Vol 13, No 1 (2024): Материалы XVII Всероссийского форума с международным участием «Инновационные технологии в хирургии»

The paper presents own observations and 5 cases of non-parasitic cysts of the spleen. The own tactics of examination and surgical treatment are developed. Objective. To analyze the diagnostic results of laparascopic resection of splenic cysts. Research Methods. This article presents 5 clinical cases on diagnostics and treatment of patients with spleen cysts. The laparoscopic method was used in surgical treatment. When choosing it, a number of profile medical literature was studied and analyzed. 5 patients diagnosed with spleen cysts were treated at the Grodno University Hospital. Of them there were 4 women and 1 man. Results and discussion. As a result of successfully performed surgical treatment the patients managed to save such an important organ as the spleen for maintaining the homeostasis of the organism. Postoperative complications were also avoided.

Conclusion. The therapeutic tactics for nonparasitic cysts of the spleen today implies surgical intervention in the presence of pain or compression of adjacent organs. The size of cysts is not a determining factor for the choice of treatment tactics. The results of the performed operations were positive, no complications were observed. The postoperative period in all patients was smooth. All patients were discharged with satisfactory condition.

Liver echinococcosis is a parasitic disease that requires surgical treatment. At this stage of development of surgery, minimally invasive technologies for performing liver resections are widely used. The goal of this study is to analyze and compare the results of open and laparoscopic operations for echinococcosis of the left lobe of the liver. Materials and methods. The study was conducted within the University Clinic of Grodno among patients from the Department of Surgical Pancreatology, Hepatology and Organ and Tissue Transplantation. Using the method of directed selection, two groups of patients were formed: the first group of three people who underwent open hemihepatectomy and the second group also of three patients who underwent laparoscopic left-sided sectionectomy. The research material was the primary medical documentation of the hospital. Results. The average duration of the operation, the average amount of intraoperative blood loss and bed days in both observation groups were determined. No complications were identified during the operation or in the early postoperative period. Conclusions. The duration of the operation and intraoperative blood loss during laparoscopic and open interventions on the left lobe of the liver do not differ significantly. Minimally invasive surgical techniques promote early activation of patients, which significantly reduces their hospital stay.

Introduction. The hand is involved in all kinds of human activities, so it is most often subjected to injuries of various types. Despite the new methods of treatment, the problem of combating purulent-inflammatory diseases of the hand in children remains at a high level. 

Objective. To evaluate the development of complications after surgical treatment of purulent-inflammatory diseases of the hand.
Materials and methods. The study was conducted on the basis of  BOOZ VO ODKB 2 in Voronezh in the purulent-septic department. A retrospective analysis of 156 case histories of patients treated in the clinic from 2005 to 2023 was carried out. The age of the patients at the moment of treatment was from 1 to 17 years, 33 patients were treated with the diagnosis of phlegmon, 123 patients were treated with the diagnosis of panaricium. The development of complications after surgical treatment of pustular diseases was assessed by collecting anamnestic data from the parents of the patients.

Results. The results of the study showed that the majority of patients with the diagnosis of panaricitis had no motor disorders of the operated hand, the scar did not cause psychological and physical discomfort in the patients - 80.5%. Motor disorders were detected in 9% of patients diagnosed with phlegmon, in 54.7% - the scar causes physical and psychological discomfort, no disorders of the hand function were detected.

Conclusions. The frequency of purulent-inflammatory diseases of the hand and fingers today remains high, in this connection the treatment tactics requires annual revision and introduction of new methods and technologies.

