卷 25, 编号 5 (2021)

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Introduction. The basic technique for treating patients with liver neoplasms is a surgical one. Currently, there is a trend to decrease a traumatic impact. One of the options for this is to develop and to implement minimally invasive surgical techniques which make postoperative period and rehabilitation easier.

Purpose. To find out the most optimal tactics for surgical treatment of children with liver tumors.

Material and methods. In 2014-2020, 26 patients, aged 0-17 years, with liver tumors were treated in Morozov Children’s City Clinical Hospital. 16 boys (61.5%) and 10 girls (38.5%). 17 patients with hepatoblastomas (68%); 2 (8%) in twos - hepatocellular cancer, embryonic liver sarcomas and focal nodular hyperplasias; 1 (4%) by ones - adenoma and hamartomas. In the morphological picture, hepatoplastoma was the most common (16 patients). 25 liver resections were performed; in 5 out of them (20%) (patients aged 3-9 years) minimally invasive technologies were used.

Results. Surgical time was significantly shorter in patients who were operated on with laparoscopic access (30–60 minutes), if to compare with laparotomic access (180-270 minutes). The volume of intraoperative blood loss in laparotomic access is more than 5 times larger than in laparoscopic access. In the group of patients operated on with the open access, intraoperative complications were noted in 2 (8%) cases: lethal outcome (4%) and injury of the extrahepatic biliary tract (4%).

Conclusion. Laparoscopic techniques reduce surgical time and blood loss. They also prevent complications both during surgery and in the postoperative period, shorten the hospital stay and promote early patient’s mobilization and early enteral feedings as well as early chemotherapy; they reduce pharmpreparation loading and prepare conditions for radical surgery

Introduction. Funnel-shaped deformity of the chest (CFD) is the most common anomaly, which accounts for about 90% of all congenital malformations of the chest. At the same time, complaints about the cosmetic defect of postoperative scars are characteristic of children of all age groups, but at the age of over 14 years they become prevalent, causing psychological discomfort in patients.

Purpose. To assess a psychological reaction of children with the CFD at postoperative scars after surgical correction of their deformity with an open approach and with the minimally invasive technique by Nuss.

Material and methods. A questionnaire survey was conducted in two groups (Group 1, n = 29; Group 2, n = 108) of children with CFD and their parents so as to assess cosmetic results of postoperative scars after open surgery and after the minimally invasive technique by Nuss. The enrolled patients were treated in the department of thoracic surgery in Filatov City Children’s Hospital No 13 (Moscow).

Results. It was found out that patients with CFD, who were operated on with an open access (55%), would like to have a smaller scar; 13% of them told about a feeling of complexion when communicating with peers; 7% assumed that they would expect difficulties in choosing a profession because of an ugly scar. Children from Group 2, operated on by the minimally invasive Nuss technique, had the following results: 100 (92.59%) respondents would also like to have a “better scar” on the skin surface – they meant barely noticeable scars and their smaller number. 8 (7.41%) patients would like to have an additional surgical correction of their scars because of problems with peer communication. None of the respondents from this group was preoccupied with possible difficulties in profession selection because their scars were not as rough as in patients from Group 1.

Conclusion. The minimally invasive Nuss technique for surgical treatment of CFD caused much less negative reactions in operated children due to barely noticeable scars on their chest.

Introduction. Cloacal abnormalities are rare congenital malformations having the most severe and complex forms of anorectal and urogenital malformations. Patients - always females who are born with the persistent cloaca - at the stage of embryogenesis had a merging of lower urethra, vagina and rectum into a single canal or cavity which is opened posterior to the clitoris. The persistent cloaca remains a challenging reconstructive problem for pediatric gynecologists, urologists and surgeons. Doctors must have skills in surgical urology, proctology and in all types of plastic surgery on the vagina and cervix.

Material and methods. Data searches were conducted in PubMed and Google Scholar. The following keywords were used: “Cloacal abnormalities” and “Persistent cloaca”.

Conclusion. Regardless of a technique, goals for cloaca management remain the same. The primary surgical procedure is aimed to restore normal anatomical positioning of pelvic organs and to form the urethra, vagina and rectum as well as to achieve control over bowel function, urination and reproductive potential of the patient. A surgical correction of persistent cloaca should be performed in specialized medical institutions by specialists having experience in treating children with anorectal anomalies.

Introduction. The pelvic congestion syndrome accounts for up to 4% of all causes of chronic pelvic pain in adolescent girls and infrequently may be associated with the obstruction of venous outflow due to compression of the left renal vein resulting in venous hypertension.

Case report. A clinical case of surgical treatment of a 15-year-old female patient with the pelvic congestion syndrome and nutcracker syndrome is described. The diagnosis was confirmed by MRI, phlebography with phlebotonometry of the left renal vein and pelvic ultrasound with Valsalva maneuver performed with an empty bladder. Disease symptoms were manifested by chronic pelvic pain and dysmenorrhea. The authors made a gonadoileal bypass with the formation of an end-to-side anastomosis to achieve the most physiological discharge of blood through the gonadal vein and to exclude the formation of stenosis in the anastomosis.

