卷 26, 编号 1 (2022)

Introduction. Minimally invasive procedures used in the treatment of children with Hirschsprung’s disease (HD) have reduced the rate of complications and allowed to perform these surgeries at any age. In literature, one can find much information on surgical treatment, complications, long-term results. However, features of postoperative period and mechanisms of colon function restorations after different pull-through procedures are not well described.
Material and methods. From 2008 to 2019, 77 patients with different forms of HD were operated in Children’s Clinical Specialized Center of High Medical Technologies in St-Petersburg. Patients were aged from 14 days till 3 years. They were divided into 3 groups according to the applied endorectal technique- Soave, «Soavson», Swenson. The following parameters were analyzed: age, sex, stoma, surgery duration, length of hospitalization, features of postoperative period, complications.
Results. An early postoperative period was similar in all groups. Two children after Soave procedure (9%) had wound infection; two children had anastomotic stricture (1 – Soave, 1 - «Soavson») which was treated with regular dilatations. Enterocolitis was diagnosed in 19 patients (25%). 20 patients (26%) had no self-defecation for 14 days – 6 months after the surgery. Most of the patients had HD of the rectosigmoid form. These disorders developed more often in patients after Soave and «Soavson» procedures, less often- after Svenson one.
Discussion. An issue of choosing an optimal technique for rectal dissection is still a debatable one. There has been no any significant difference revealed between the three variants of endorectal dissection during an early postoperative period.
Conclusion. A transanal endorectal pull-through procedure in children with HD is a preferable option of choice. It gives good functional outcomes. Features of the postoperative period are caused by the adaptation of new intestine to new defecation conditions.

Introduction. Ectopic pancreas (EP) in children is a rare malformation. In the pediatric practice, it is rarely manifested with a pain syndrome. Although most ectopia cases are asymptomatic, some children have signs of the disease at an early age what may require a surgical intervention.
Material. The researchers have analyzed domestic and foreign literature on the pancreatic ectopia in the gastro-duodenal zone which was published over the past 20 years and up to the present. The literature search with key words was done at such search engines as: Library, eLibrary, PubMed, Medline. The researchers analyzed the most important works published in the last century.
Results. A review of 32 literature sources with data on epidemiology, classification, origin, diagnostics and treatment of ectopic pancreas in the gastro-duodenal zone is presented in the article. This paper specifically draws attention to a minimally invasive surgery for the radical correction of this congenital malformation.
Conclusion. Surgical intervention is required for patients with a marked pain symptom after ineffective conservative treatment. The aim of surgery is to perform layered resection of the stomach wall in which the ectopic pancreatic tissue is located.

Introduction. The authors present their experience in experimental and clinical studies on the application of Xenon (Xe) in subnarcotic concentrations for pain relief and for the treatment of acute stress disorders. Preparing wounds for plastic closure in children is a long and painful process which requires many anesthesia procedures during dressings. It leads to cognitive disorders, affects memory and learning potentials. Every third child who survived a severe trauma suffers of acute stress disorders: bad sleep, emotional imbalance, anxiety, asociality, inappropriate actions. Xenon is a non-toxic anesthetic. In the concentration of 20–50%, it is not only anesthetizes, but also decreases acute stress disorders, has sedative and anti-stress effects and normalizes sleep.
Objectives. To study literature data on the potentials of gas Xe in subnarcotic concentrations for pain relief and for decreasing acute stress disorders at the stage of preparing a child for plastic closure of a wound defect.
Material and methods. Literature search was done in PubMed, Scopus, eLIBRARY, Cyberleninka in English and Russian using key words: “Xenon”, “Xenon and anesthesia”, “Xenontherapy” “Actions of Xenon”, “Treatment of extensive wounds in children”, “Acute stress disorders”.
Results. The analysis of the data of the conducted studies showed the non-toxicity of Xe, which makes it possible to use it repeatedly for anesthesia in children. The fact that Xe reduces the manifestations of anxiety, depressive and psychosomatic symptoms in patients with acute and chronic stress disorders allows us to count on its positive effects in the treatment of children with extensive wounds of traumatic origin at the stage of preparing them for plastic closure.
Conclusion. The practical absence in the available scientific literature of a study to assess the effectiveness of the use of subnarcotic concentrations of Xe, when dressing extensive wounds at the stage of preparation of the wound process for plastic closure in children with acute stress disorders, justifies the conduct of an appropriate scientific study.

Introduction. A surgical care in complicated hernias of the anterior abdominal wall remains an acute issue in pediatric surgery. Strangulated hernia is the most common and dangerous complication. It is worth mentioning that the risk of developing this complication in children during the first six months of their life reaches 24%. The clinical course of strangulated hernia in children is characterized by a large variety of symptoms depending on patient’s age, anatomical and pathomorphological features of his/her organs and systems. A correct assessment of clinical, laboratory and instrumental findings can help in identifying uncommon types of hernia infringement.
Material and methods. A case of clinical observation and surgical treatment of a 6-month old child with Littre hernia is presented.
Results. By the literature data, emotional and motor restlessness prevails in the structure of complaints in infants with strangulated hernia. Patients with uncommon types of hernia infringement may be regarded as a separate group. Patients with Littre hernia, which is one of the types of parietal infringement, belong to this group. Littre hernia incidence does not exceed 0.5% of the total number of hernia strangulations. Clinical symptoms of the atypical hernia infringement may be mild or non-classical. It is known that mild clinical manifestations of strangulated hernia as well as limited diagnostic potentials of laboratory, X-ray and ultrasound examinations in young children increase the risk of developing destructive changes in the intestinal wall. Therefore, an active surgical tactics of hernia treatment prevents the development of atypical forms of hernia infringement and complications associated with it.
Conclusion. Thus, early detection of hernias of the anterior abdominal wall, since the neonatal period, an adequate observation tactics and timely performed surgical intervention is the basis for preventing peritonitis and intestinal obstruction in young children.

Introduction. Congenital vascular malformation is one of the most difficult pathologies in modern vascular surgery. Due to a large variability of lesions in each case, a personalized approach is required.
Material and Methods. A 16-year-old girl with a right half – face venous malformation was consulted in the clinic. While visiting a local clinic at the place of her residence, she was proposed to have a radical excision of the lesion, but her parents refused of it. Our additional examination revealed a subtotal lesion of the right masticatory muscle with invasion into the upper lip and in the area of nasolabial triangle. It was decided not to do an open surgery because of the volume and location of the lesion. The patient had the staged sclero-obliteration of angiomatous tissues.
Results. After the treatment, the lesion was significantly reduced in size; there was a complete relief of pain syndrome; in addition, the patient’s face became more symmetrical.
Conclusion. An individual approach when choosing the optimal tactics for the treatment of venous malformations allows to achieve the best functional and cosmetic outcomes.

Introduction. Congenital bronchopulmonary vascular malformations manifest a wide range of disorders in the three main components of the lungs: respiratory tract and lung parenchyma, arteries and veins. Malformations of all the main components of lung tissues, namely, arterial blood supply, venous outflow and respiratory tract - may be variants of a single primary complex of pulmonaryvascular anomalies.
Observation. A described clinical case demonstrates an extremely interesting mixed bronchoarteriovenous malformation affecting the pulmonary respiratory tract, pulmonary artery and pulmonary vein. Various instrumental techniques were used for the diagnostics, the key of which was computed tomography with intravenous contrast.
Conclusion. The article presents a wide range of pathological changes observed in this clinical case; it also analyzes the nature of each component and terminology.

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