To date, the incidence of injuries, neoplasms and parasitic liver diseases continues to grow, but resection remains one of the main methods of surgical treatment for its pathology. Liver resection, even with the use of modern technologies, remains a highly traumatic operation, leading to disruption of metabolic, hemostatic, detoxification and other functions, leading to the development of complications in 4.1–47.7%, fatal outcomes in 0.24–9.7% of cases.
Goal. To study modern surgical approaches to liver resection.
Materials and methods. The data presented in PubMed, Elibrary and Cyberleninka are reviewed. The search was conducted using the keywords "liver resection", "liver". Criteria for exclusion from the analysis: description of individual clinical cases; books and documents; comparison of treatment results of individual patients.
Results. To date, atypical and anatomical liver resections are performed, i.e. taking into account the internal structure of the organ. The choice of surgery technique is also important. In addition to open methods, there are minimally invasive techniques, which include laparoscopic and robot-assisted resections. It is proposed to divide minimally invasive liver resections into three main options with different technical features – laparoscopic resection using laparoscopic ports, hand-assisted surgery, and hybrid surgery.
Conclusion. Liver resection, even with the use of modern technologies, remains a highly traumatic operation, which is why the choice of surgical intervention technique is a key point in the treatment of patients with liver pathology requiring surgical treatment.

The limited applicability of contemporary techniques for evaluating the microvasculature stems from the requirement for intrusive research and inadequate outcome reliability. Only mucosal membranes or exposed organ regions can be treated intraoperatively with these techniques. Promising is the suggested non-contact technique for measuring the microvasculature, which is based on evaluating the local myogenic response of venules and arterioles to a cold substance. Aim of the study. Assessing the microvasculature and investigating local reserves of temperature regulation of microcirculatory in volunteers aged 20-45, stratified by gender, age, ethnicity, and existence of negative habits, using a non-contact sensor. Materials and methods. Microcirculation was assessed with a non-contact sensor at a distance of 3-5 cm from the skin on the foot, lower leg and the back of the brush. The technique consisted of continuously alternately assessing the base temperature, the temperature at the moment of supply of the refrigerant (within 30 seconds) and monitoring the rate of recovery of the base temperature. The duration of the technique (no more than 1 minute per measurement), is universal for any part of the body and is safe, because the device does not require invasive monitoring. Results. With normal blood supply, temperature recovery occurred within 2 minutes. Such data were obtained from people who did not have vascular pathology or smoke burden. A slower reaction was observed in smokers. In patients in the traumatology department, after undergoing spinal anesthesia, the line was fluctuating, and recovery of the microvasculature took longer (3 or more minutes). Conclusions. The technique of non-contact monitoring of the microvasculature response is a promising method for assessing ischemia during emergency surgery, determining the boundaries of resection of an ischemic organ, addressing the issue of tissue viability, and identifying the type of tissue based on blood supply levels in the context of cancer vigilance.

Relevance. An intracerebral hematoma is a limited space localized in the substance of the brain and filled with liquid blood, cerebral detritus or blood clots. This type of hematoma is very rare and most often the main causes are hypertension, aneurysms or arteriovenous malformations. The purpose of the work. Description of a clinical case of intracerebral hematoma and subarachnoid hemorrhage resulting from an arterial aneurysm and an anomaly in the structure of the anterior cerebral artery, which increases doctors' awareness of this disease and helps to diagnose it in a timely manner, as well as fully prescribe the necessary treatment or perform surgery. Materials and methods. As the research material, a clinical case is presented, which was studied on the basis of medical documentation of the neurosurgical department of the VOKB No. 1. The research method used in this work is descriptive. The results and their discussion. A 59-year-old man was admitted to the neurosurgery department complaining of acute headaches and nausea. The patient's consciousness is moderately stunned, as well as the patient was adynamic upon admission and, therefore, speech contact is somewhat limited. During CT scan, intracerebral hemorrhage in the frontal lobe on the right was verified, and a subarachnoid hemorrhage of unknown origin was also detected. The necessary laboratory tests and preparation of the patient for surgery were also carried out. Against the background of medical and surgical treatment, the patient's condition improved. Conclusion. Due to the fact that this pathology occurs in neurosurgical practice, the analysis of clinical cases demonstrates the importance of the doctor's knowledge and allows for a full examination and surgical intervention to eliminate the threat to the patient's life.

