№1-2016

TACTICS OF TREATMENT OF ACUTE PANCREATITIS WITH PANCREATIC FISTULAS AND PSEUDOCYSTS IN CHILDREN
Mashkov A.Ye., Sigachev A.V, Nalivkin A.Ye., Scherbina V.I., Filyushkin Yu.N., Fedulov A.V.
Moscow Regional Science and Research Institute named after M.F. Vladimirskiy (MONIKI)

Abstract
Background: Until now no consensus has been reached on surgical approach to pancreatic pseudocysts and fistulas in children who suffered from acute pancreatitis (AP).
Objective: To present our surgical tactics used to treat children with AP complicated by external pancreatic fistulas (EPF) and pseudocysts (PPC) in the Department of Pediatric Surgery of MONIKI.
Materials and methods: Our retrospective research included 129 cases of AP in children (aged from 6 months to 17 years) who received treatment in the Department of Pediatric Surgery of MONIKI named after M.F.Vladsimirskiy from 1990 till 2014.
Research data included age, sex, symptoms, blood levels of amylase and lipase, treatment procedure, hospital stay, PPC or EPF and treatment outcomes.
Results: 80 (62%) children had mild pancreatitis, 8 (6%) – moderate and 41 (32%) suffered from severe disease. PPCs and EPFs were observed in 22 (17%) patients with destructive pancreatitis. Mean hospital stay made 31,3±15 days. 12 (9,3%) children had PPC, 7 (5,4%) patients had EPF and in 3 (2,3%) children the combination of both complications was observed. All patients with EPF received complex conservative treatment with its outcomes of total EPF repair without surgery in all cases within the period from 1 to 3–4 months. 7 children with PPC less than 5 cm in diameter and no communication between PPC and pancreatic duct received conservative treatment. In cases of PPC more than 5 cm in diameter and no communication to pancreatic duct our surgery options included percutaneous US-guided punctures. Endoscopic drainage was performed in 2
children with chronic large PPC located near head and body of pancreas and with communication to pancreatic duct.
Conclusion: In cases of AP with EPF in children we recommend active conservative treatment for 3 months since fistula manifestation. The choice of either surgery or conservative treatment is to be determined by PPC size and location, how long it persists and whether there is a communication between PPC and pancreatic duct, the effect of therapy is also to be counted.
Key words: acute pancreatitis, pseudocyst, pancreatic fistula, children.



RUPTURES OF THE CYSTS AND SPONTANEOUS PERFORATION OF THE EXTRAHEPATIC BILIARY DUCTS IN CHILDREN
Ergashev N.Sh., Yakubov E.A.
Tashkent Pediatric Medical Institute, Republic of Uzbekistan, 100140, Tashkent
Abstract
Aspects of diagnostics and surgical tactics are cited considering literature data on the ruptures of cysts and spontaneous perforation of biliary ducts and analysis of 6 proper observations. Possible reasons, peculiarities of clinical signs and results of supplementary methods of the study are analyzed. The need for proper intraoperative revision aimed at the establishment and elimination of obstruction in the distal area of the common bile duct and usage of the differentiated approach in rupture of the cyst complicated by bile peritonitis and perforation followed by a false cyst formation is underlined. Usefulness of two-stage application of T-shaped drainage with the subsequent cystectomy and Roux-en-Y hepaticojejunostomy is confirmed.

Key words: cysts of the biliary duct, complications, rupture, spontaneous perforation, diagnostics, treatment, children



