卷 26, 编号 3 (2022)

   The purpose of this article is to assess the immediate results of laparoscopic transposition of aberrant renal vessels as an effective alternative to pyeloplasty in the treatment of children with external obstruction of the pyeloureteral junction.
   Material and methods. The laparoscopic vascular transposition technique was used in 3 children with hydronephrosis caused by aberrant renal vessels. The preoperative diagnostic examination included: ultrasound / Doppler scanning, radioisotope renal scanning and contrast computed urography. Renoscintigraphy showed that all patients had intermittent hydronephrosis (24–36 mm) and an obstructive pattern. In order to select patients in whom vascular transposition is possible, the diuretic loading test was made at the beginning of the surgery. During the surgery, accessory renal vessels were mobilized and moved upward, where they were fixed by "wrapping" with renal pelvis tissue.
   Results. The median operative time was 59.0±10.2 minutes, and the median hospital stay was 3.6±0.5 days. There were no complications at the early observation period. At the follow-up (6.0–24.0 months), all patients showed a decrease in the degree of hydronephrosis and an improvement in excretory function at the renogram.
   Conclusion. Preliminary results of the study have demonstrated safety and efficacy of laparoscopic repositioning of aberrant renal vessels for the treatment of hydronephrosis. A careful selection of patients through intraoperative functional tests is an important step to confirm indications for this procedure and to maintain its high success rate. Any concerns about the presence of additional internal stenosis of the pyeloureteral junction, of course, should transform this surgical intervention into the classic pyeloplasty.

   Introduction. Lymphatic malformations (LM) is the developmental anomaly of lymphatic vessels which is formed at the stage of early embryogenesis. Intraabdominal and retroperitoneal LM are very rare and account for 4 % of all observed LM.
   Purpose. To clarify the effectiveness of minimally invasive surgical interventions in children with abdominal LM.
   Material and methods. Over a ten-year period, 15 children with retroperitoneal lymphangiomas , aged from 1 to 17, were operated on in our clinics. To clarify diagnosis, a comprehensive examination was performed: ultrasound, spiral computed tomography, magnetic resonance imaging of the abdominal cavity. Laparoscopic access was applied in all 15 cases for surgical intervention.
   Results. In all cases, lymphatic malformations were diagnosed before surgery which was later confirmed at laparoscopy. Malformations were excised laparoscopically. In 2 patients, lymphangiomatous tissue was partially left at the site of the greatest fusion with renal and iliac vessels due to a high risk of their damage.

   Conclusion. Endovideosurgical technologies in children with retroperitoneal LM may be used at any child’s age and at any size of retroperitoneal cystic formation since emptying the cystic cavity creates the necessary working space in the abdominal cavity. Such an approach minimizes surgical trauma, shortens surgical time and facilitates the postoperative period.

   Introduction. The authors present their experience in the practical application of thoracoplasty technique in asymmetric keeled deformity of the chest in children.
   Material and methods. 21 children with asymmetric keeled deformity of the chest were operated on with a new technique for thoracoplasty developed by the authors. A corrective plate was inserted directly under the sternum through the intermediate tunnel under visual control of the operational zone from an additional access at the edge of the sternum and adjacent deformed ribs.
   Results. In the vast majority of cases (20 out of 21), good (excellent) results were obtained; in one case, the outcome was satisfactory because of a slight residual bulging of the sternum and adjacent ribs what made the patient feel slightly discomfortable among peers.

   Conclusion. The developed technique of thoracoplasty in asymmetric keel deformity of the chest in children has resulted in optimal cosmetic outcomes in almost all the patients.