Tricuspid valve atresia (ТVA) is a congenital defect characterized by a lack of communication between the right atrium and the right ventricle. The prevalence of the defect ranges from 1.6 - 3% of all CHD and ranks third among the defects of the blue type. In the case of ductus-dependent pulmonary blood flow, the tactic of applying a systemic pulmonary shunt or stenting an open arterial duct (OAD) is adopted. Goal. To give a comparative assessment of the immediate and long-term results of surgical treatment of ATC in children on the basis of the VOKB No. 1 medical school. Materials and methods. From 2014 to 2016, 4 children with TVA underwent surgical treatment in the Department of Cardiac Surgery №1 of the VOKB №1 Medical Center. Surgical treatment consisted of OAD stenting. Results. The assessment of the immediate and long-term results of the stages of surgical treatment was carried out. The effectiveness and safety of this method of correction of congenital malformation as an alternative to the modified Blackock–Taussig shunt is substantiated. Conclusions. OAD stenting, as a stage of surgical correction in newborns with TVA, is an effective method of surgical treatment.

Currently, diseases of the cardiovascular system are recognized as the main cause of death in the world. One of the reasons for the development of pathologies in the cardiovascular system is the processes of atherogenesis and the formation of atherosclerotic plaques. Regardless of the level of development of modern diagnostic methods, primary diagnostics is of great importance, which, in addition to the usual collection of anamnesis, physical examination, and necessary laboratory and instrumental studies, includes specific functional tests. Goal. To determine the effectiveness of functional tests for obliterating atherosclerosis of the arteries of the lower extremities in the conditions of initial examination of the patient. Materials and methods. To identify the trigger factors for the development of atherosclerosis and determine the effectiveness of functional tests for obliterating atherosclerosis of the lower extremities, an initial examination was performed taking into account the above methods. 100 people participated in the study. Of which 58% are women, 42% are men. Results. Based on individual risk factors for the occurrence of obliterating atherosclerosis of the arteries of the lower extremities, it is possible to assume the risk of the occurrence or progression of atherosclerosis without complex laboratory studies. Conclusion. The use of only functional tests for the early diagnosis of atherosclerosis of the arteries is not suitable, since the samples are positive only in people with terminal stages of the disease.

The relevance of this pathology is determined by the frequency of the disease, the young age of the patient, and the results of treatment that do not satisfy the doctors of coloproctology today. With the use of mass medical examination, 3% of the examinees have shown signs of a pilonidal sinus being present. This particular pathology represents 1-2% of all the surgeries that are currently being performed, while also yielding to the 12% of all the coloproctology surgeries being administered. The aim of the study. To develop new methods of surgical treatment of coccygeal pilonidal sinus, allowing to significantly improve the immediate and long-term outcomes of diseases. Materials and methods. Were examined and operated on 230 patients with coccygeal pilonidal sinus. The control group included 102 patients. The main group consisted of 128 patients, who took a differentiated approach to the choice of operation method. Results. In the control group 19 (18.6%) complications were observed: wound suppuration in 8 (7.8%), development of inflammatory infiltrate in the wound in 5 (4.9%), marginal necrosis of the skin in the area of the wound edges in 6 (5.9%) operated patients with subsequent edge detachment in 3 patients. In the main group complications were noted in 6 (4,7%) patients: wound suppuration in 2 (1,6%), development of inflammatory infiltrate in the wound in 4 (3,1%). The long-term results were traced within the period from 1 to 8 years. Recurrence of the disease occurred in 11 (10.8%) patients in the control group. There were no recurrences in the main group. Conclusion: our proposed method of surgical treatment of coccygeal pilonidal sinus, taking into account the intensity and prevalence of the inflammatory process, topographic-anatomic structure of the gluteal-sacrococcygeal region, using intradermal sutures allowed to improve the immediate and long-term outcomes of the disease.