卷 9, 编号 2 (2019)

Introduction. Development of pediatric surgical science is an essential part of preservation and strengthening of the entire speciality and ‘pediatric surgical sovereignty’. A report entitled The State and Perspectives of Research Studies in Pediatric Surgery was presented in 2015.

Purpose. To analyze the status of principal outcomes of research work done by the Russian Association of Pediatric Surgeons in 2015–2018 and justify the necessity in a coordinating institution (Research Council of the Association).

Material and methods. Data obtained from 32 academic teams of the country such as department staff, post-graduate and post-doctoral students, Ph. D. and doctoral papers, publication in journals (including Scopus indexed and foreign journals), patents, scientific papers in Russia and abroad, grants, multicenter and international scientific programs).

Results. The potential was found to be high: 15 doctoral papers and 64 Ph. D. papers, over 1,200 scientific publications in Russian journals (14.4% in Scopus) and 67 full-text articles published abroad, over 1,600 scientific papers in Russia and 235 papers on foreign recognized forums. The Research Council of the Russian Association of Pediatric Surgeons has been reconstructed since 2019; initiated coordination of work within the framework of task and expert groups.

Conclusion. High potential should be used in the new strategy development: planning of scientific efforts in the country, its quality control, support of multi-center studies and cluster functioning, strengthening of fundamental science, full integration into the world scientific space.

Introduction. During treatment of intussusception, the greatest difficulties occur when the disease is combined with other disorders and malformations.

Materials and methods. Clinical observation on treatment in a child with bowel intussusception and malformation is presented. The course of the disease was rather difficult for exact diagnosis. Control of conservative disinvagination was inconclusive. During a surgery, a malrotation was detected. This affected the diagnostic and therapeutic tactics. The second component of obstruction represented by the abdominal adhesive process was also found and removed.

Results. The conducted surgery allowed to confirm the effectiveness of the given conservative treatment, detect the concurrent pathology and remove the mechanical obstruction.

Conclusion. The presented observation clearly demonstrates difficulties in exact diagnosis and control of conservative disinvaginaton when intestinal invagination is combined with congenital malrotation. As a result, the outcome of conservative disinvaginaton could be significantly controlled, commissure or the second component of invagination was removed and an exact diagnosis was made.

Objective: to present a case of successful treatment of rare severe lung lesions in a child.

Methods: the article analyzes the result of the treatment of lung histiocytosis in a child aged 4 years. The clinical manifestation of the disease began with an increase in the parotid lymph nodes, otitis, pneumonia, and rapidly progressive respiratory failure. On the roentgenogram, bulle transformation of both lungs was noted. The severity of the disease was complicated by bilateral pneumothorax, the formation of bronchopleural fistulas. Histiocytosis of the lungs from Langerhans cells (GCR) was determined morphologically when examining tissue taken at thoracoscopy. Endoscopically, the lung was without signs of inflammation, with multiple subpleural air cavities. The child underwent chemotherapy (vinblastine, prednisone), repeated drainage of the pleural cavity with recurrent intense pneumothorax. For health reasons, a longitudinal sternotomy was performed, total decortication of the costal pleura on both sides (mechanical pleurodesis), which contributed to subsequent fixation of the lung to the chest wall and prevention of recurrent total stressed pneumothorax. Twice developed limited pneumothorax was stopped by drainage and chemical pleurodesis.

Results: Against the background of ongoing complex therapy (drainage of the pleural cavity, mechanical and chemical pleurodesis, chemo- and antibacterial therapy), the condition improved (clinically and radiographically). The child was discharged on day 152 of treatment. On the control MSCT of the lungs, eight months after discharge, there are minimal signs of bullous transformation, and the symptoms of pneumosclerosis of both lungs are moderate. There are no manifestations of pulmonary hypertension.

Conclusion: verification of the diagnosis of pulmonary GLC is very difficult. The complex treatment requires the participation of a wide range of doctors, including a pediatric surgeon.

Introduction. An inguinal hernia is a serious surgical issue in premature infants as this is one of the reasons leading to increased lethality and longer treatment duration. The purpose of the study was to estimate the possibility and effectiveness of endosurgical treatment of inguinal hernias in premature infants.

