卷 23, 编号 6 (2019)

Introduction. 30-60% of all patients with congenital hyperinsulinism have a delayed psychomotor development, and 15-25% of them have severe organic brain damage, including epilepsy. Timely diagnostics and intensive treatment can prevent severe neurological complications. With the ineffectiveness of conservative therapy, surgical treatment is a necessary alternative. Objective. To define indications for various options of surgical correction of focal forms of congenital hyperinsulinism. Material and Methods. In the Department of Pediatric Surgery of V.A. Almazova National Medical Research Centre, in 2017-03.2019, 14 children with focal forms of congenital hyperinsulinism were operated after analyzing their PET-CT findings; in 2 patients out of them they were doubtful. Results. 13 (93%) patients had a complete relief of hyperinsulinism and a significant improvement in their psycho-motor development. 10 (71%) of 14 children had a complete recovery; 1 (7%) - a significant positive trend. 3 (21%) patients needed insulin therapy with minimal dosages. They all were children with an atypical (mixed adenomatous-diffuse) form of hyperinsulinism. Conclusions. In case of focal lesions in the pancreas, partial pancreatectomy with maximal preservation of healthy tissue, defined by the express biopsy, and with any lesion localization is indicated. For atypical forms, the volume for pancreatectomy dissection is defined individually.

Introduction. Current trends in the diagnostics of acute appendicitis have the following main objectives: to improve the diagnostic accuracy in destructive forms; to reduce the number of negative appendectomies and diagnostic laparoscopies. Purpose. To compare the effectiveness of Alvarado and PAS scales and to find out which of them is more appropriate in the differential diagnostics of acute abdominal pain in children. Material and Methods. A prospective randomized blind clinical trial was performed. 326 children aged 5-17 years with abdominal pain were examined. Results. No significant advantages of any of the analyzed scales were found in the differential diagnostics of acute abdominal pain in children aged 5-17 years. Both scales can be used in the primary stratification of patients. With the conclusion “Acute appendicitis is likely possible,” the level of non-diagnosed cases of acute appendicitis will not exceed 3%. Conclusions. Further assessment of various scales for the diagnostics of acute appendicitis in children has to be done in order to select the optimal one. The obtained results urge to make scales’ modification so as to improve the diagnostic accuracy and to reduce the number of negative appendectomies and diagnostic laparoscopies.

Treatment of patients with severe traumatic brain injury is very expensive. The main problem of medical care with its adaptation to neurological outcomes is the choice of diagnostic techniques as predictive tools that reliably predict long-term neurological and psychological outcomes. The extended range of magnetic resonance techniques, including SWI, diffusion-weighted and diffusion-tensor images (DWI / DTI), magnetic resonance spectroscopy (MRS) and functional magnetic resonance imaging allows to identify not only anatomical, but also functional brain damage. In the review, the authors discuss the latest information on visual and quantitative assessment of abnormalities in patient with TBI; new understanding and clinical significance of various MRI methods are shown as well. The authors define new biomarkers and their potential for predicting TBI outcomes. Several combined modalities not only provide better understanding of major physiological changes in patients with TBI, but they also improve diagnostic accuracy in outcome predicting. The present review is a summary of some important researches published recently.

Introduction. A complete laparoscopic intestinal anastomosis remains a challenge for pediatric surgeons. The aim of the study is to demonstrate its effectiveness in patients with small bowel atresia. Material and methods. This article describes laparoscopic surgery in a patient with small bowel atresia of type I. During laparoscopy, stitches were placed on the blind end of the atresia segment of the intestine to stabilize the movable intestinal segment; the stitches were passed transdermally to the outside. The design of the laparoscopic anastomosis did not differ from that of the open technique proposed by Jannie Louw. At the final stage of the trial, the researchers assessed immediate and long-term results after this new surgical intervention. Results. Laparoscopic intervention for small bowel atresia of type I was performed on the second day of life. The surgery lasted for 75 minutes. No complications were registered during it. The enteral nutrition was started after the decrease in the rate of losses in the gastric tube lower than 10 ml / kg / day. It was on day 3 after the surgery. A gradual increase in the volume of feeding promoted patient’s transfer to the full enteral nutrition on day 7 after the surgery. Next day, the baby was discharged from the hospital. Early follow-up revealed no any signs of anastomosis failure. One-year follow-up revealed no signs of impaired intestinal transit too. Conclusion. It seems that the care of small bowel atresia has taken a significant step forward. Anastomoses constructed laparoscopically in such patients are not only a possible option, they have demonstrated their effectiveness and safety as well.

Purpose. To evaluate outcomes in care of children with intestinal intussusception and to analyze the cause of recurrences of the disease. Material and methods. 196 children with intestinal intussusception were taken into the study. In 2009-2019, they all had standard examination, including ultrasound, radiography, laparoscopy and histological examination of the removed tissues. Results and discussions. 32 patients out of 196 children had a disease relapse. It developed after conservative desinvagination. These relapses developed: in 8 children because of the sagging of ileum mucosa into the cecum; in 4 patients- Mechelen diverticulum; in 6 - tumors of the ileocecal angle; in 8 children - hyperplasia of the lymph nodes of the mesentery. In 6 children the cause of intussusception recurrence was not defined. Conservative and laparoscopic desinvagination was not successful in any of cases with returned intussusception. Conclusion. 1) In most cases, intussusception recurrence in children was caused by mechanical factors: sagging of the ileum mucous into the cecum, Mechelen diverticulum, tumors of the ileocecal angle. 2) In case of intussusception recurrence, diagnostic laparotomy and revision of the abdominal cavity are recommended.

Introduction. Tracheal and bronchial injuries in children are not at the last place in the trauma incidence structure . It is an urgent issue for both adult and pediatric surgeons. Purpose. To show ways for obtaining good outcomes in patients with trachea and bronchi rupture. Material and methods. The researchers analyzed outcomes of surgical treatment of 19 patients with trachea and bronchi ruptures. The patients had surgeries at various intervals after the injury: from few hours to 10 days. X-ray and tracheobronchoscopy examinations were made. On the first day after the injury, a radical surgery was performed to restore the airway patency. Late surgical interventions ended with pulmonectomy or lobectomy. At the final stage of the trial, early and long-term results were analyzed. Results. The radical surgical treatment consisting of thoracotomy and complete restoration of anatomical integrity and airway patency had 16 children of various age on the first day after their injury . Surgery lasted for 85 ± 15 min. There were no any complications during the surgery. At the early period of observation after the surgery, a ventilation failure of degree I was seen in 3 patients. Two years later, compensated stenosis of the bronchus without signs of ventilation failure was seen in one child. Three children were operated on in 10 days after their injury. Organ-sparing surgeries were performed in them (lobectomy and pulmonectomy). These surgeries lasted for 130 ± 15 min. At the early postoperative period, all three patients had ventilation failure of degree II. In 2 years, two children developed a persistent deformation of the chest, two children were disabled. Conclusion. A successful treatment of children with lower airways injury may be expected if the radical assistance is provided by a thoracic surgeon and shortly after the injury.