DETERMINATION OF PORTAL BLOOD OPTIMAL SHUNTING VOLUME PRIOR TO THE SURGERY IN EXTRAHEPATIC PORTAL HYPERTENSION
N.A. Ranchaeva, V.A.Yurchuk
Department of pediatric surgery named after V.P.Krasovsky
State Budgetary Educational Institution of Higher Professional Education Krasnoyarsk Medical University named after professor
V.F.Voyno-Yasenetsky of the Ministry of Health of Russia Territorial Government-Owned Publicly Funded Health Care Institution Territorial Interdistrict Clinical Hospital No. 20 named after I.S.Berzon
Abstract
Purpose of the study: to determine the necessary shunt diameter and optimal shunting volume of portal blood in children with extrahepatic portal hypertension prior to portosystemic shunting.
Methods of the study: a complex ultrasound examination was carried out (B mode in real time and duplex scanning in color flow mapping mode). Changes in the liver hemodynamics before and after portosystemic shunting were examined. In 30 children the surgery was done without determination of the necessary shunt diameter. Determination of diameter, speed characteristics and blood flow in the vessels of the portal system, hepatic and splenic arteries was done in 51 patients prior to the surgery to determine the necessary shunting volume.
Material performance: 106 children aged 4 to 7 were examined. 25 of them were healthy and 81 children had extrahepatic portal hypertension.
Results: it was established that before portosystemic shunting in patients with extrahepatic portal hypertension it is necessary to determine the diameter of the shunt and volume of blood shunting needed to preserve the portal blood flow in the liver and decrease the pressure in the portal system effectively.
Conclusion: portosystemic shunting decreases the portal pressure, preserves hepatic hemodynamics and prevents esophagogastric hemorrhages in patients with extrahepatic portal hypertension with individual determination of the necessary volume of blood shunting.
Key words: extrahepatic portal hypertension, volumetric hepatic blood flow, portosystemic shunting, ultrasound examination.


COMPLICATIONS OF DIAGNOSTICS END TREATMENT OF PATIENTS WITH TOTAL AND SUBTOTAL INTESTINAL AGANGLIOSIS
Chubarova A.I., Kostomarova E.A., Mokrushina O.G., Shumikhin V.S., Cherkasova S.V., Tshapov N.F., Dmitrieva I.B.,
Selivanova E.V., Petrova L.V., Emirbekova S.K., Koshko O.V., Korchagina N.S.
Russian National Research Medical University named after N.I. Pirogov, academician V.A.Tabolin department of hospital pediatrics, Russian National Research Medical University named after N.I. Pirogov, department of pediatric surgery, Filatov Moscow Pediatric Clinical Hospital No. 13
Abstract
Total and subtotal intestinal aganglionosis (hypogangliosis) is a severe and potentially lethal condition related to neuromuscular intestinal diseases. Some authors consider it as a rare, atypical and most severe form of rectocolic aganglionosis which constitutes 1% of all cases related to the disease [6,7,8]. According to meta-analysis performed by Ruttenstock, 68 patients with total aganglionosis were found in the world literature for 2009 [8].Different surgical methods (Martin, Kimura, Zigler procedures (extended myectomy and myotomy), bringing down the ileum with formation of ileoanal anastomosis, Bianchi’s plasty and STEP-procedure, intestinal transplantation) are proposed for treatment of total intestinal aganglionosis; however, none of them were considered as superior to the others [3,6,8]. The article describes three clinical cases of total and subtotal intestinal aganglionosis in patients of the neonatal surgery department of Filatov Moscow Pediatric Clinical Hospital No. 13 in 2015-2016. According to our experience, the tactics of sparing resection with preservation of the small intestine maximum length is being optimal. However, it doesn’t exclude the need for durative parenteral nutritional support. Using domestic parenteral nutrition in the management of this group of patients is pharmaco-economically viable.
Key words: total intestinal aganglionosis, rectocolic aganglionosis, parenteral nutrition, domestic parenteral nutrition



