卷 25, 编号 4 (2021)

Introduction. The aim of this study is to demonstrate the experience of non-surgical treatment of congenital and acquired chylothorax in children using povidone-iodine.

Material and methods. The study presents results of treatment of 10 patients with chylothorax who had chemical pleurodesis with povidone-iodine. The study covered a time period from 2016 to 2020. The congenital character of the disease was registered in 2 patients, the acquired one - in 8 patients. The main indication for surgery was ineffective conservative therapy, including the withdrawal of feeding and the administration of preparation Octreotide. The procedure consisted of intrapleural injection of 4% povidone-iodine solution into the pleural cavity with the calculated dose of 1 ml/kg and solution exposure for 4 hours. Results. The interpleural administration of povidone-iodine was effective in all patients. Complications of chemical pleurodesis were observed in 2 patients and were associated with pulmonary edema on the injection side. Lymph outflow was stopped on average in 4 days. There was one adverse episode which developed because of the lung malformation incompatible with life. Conclusions. Intrapleural administration of povidone-iodine is an effective treatment of chylothorax in children.

Introduction. Subglottic stenosis is one of the most common causes of upper airway obstruction. The incidence of post-intubation stenosis ranges from 0.9% to 3% (Rodríguez H. et al.), or from 0.2% to 20% (Haranal M.Y. et al.). Currently, there is no consensus on the choice of surgical tactics due to a large number of modalities for surgical restoration of the laryngeal lumen.

Material and methods. 44 patients with postintubation laryngeal stenosis were treated in the surgical thoracic department of the National Medical Research Center of Children’s Health subordinate to the Ministry of Health of the Russian Federation during 2019-2021. The average age of patients in this group was 4 years 8 months ± 3 years 8 months. Endoscopic treatment was done to 24 patients (54.5%). Laryngoscopy, fibrobronchoscopy, multispiral computed tomography and, if necessary, barium esophagogram were done for additional diagnostics.

Results. The average number of endoscopic procedures per patient was 2.9 ± 1.5 (range from 1 to 7). Good results were seen in 20 patients (83.3%).

Conclusions. Endoscopic techniques are alternative options to open reconstructive surgery. These techniques give good results in treating stenoses in the subglottic space and give a good chance to avoid tracheostomy in a certain group of patients, which, according to the results of our study, was as large as 79.1%.

Introduction. In modern literature, there are still debates on causes of the most common complications after surgeries for idiopathic scoliosis in adolescents and their risk factors. Currently, there are growing potentials to reduce the length of patients’ postoperative stay in hospitals, but it arises the need for attending physicians to know better the main types of complications of juvenile idiopathic scoliosis after surgery, their risk factors so as to predict and avoid them, to develop an individual program for patient’s management in the postoperative period, especially for patients from the risk group.

Material and methods. Literature search was done in databases Pubmed, Medline, Google Scholar, using key words, on complications of surgical correction of juvenile idiopathic scoliosis.

Results. On analyzing the obtained literature data, two large groups of postoperative complications were described in details: somatic and neurological. In addition to most common complications, some rare ones are described too which include superior mesenteric artery syndrome and distant deep infections.

Conclusion. Over the past twenty years, the incidence of postoperative complications after surgical correction of scoliotic deformities has significantly decreased. When analyzing findings of various trials, it can be concluded that the overall complication rate decreased in 2004-2007 from 5.7% (2000-2003) to 4.95% and then to 0.98% (2013-2016). Despite the general decrease in the incidence of complications, the latter still remain a problem for clinicians. The basic risk factors for such complications are: concomitant renal pathology, large volume of surgical blood loss, significant increase of exposure to anesthesia and surgical intervention, application of stainless steel constructions, anterior or combined surgical access, refusal of intraoperative neuromonitoring.

Introduction. Esophageal stenosis in childhood is quite a common disease characterized by different etiology, specific clinical picture, wide range of differential diseases and a variety of approaches to its treatment.