Material and methods. 705 patients with inguinal hernias aged 0–3 months have been treated at the Center for Surgery of Newborns in Irkutsk during the last 15 years from January 2004 to December 2018. The gestational age of 51 infants was less than 37 weeks. All the patients underwent laparoscopic hernia repair with extracorporeal ligation. During the final stage of the study, demographic data, intra- and postoperative results were compared.

Results. The experience of treating 51 premature infants with inguinal hernias was analyzed. The children were distributed into groups as follows: 1,500–2,500 g for 35 patients, 1,000–1,500 g for 14 patients, less than 1,000 g for 2 patients. The average weight and age was 1,870 g/36.9 days for children with low body weight, 1148.3 g/48.9 days for children with very low body weight and 810 g/69 days for children with extremely low body weight. The average surgery duration ranged from 28.8 min to 35 min. According to the results of the study, increased gestational age and body weight decreases the risk of postoperative apnea from 100% to 11.8%.

Conclusion. It must be noted that minimally invasive surgeries are less traumatic and effective interventions when treating premature infants with inguinal hernias. In infants with premature hernias, a surgery is always associated with the risk of postoperative apnea and AVL dependent on the body weight and gestational age.

Purpose: to estimate the effectiveness of extracorporeal hemocorrection in treatment of refractory meningococcal septic shock in children.

Methods: patients with generalized form of meningococcal infection, multi-organ system failure and refractory septic shock admitted to the resuscitation department of Children’s Clinical Research Center for Infectious Diseases of the Federal Medical and Biological Agency of Russia underwent extracorporeal hemocorrection (polymyxin adsorption, continuous veno-venous hemofiltration, continuous veno-venous hemodiafiltration). MultiFiltrate apparatus was used (Fresenius Medical Care, Germany).

Results: application of extracorporeal hemocorrection technique in the therapy of refractory meningococcal septic shock reduced the mortality from 44.4% to 25%.

Conclusion: effectiveness of extracorporeal hemocorrection when treating patients with refractory meningococcal septic shock is established. A small number of examined patients is a limitation of the study.

Purpose: to select the surgical approach in appendicular peritonitis using the peritonitis index and laparoscopic intraoperative assessment of abdominal inflammation intensity.

Methods and materials: experience of treating 186 patients with appendicular peritonitis is presented. Retrospective analysis of medical records of 186 patients with complicated appendicitis in 2011–2014 was performed. It was accompanied by prospective analysis substantiating the criteria for laparoscopic intraoperative assessment of the intensity of abdominal inflammatory changes in 2015 to 2018.

Results. In our study, there were 98 cases (52.6%) of local peritonitis in the total structure of peritonitis (186 cases). 57 cases (30.6%) of diffuse peritonitis were observed. Among patients with acute appendicitis (1863 cases) during the examined period, local peritonitis was found in 5.2% of patients, diffuse peritonitis – in 3.05% of patients.

Conclusion: criteria assessing the intraoperative severity of peritonitis enabled to decrease the rate of laparotomy from 9.1% to 6.45%.

Purpose: to study the morphological changes of testis in patients who had cryptorchidism in childhood.

Methods. The examination results of 9 patients who underwent treatment for cryptorchidism and presented with infertility within marriage when they were 24–30 y. o. were studied. Clinical examination, ultrasound imaging of the scrotum, complete spermograms, hormonal studies, open biopsy of the testis with subsequent pathomorphological assessment of biopsy specimens were carried out.

Results: observation of 9 patients with azoospermia who had undergone a course of conservative and surgical treatment for cryptorchidism when they were 4–14 years, resulted in testicular atrophy leading to the decrease in the tissue mass of the organ and high level of FSH.

Conclusion: hormonal tests, ultrasound examinations and pathomorphological studies enable to estimate the extent of epitheliospermatogenic layer involvement.

Purpose: analysis of modern data devoted to the issue of stress-free and safe magnetic resonance imaging in children using both non-drug methods and different agents for anesthesia along with their delivery systems.

Discussion. It is difficult to complete MRI in younger children due to some reasons and possible development of stress. The technique often requires the presence of an anesthesiologist, especially if patients present with neurological pathology. The article describes how to deal with this problem to ensure safety and comfort during the procedure at the X-ray diagnostic department.

Conclusions: a broad spectrum of non-drug methods is available and successfully used today. Different types of sedation and anesthesia ensure safety and comfort of a patient who undergoes an examination at the X-ray diagnostic department.