SURGICAL TREATMENT OF ATRESIA OF THE LARGE INTESTINE
Kozlov Yu. A., Novozhilov V.A., Kovalkov K.A., Chubko D.M., Baradieva P.Zh., Us G.P., Kuznetsova N.N.
Ivan and Matryona Municipal Children’s Clinical Hospital, Irkutsk;
Irkutsk State Medical Academy of Postgraduate Education;
Irkutsk State Medical University;
Municipal Budgetary Healthcare Institution Children’s City Clinical Hospital, Kemerovo;
Territorial Children’s Hospital, Krasnoyarsk
Abstract
Introduction. The purpose of the study is to discuss treatment of atresia of the large intestine at a regional center of newborn surgery in the Russian Federation.
Material and methods. 12 patients (8 boys and 4 girls) with atresia of the large intestine were treated in our hospital in 2006-2015. Anatomical types of atresia of the large intestine were distributed as follows: type 1 (membrane) in 3 patients; type 2 (separation of segments connected with the fibrous bridle) in 3 patients; type 3 (separation of segments with the V-shaped mesentery defect) in 6 infants. The most frequently occurred congenital obstruction of the large intestine was localized in the area of the transverse colon of 7 patients. This was followed by patients with atresia at the descending (3 patients) and ascending section (2 patients) of the large intestine in decreasing order of frequency of occurrence. Authors of the article reported of 2 technologies of surgical therapy of atresia of the large intestine i.e. direct end-to-end
anastomosis in 10 patients and end-to-side anastomosis with the formation of the external Bishop-Koop colostoma (group 3) in 2 patients.
Results. The mean age of patients during the surgery amounted to 2 days - 2 ± 0.28 days (range of 1-4 days). Gestational age of patients was 38 weeks - 38.2± 0.28 weeks (range of 34-40 weeks). Weight of patients at the surgery was 3054±258 g (range of 1200-4800 g). Average time of surgeries amounted to 55 ± 6 minutes (range of 50-60 min). The surgeries weren’t accompanied by blood loss. Duration of the patients’ stay at the surgical hospital was 16 days in average (range of 8-28 days). No complications related to the surgery were registered in the early postoperative period. Remote (1 month- 1 year) observation revealed no negative consequences of the surgery. The second stage of surgery following Bishop-Koop operations and intended
for the closure of the external intestinal stoma was performed not earlier than in a month after the 1st surgery.
Conclusion. Methods of treatment of atresia of the large intestine remain controversial but anastomosis of any type is one of the best variants of the state correction.
Key words: newborns, atresia of the large intestine, intestinal anastomosis



ACUTE DESTRUCTIVE PYELONEPHRITIS IN CHILDREN – THERAPEUTIC TACTICS CONTROLLED BY HIGH-RESOLUTION ECHOGRAPHY
Runenko V.I., Bykovsky V.A., Sokolov Yu.Yu.
Abstract
Echographic semiotics of acute pyelonephritis is presented in children whose stages of inflammatory process development are characterized according to the stages of pathomorphogenesis of the disease. Stages of destructive changes in the kidney accompany the data on dissemination of the process and regenerative organ resource resulting in timely determination of patient management and choosing among conservative or organ-preserving tactics. Implementation of the presented technologies led to the reduction of the total volume of radical surgeries with kidney revision in destructive forms of pyelonephritis by
72%.
Key words: acute pyelonephritis, destructive pyelonephritis, treatment, surgery, regenerative resource of the kidney, urosepsis, ultrasound diagnostics, echography, kidneys, children



EFFECTIVENESS OF VACUUM THERAPY IN THE STIMULATHIONS OF WOUND RETRACTION
Budkevich L., Dolotova D.D., Zaitseva T.V., Rosinov V.M., Shilkin I.P.
State Budgetary Educational Institution of Higher Professional Education Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of Russia G.N. Speransky Municipal Children’s Clinical Hospital No 9, Department of Health, MoscowFederal State Budgetary Institution (Protection) All-Russian Center for Emergency Medicine of the Ministry of Health of Russia
Abstract
The results of the study examining the effectiveness of negative pressure wound therapy in children with the wounds of soft tissues. 50 patients with wounds of different etiology were examined. In a half of clinical studies vacuum therapy was implemented whereas other patients used modern wound dressings (comparison group). The influence of negative pressure on the process of wound retraction was estimated based on the results of computer photoplanimetric studies. It is shown that vacuum therapy forms favorable conditions for the retraction of wound defects significantly exceeding the corresponding indicators of wound area reduction in patients from the group of comparison.
Key words: children, burns, vacuum therapy.


