83%) as compared to the group of primary anastomosis (27%) (р<0.05). The esophagus was preserved in two patients who underwent step-wise surgery. 4 patients had coloesophagoplasty. The postoperative period was similar in both groups. 6 patients (50%) from the step-wise group and 5 patients (45%) from the group of primary anastomosis died. Conclusion. Staging plasty of IA/TEF in newborns does not improve the quality of life. In this group, gastro- and esophagostomy exteriorization is a preferable surgical approach.

Introduction A tendency to the increasing rate of follicular jaw cysts in children has been observed in Nizhny Novgorod region lately. Material and methods. 240 children (131 (54.6%) boys and 109 (45.4%) girls) with follicular jaw cysts aged 4 to 17 inclusive were treated at the maxillofacial department of Nizhny Novgorod Regional Children’s Clinical Hospital between 2003 and 2018. The follicular jaw cyst was diagnosed based on complaints, past medical history, and X‑ray examination (orthopantomography, computed tomography) done on the outpatient basis. All patients were operated using standard methods such as cystectomy, cystotomy, cystectomy with maxillary sinusotomy (when a cyst penetrates the maxillary sinus). Results. Within the last years, duration of hospitalization was reduced from 17.0±0.6 to 4.0±0.3 calendar days (2017) and to 4.8±0.4 calendar days (2018). The amount of immature permanent teeth increased as well. Conclusions. Thus, in spite of a greater number of children with follicular jaw cysts in Nizhny Novgorod region, it was possible to reduce duration of hospitalization and increase the number of preserved immature permanent teeth due to better diagnostics, earlier cyst detection and use of cystectomy.

Introduction: to analyze pathological processes in a patient with multiple trauma. Classification and structuring are not taken into account, as they require estimation of condition severity and dynamics of pathological process. It is frequently impossible to do so. In every specific case, it is necessary to structure multiple trauma. The Injury Severity Score (ISS) system is useful in this case, as it consists of a combination, certain quantitative and qualitative estimate which makes it possible to estimate a patient’s condition at early pre-hospital stage and adjust treatment. Purpose: to make a structural analysis of a multiple trauma in children in the state of shock using ISS and concentrations of S100B protein and cystatin C to change the examination tactics and improve treatment outcomes. Materials and methods. 44 patients in shock with multiple trauma were structured and examined. The patients came for treatment from cities of the northern region and the city of Kemerovo. Patients mainly had a predominant severe cranial cerebral injury (SCCI). There were 36 patients including two patients with diffuse axonal injuries and 8 patients with predominant skeletal trauma (ST) and damage of internal organs with the syndrome of intraperitoneal bleeding (SPB). Results: treatment protocols were taken into account alongside with objectively obtained data on multiple trauma structure based on the ISS severity scale. We obtained reliable data on the type of changes in S100B and cystatin C concentrations during the acute period of multiple trauma. Conclusions: multiple trauma structuring in children using the ISS system and S100B protein and cystatin C concentrations enables objective detection of signs characterizing the severity of an acute period among those injured and optimization of the examination scheme along with a treatment program.

Purpose: to evaluate effectiveness and safety of wound dressings featuring Safetac ® technology in local conservative treatment of children with skin burns. Materials and methods: retrospective analysis of the results obtained when using a line of wound dressings with Safetac® technology in children aged 1 months old to 3 years old with superficial I– II‑degree skin burns and borderline III degree skin burns who have been staying at the burn center of G. N. Speransky Children’s Hospital No. 9 during the last 5 years. The area of burn wounds ranged from 1% of body surface area (BSA) to 25% of BSA. In the observed patients, hot fluid was the basic damaging agent. Routine examination methods were used to confirm effectiveness and safety of the following medical procedures: monitoring of the course of the wound process, estimation of temperature and possible allergic reactions against the background of dressing application, microbiological follow-up control of burn wounds determining sensitivity to antimicrobials, and epithelization duration of damaged skin areas. Some dressings that belong to this batch (Mepilex® Lite, Mepilex® Transfer and Mepilex® Border) are reviewed here. Results and conclusions: effectiveness and safety of therapeutic dressings in patients with thermal injuries are verified using clinical experience. It is proved that a combined line of dressings provides for a good therapeutic effect depending on the wound process phase and depth of tissue affected with hot fluid. Possible complications in the form of allergic reactions (and contact dermatitis, is particular) are found. Methods of their prevention are recommended. In case of their development, adequate local therapy is provided. According to the study, wound dressings with Safetac ® technology are effective and safe in children with local superficial I–II‑degree skin burns and borderline III degree skin burns (ICD‑10).