Material and methods. The review analyzes scientific literature presented in such search engines as Medline, PubMed, Cochrane Library, eLibrary, 20 years deep. The most significant works of the last century were included too. Keywords were used for search.

Results. There were selected 60 literary sources which included the description of modern concepts of etiopathogenesis, classification, diagnostic and curative techniques for the treatment of esophageal stenosis in children. A particular attention is paid to the safety and effectiveness of minimally invasive endoscopic interventions (bougienage, balloon dilation) as well as to the topical application of Mitomycin C in the treatment of esophageal stenosis in children.

Conclusion. Innovative endoscopic technologies applied for the restoration of the esophageal lumen seem to be promising, effective and safe. In the overwhelming majority of cases, they allow to reduce surgical aggression and avoid complex reconstructive surgeries.

Introduction. A combination of two rare congenital lung diseases - congenital cystic-adenomatous malformation of the lower lobe of the left lung and intralobar sequestration of the lung- is an extremely rare pathology in medical practice.

Material and methods. The article describes a case of successful treatment of an 8-year-old child with cystic-adenomatous transformation of the lower lobe of the left lung in combination with intralobar sequestration. A child with chronic pneumonia was prescribed CT of his chest organs with intravenous contrast enhancement. A combination of cystic adenomatous malformation with intralobar sequestration of the lung was revealed at this examination. The sequestration zone was supplied with blood via the artery from the thoracic aorta, and the wide vein went towards the opposite hemithorax and flowed into the azygos vein. The patient had a planned surgery: left-sided lateral thoracotomy, lower lobectomy with ligation of additional vessels.

Results. The early postoperative period was uneventful. Next year, there were no exacerbations of pneumonia. The child considers himself healthy. The histological report No. 31568 - 31577 confirmed type II cystic adenomatous malformation with sequestration of the lung.

Conclusion. Modern diagnostic tools allow to put a correct diagnosis at the preoperative stage. In the described case, possible intraoperative complications were avoided because surgeons knew specific blood supply in the diseased area before surgery.

Introduction. Inflammatory myofibroblastic tumor (IMT) is a rare volumetric neoplasm in the childhood which originates from the mesodermal tissue , and by the classification of soft tissue tumors refers to the tumors with intermediate biological potential.

Purpose. To present a case of rare volumetric formation in the lungs and mediastinum in children.

Material and methods. The publication presents three clinical observations of children with IMT. In all three boys (aged 6, 8 and 15), tumors were localized in the right hemithorax: lower lobe of the lung (two children), upper anterior mediastinum (one) without a reliable organ accessory.

Results. There were no specific clinical symptoms of the disease. In two children, the volumetric formation was found accidentally: in one child, a rounded tumor above the liver was found during an ultrasound examination of the abdomen; in the other one, during chest X-ray prophylactic examination. Only in one case, the lung tumor caused respiratory failure during exercise due to the complete atelectasis of the lower lobe and emphysema of the middle lobe which was caused by the growth of the tumor from the parenchyma of the lower lobe into the lumen of the lower lobe and intermediate bronchi. There were no significant shifts in clinical and biochemical blood tests. Cancer markers were negative. Surgery was indicated because of the volume formation topography which was confirmed by the multispiral computed tomography with vascular contrast and fibrobronchoscopy. Surgical volume – thoracotomy, lobtumorectomy (1 child); thoracotomy, pulmonotomy, tumorectomy (1 child); thoracoscopy, removal of the mediastinal tumor (1 child). The most technically difficult was mobilization and removal of the mediastinal tumor when it was separated from the superior vena cava and in the chest aperture where it was intimately fused with the brachiocephalic vein. The postoperative period was without complications. All children recovered.

Conclusion. IMT of the thoracic organs is not a rare case. It is not possible to reliably verify the nature of the tumor process in the preoperative period. Surgical treatment is radical and, in some cases, endovideotechnologies may be applied.