OPTIMIZATION OF SURGICAL CORRECTION OF ESOPHAGEAL ATRESIA IN NEWBORNS
Erhashev B.B., Eshkabilov Sh. D.
Republican Educational Therapeutic and Methodological Center of Neonatal Surgery at the Republican Perinatal Center, Tashkent, Uzbekistan
Department of Hospital Pediatric Surgery and Oncology of the Pediatric Medical Institute in Tashkent
Abstract
The study aims at the improvement of surgical treatment results of esophageal atresia in newborns by improving the technique of esophageal anastomosis.
Materials and methods: the results of surgical correction of esophageal atresia (EA) were comparatively analyzed in 116 newborns staying at the department of neonatal surgery of the Republican perinatal center. Simultaneously, correction of such accompanying abnormities in 10 cases was performed. These were 6 cases of sigmoidostomy, 2 cases of correction of duodenal ileus, 1 case of proctoperineoplasty, and 1 case of patent arterial duct (PAD) dressing.
Depending on a method of surgery the patients were divided into two groups: 1st (basic) group comprised 51 patients with EA who underwent surgery using a new technique, 2nd (control) group consisted of 65 patients who had a usual surgery.
Results: among the patients from the basic group who underwent surgery using a modern technique anastomotic leakage was observed in 4 children only (8%) which is almost three times less than when the anastomosis was applied traditionally. For the control group (n=65), the anastomotic leakage was noted in 15 patients (23%) in the early preoperative period. 6 (40%) patients had severe purulent and septic complications which was one of the leading reasons for postoperative lethality.
Conclusion: thus, based on the results of our observations we can make a conclusion that usage of the modern surgery technique considerably decreases the risk of postoperative leakage improving the results of sophageal atresia surgery.
Key words: esophageal atresia, anastomotic leakage, treatment, children



LAPAROSCOPIC TREATMENT IN GIRLS WITH ADNEXAL TORSION
Korovin S.A., Dzyadchik A.V., Galkina Ya. A., Sokolov Yu.Yu.
Russian Medical Academy of Postgraduate Education
Z.A.Bashlyaeva Children’s Municipal Clinical Hospital, Moscow
Abstract
The article sums up the experience of using laparoscopic treatment in 57 girls with adnexal torsion aged 1 month-18 years treated at Z.A.Bashlyaeva Children’s Municipal Clinical Hospital from 2005 to 2015. The patients were hospitalized within 2-240 hours from the onset of the disease. Ultrasound examination of the abdomen (57) was performed in all patients on admittance. X-ray examination and abdominal CT (2) were performed when teratomatous ovarian elements were suspected.
Laparoscopic interventions were effective in all patients. Laparoscopic detorsion of the uterine adnexa were accompanied with puncture, aspiration of retention cysts (21), removal of parovarian cysts (12), and resection of teratomatous elements.
Salpingo-oophorectomy was done in necrosis of the uterine adnexa. No complications were found during surgeries and in the postoperative period. Based on the results of histological studies, all removed cystic new formations were benign.
Key words: laparoscopy, adnexal torsions, girls



REHABILITATION TREATMENT OF CHILDREN SUFFERING FROM MALIGNANT SOLID TUMORS IN THE EARLY POSTOPERATIVE PERIOD
Katyzhenkov А. А., Bukreeva Е. А., Petrichenko А. В., Savlaev К. F., Ivanova N.М., Sharoev Т. А.
State Budgetary Educational Institution Research and Practical Center of Specialized Medical Pediatric Aid named after V.F.
Voyno-Yasenetsky of the Health Department of Moscow
Abstract
The issue of development of rehabilitation treatment programs for children who underwent surgeries due to malignant tumors is becoming more pressing because of the increased amount and quality of high-tech operations, organ preservation treatment including usage of different implants and complex innovation equipment. It resulted in the reduction of intervals between the stages of local tumor control and adjuvant treatment. Individual rehabilitation programs were compiled for every patient.
Rehabilitation activities must enable timely onset of polychemotherapy (PCT), reduction of intervals between the stages of local tumor control and adjuvant treatment.
Rehabilitation activities must be as early and active as possible. Timely provided rehabilitation therapy in the complex treatment of children suffering from solid malignant tumors enables to increase both oncological and orthopedic result significantly. Adequate multimodal rehabilitation treatment conducted in the early postoperative period enables correction of consequences of special treatment at early stages significantly decreasing disability of children and increasing their social adaptation and quality of life.
Key words: pediatric oncology, postoperative treatment, rehabilitation, programmed therapy


RECONSTRUCHION OF FACIAL DEFECTS WITH FULL-THICKNESS SKIN AUTOGRAFTS IN CHILDREN
Bogdanov S.B., Babichev R.G.
State Budgetary Health Institution ‘Research Institute – S.V.Ochapovsky Regional Clinical Hospital No1’ of the Ministry of
Health of the Krasnodar Territory
Abstract
The article shows the urgency of improvement of deep facial burns surgery in children. The developed method of facial defects reconstruction with a single-piece full-thickness skin autograft allows achieving a positive functional and cosmetic result in the postoperative period. This reconstruction technique improves the quality of life of the injured.
Key words: children, burns, face, full-thickness skin autograft, treatment