Results. 3 months after the surgical treatment, the created gonadoileal bypass functioned well with 30 cm/s blood flow velocity without signs of stenosis and reflux in the ovarian vein.

Conclusion. The end-to-side gonadoileal anastomosis is a reasonable curative option in children with the pelvic congestion syndrome and nutcracker syndrome as it has been demonstrated with satisfactory results of shunt functioning at the early and late postoperative periods and an adequate decrease of renal venous hypertension. A multidisciplinary approach is important in the management of pediatric and adolescent patients with chronic pelvic pain and pelvic congestion syndrome for early detection of pathology and its surgical treatment to exclude progression of the disease in adulthood.

Introduction. The antireflux reimplantation of the ureter may be performed using different surgical approaches with the known techniques. Despite the high efficiency of these surgical interventions, there are cases of reflux relapses even after several surgical interventions on the ureterovesical junction (UVJ). The range of ways for laparoscopic reconstruction of the upper urinary tract is increasingly expanding what allows toperform a successful correction of the defect even in technically difficult positions. The main purpose of the present clinical demonstration is to illustrate a successful application of laparoscopic access in the correction of recurrent forms of vesicoureteral reflux (VUR).

Material and methods. The authors present a clinical case and management of a patient with Grade 4 VUR on the right (classification by P.E. Heikel et K.V. Parkkulainen, 1966). Previously, a 12-year-old boy had four surgical interventions, both open traditional correction and endovesical implantations of volume-forming drugs. The reflux persisted and was accompanied with constant recurrences of pyelonephritis and progressive deterioration of the kidney function on the right.

Results. Despite technical difficulties associated with cicatricial changes in UVJ, an antireflux surgery with laparoscopic access was performed. The follow-up control within one year revealed no recurrences of urinary tract infection. Findings of VUR control examination demonstrated that the renal function was stabilized.

Conclusions. A rational approach and justified surgical access have given good outcomes in this patient.

Introduction. Lymphatic malformations are relatively rare in childhood. Their occurrence depends on age and varies between 1/600000 to 1/2500000. By literature data , the only radical curative option for this pathology is surgery; however, the relapse rate amounts to 25%. Therefore, further studies on the management of this pathology are needed.

Purpose. to present a rare clinical case of successful surgical treatment of a child with lymphatic mesentery malformation of the small intestine.

Materials and methods. The authors discuss various approaches to therapy and surgical care; they also present modern literature data and discuss the relevance of sclerosing preparations for injections directly into the cystic cavity. A clinical case of 2-year-old child with lymphangioma of complex anatomical location is described. The authors analyze ways of surgical intervention, early postoperative course and correction of the developed complications.

Results. Follow-up data were analyzed; the obtained results confrm a radical type of the performed surgery without worsening the quality of life.

Conclusion. Lymphangiomas at diffcult anatomical locations require a special attention during examination and treatment; radical removal can be considered as an effective option for treating such children.

Introduction. The existing problem of post-burn scar treatment is associated with diffculties in delivering enzyme preparations through the cicatricial tissue; so, it is stimulating searches for the preparations with proteolytic and anti-inflammatory effects which could penetrate deep into scar thickness. Such a preparation is the gel "Karipain Scar" (manufacturer LLC "Scientifc and production company "AS-COM", Moscow, Russian Federation), containing proteolytic enzymes and a transcutaneous conductor – titanium glycerosolvate aquacomplex in the form of a gel (trade name Tizol®, LLC "Society for Laboratory Research of Medicines", Ekaterinburg, Russian Federation). The article describes administration of this preparation in a pediatric combustion unit to treat post-burn pathological scars, including old scars , by applying the drug on scars and by electrodragging.

Material and methods. The described technique is used one month after the wound healing. At the frst stage of the study, Karipain Scar was applied on the scar area twice a day to the patients of experimental group (20 children aged 4-16 years with scars on limbs, torso, and large joints). At the second stage, Karipain Scar gel was applied to 18 patients aged 4-16 with scars on limbs, torso, and joints using electrodragging. The scars were photographed once a week and assessed by the Vancouver Scar Scale (VSS).

Results. At the frst stage , all participants of the experimental group reported less itching until its complete disappearance by the end of the second week and the decrease of scar height at the beginning of the second month of treatment. The scars turned pale by the end of the 2nd month. At the second stage, 100% of patients from the experimental group reported the improvement in scars since the 5th procedure. There was no signifcant difference between fresh and old scars. Karipain Scar gel was well-tolerated. There were no allergic reactions and complications.

Conclusion. The conducted studies has confrmed the effectiveness of Karipain Scar gel for treating children with post-burn scars

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