   Introduction. The incidence of cicatricial esophageal stenoses in children after severe chemical burns is quite high. Bougienage is a preferred modality in cicatricial stenoses of the esophagus. The new technique of esophageal bougienage which is thought to be the most safe and effective is dilatation with a wire guide.
   Purpose. To compare management of children with cicatricial esophageal narrowings using various dilatation techniques.
   Material and methods. 481 patients with chemical burns of the esophagus were treated at the department of pediatric surgery in Abualiibni Sino Tajik State Medical University (Dushanbe). 236 (49 %) children had burns of degree I; 124 (25.8 %) – of degree II; 121 (25.2 %) – of degree III. Cicatricial narrowings in the esophagus in children are mostly of degree III; that is why such pathology was chosen as the object of the study. Patients were divided into two groups depending on the bougienage technique. The control group included 68 (56.2 %) patients: 47 (38.8 %) of them had “blind” bougienage; 21 (17.4 %) – “thread” bougienage. In 53 (43.8 %) patients from the studied group, bougienage of the esophagus was made with a guided bougie.
   Results. 78 patients in whom cicatricial stenoses developed after tissue damage with the vinegar essence were admitted to the hospital. 28 (36.8 %) of them – one month and more after the injury. 4 children from the control group and 2 children from the studied group had esophageal perforation as a complication of esophageal dilatation. These patients had extended and subtotal cicatricial stenoses. 3 other patients developed cicatricial stenoses after accidental swallowing of batteries; one had thread bougienage after gastrostomy, and the other two had wire-guided bougienage. Two children had burn lesions caused by unknown reagent with the subsequent formation of cicatricial stenosis of the organ; they had thread and wire-guided bougienage. In the first case, outcome was successful; in the second one – not, because of extended stenosis.
   Conclusion. The technique of wire-guided bougienage has been proven to be effective.

   Editrial comment. The described long-term multi-stage surgical treatment – performed at the child's place of residence was not adequate and was the threat of losing the only kidney. Management of patients with a non-reflexing form of megaureter, especially in the neonatal period, requires the assessment of not only the state of the kidney and ureter, but also the state of the bladder, in order to exclude the bladder-dependent form of megaureter. Proximal ureterocuteniostomy, especially of a single kidney, should not be used without a preliminary, full-fledged urological examination. Children with complex malformations of the urinary system should be promptly consulted in specialized medical institutions.
   Introduction. Among congenital malformations of the urinary system, one of the most common is megaureter. The recently developed surgical techniques and, namely, minimally invasive ones for megaureter treatment, in some cases prevent or delay surgical intervention. However, if deterioration of the renal function is seen, especially in patients with the only functioning kidney, radical surgery has to be performed in a timely manner, before the formation of irreversible changes in the renal parenchyma leading to nephrosclerosis.
   Purpose. To illustrate a successful surgical outcome in a patient with megaureter in the only functioning kidney when surgeons had to consider all anatomical features after ineffective previous surgical corrections.
   Material and methods. The authors present a clinical observation and management of a 10-year-old patient with megaureter in the only kidney after previous ineffective surgical corrections when both open traditional methods and long-term endovesical stentings were performed but without taking into account the anatomical localization of the ureteral junction. The patient also developed a latent course of urinary tract infection and chronic kidney disease stage 3 by classification of the National Kidney Foundation (NKF), and the working group on improving outcomes of kidney diseases, Kidney Disease Outcomes Quality Initiative (KDOQI).
   Results. Despite the existing problems – deficit in the ureter length caused by previous surgeries, impossible endovideosurgical laparoscopy because of metabolic disorders – the performed treatment was successful. The surgeons formed ureterocystoanastomosis by Cohen technique with extra-bladder mobilization of the ureter. Dynamic follow-up after surgical treatment lasted for 2 years. During the observation period, urodynamics of the upper urinary tract was restored and, one could see the elimination of leukocyturia, improvement of blood flow in the parenchyma of the only functioning kidney as well as stabilization of nitrogen metabolic parameters and glomerular filtration rate.
   Conclusion. While choosing surgical management, surgeons should consider anatomical features of the ureterovesical junction. Such an approach has promoted good results in the discussed case.

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