MENINGOCOCCAL INFECTION IN THE EARLY POSTOPERATIVE PERIOD AFTER SPLEEN SAVING SURGERY FOR TRAUMA

Morozov D. A., Klyuev S. A., Tatochenko V. K. , Bakradze M. D.
Sechenov First Moscow State Medical University, Moscow, Russian Federation
Federal State Autonomous Institution "Scientific Center of Children's Health"
Of the Ministry of Health of the Russian Federation, Moscow
Correspondence to: Sergey Klyuev, pediatric surgeon, sergey1klyuev@yandex.ru

Abstract
A clinical case of meningococcal meningoencephalitis in late postoperative period after laparoscopic omentosplenopexy for spleen injury. The Neisseria meningitidis on a par with the Haemophilus influenzae and the Streptococcus pneumonia are most common causative agents of overwhelming postsplenectomy infection. This clinical case demonstrates that immunodeficiency accompanies spleen regeneration after severe injury. The value of preventive measures during the regeneration of spleen requires further study and detalization.

Key words: splenic trauma, overwhelming postsplenectomy infection, regeneration of spleen, meningococcal infection.



CLINICAL CASE: RARE CONGENITAL ABNORMALITY OF THE TESTICLES – POLYORCHISM IN CHILDREN
Abekenov B.D., Sakenov B.T., Tursbekov Ch.A., Sagymbaeva А.А.
Research Center of Pediatrics and Pediatric Surgery, department of urology, Almaty, Kazakhstan
Abstract
The article considers the clinical case of treatment of a patient aged 8 with moderate stage of polyorchism at the onset of the disease. The patient underwent surgical treatment. The observation period lasted 24 days.
Key words: polyorchism, testicle, spermatic cord, clinical case.


ETIOLOGY AND PATHOPHYSIOLOGY OF CHRONIC INTESTINAL SYNDROME OF PSEUDO-OBSTRUCTION IN CHILDREN
(PART II: primary and secondary chronic syndrome of pseudo-obstruction in children and adults)
Averyanova Yu.V., Razumovsky A.Yu., Stepanov A.E.
Russian Pediatric Clinical Hospital of the Ministry of Health of the Russian Federation
Department of Pediatric Surgery at the State Budgetary Educational Institution of Higher Professional Education Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of the RF
Abstract
Chronic intestinal syndrome of pseudo-obstruction is a rare syndrome manifested through recurrent phenomena of bowel obstruction developed against neuropathies, myopathies and neuromyopathies of congenital or acquired genesis. The article deals with the peculiarities of ethiopathogenesis of different forms of the disease including de nova mutations revealed within the last decades. The article is interesting both for surgeons who must diagnose intestinal pseudo-obstruction in a timely manner to avoid unnecessary surgeries and for other doctors who can come across the syndrome during their practice.
Key words: chronic intestinal syndrome of pseudo-obstruction, children


RECOMMENDATHIONS FOR TREATMENT OF CHILDREN WITH CRANIOCEREBRAL TRAUMA
Semyonova Zh. B., Melnikov A.V., Savvina I.A., Lekmanov A.U.,
Khachatryan V.A., Gorelyshev S.K.
Research Institute of Emergency Pediatric Surgery and Traumatology of the Department of Health of Moscow
A.L. Polenov Russian Scientific Research Institute of Neurosurgery of the Federal North-West Medical Research Centre of the Ministry of Health of the RF Research Institute of Pediatric Surgery of the State Budgetary Educational Institution of Higher Professional Education Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of the RF N.N.Burdenko Research Institute of Neurosurgery of the Ministry of Health of the RF
Abstract
Clinical recommendations related to treatment of children with the craniocerebral injury at prehospital and hospital stages are presented. The possibilities of monitoring, intensive treatment and surgical treatment are determined. The recommendations are given as standards, options and recommendations.
Key words: children, craniocerebral injury, monitoring, intensive treatment