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卷 26, 编号 5 (2022)

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LECTURES

Severe trauma in the structure of childhood traumatism

Karaseva O.

摘要

The lecture presents the main definitions in the surgery of injuries in children. Special attention is paid to severe trauma, including the issue of assessing the severity of injuries. A modern strategy of providing assistance for severe injuries in children, including polytrauma, is presented.

Russian Journal of Pediatric Surgery. 2022;26(5):267-275
pages 267-275 views

ORIGINAL STUDY

20-year experience of treating esophageal polyps in children

Chepurnoy M., Kovalev M., Kivva A.

摘要

Introduction. Gastrointestinal polyps are rare in newborn children, at the same time they are most common in children aged 2 to 10 years. Many aspects of endoscopic surgical treatment of polyps in children remain controversial, since they are not sufficiently covered in domestic and foreign literature.

The aim was to conduct a retrospective analysis of surgical treatment of abdominal polyps of the esophagus in 52 children in the surgical and endoscopic department of the Regional Children's Clinical Hospital of Rostov-on-Don.

Material and methods. For a 20-year period (2001-2020) and presentation of own material for the treatment of children with esophageal polyps based on modern pathogenetic views on the occurrence and development of this pathology. The main symptom of the disease in patients was dysphagia, which occurred in 79% of patients. Under anesthesia in the operating unit, patients underwent endoscopic polypectomy using diathermocoagulation, followed by covering the defect of the esophageal wall by clipping the edges of the mucous membrane.

Results. The authors found that it is sufficient to perform polyp removal within the unaffected areas and continue antireflux therapy in order to get a full recovery of patients. Polyps of the transition zone between the esophagus and the stomach seem to have, among other things, also a morphological cause of their origin and development.

The contact of two types of mucous membranes (esophagus and stomach) suggests, under certain conditions, the possibility of the development of polyps at the junction of two different morphological structure of mucous membranes. The benign nature of the polyps was confirmed histologically.

Conclusion. The authors found that in the treatment of juvenile esophageal polyps, the suppression of gastroesophageal reflux disease should be considered mandatory both before and after surgery. There were no relapses of the disease.

Russian Journal of Pediatric Surgery. 2022;26(5):257-260
pages 257-260 views

The pedicle width predicts an accurate screw insertion

Kosulin A., Elyakin D., Kornievskiy L., Malekov D., Vasil'eva A., Bagaturiya G., Terekhina E.

摘要

Introduction. Correlation between pedicle screw malposition and small values of pedicle morphometric parameters has been confirmed in numerous studies. Definition of critical pedicle size for screw insertion is an actual problem for pediatric spinal surgery.

Material and methods. 29 patients, aged 3-17, with congenital or acquired spinal deformities were included in the study. All the patients had posterior surgery with pedicle screw implantation. All the screws were inserted by free hand technique. On preoperative CT, external pedicle width, internal pedicle width, and spongiosa proportion were measured. On postoperative CT, pedicle screw accuracy was evaluated. The binomial logistic regression was used to define dependence of pedicle screw accuracy on pedicle morphometric parameter values. ROC-curves were graphed, and AUC were calculated.

Results. 233 pedicle screws were implanted to 29 patients by free hand technique. On postoperative CT, 191 (82%) screws were confirmed to be accurately inserted. The logistic model confirmed significance of all the examined morphometric parameters (p<0.001). The external pedicle width possessed the maximal predictive value. Statistical indices for the prognostic model (sensitivity, specificity, and accuracy) were calculated for pedicle width 3.5; 6.0; 7.5 mm.

In the cut-off value of external pedicle width 3.5 mm, probability of accurate screw insertion is about 50%; this technique has been highly sensitive and maximally accurate. This morphometric feature is a technical limit of free hand pedicle screw insertion. Recommendations for selecting an implantation technique in different pedicle width are proposed.

Conclusion. The external pedicle width 3.5 mm is a critical one for pedicle screw insertion by the free hand technique.

Russian Journal of Pediatric Surgery. 2022;26(5):261-266
pages 261-266 views

CASE REPORT

Posterior femoral condylar separation: Is it a particular type of osteochondritis dissecans in adolescents?

Semenov A., Chmykhova A., Isaev I., Koroteev V., Tarasov N., Lozovaya Y., Vybornov D.

摘要

Introduction. Dissecting osteochondritis (RO) is based on damage to the subchondral bone, leading to its detachment and sequestration separately or together with articular cartilage with the possible formation of a free bone-cartilage fragment. The disease occurs more often in adolescents, accompanied by an increased risk of early arthrosis of the knee joint. Chronic traumatization of the subchondral bone leads to insufficient blood supply to a certain area of the growth zone of the secondary point of ossification of the femoral epiphysis, to ischemia and subsequent necrosis of the subchondral bone, which, according to modern literature, is the leading cause of the formation of the lesion. The typical localization of the RO focus is the lateral part of the medial condyle of the femur along the supporting surface. The present clinical analysis presents cases of atypical localization of dissecting osteochondritis with clinical features, specific signs on MRI, as well as various tactical approaches to treatment.

Material and methods. This clinical review presents 3 cases of sequestration of the posterior lateral condyle of the femur in adolescents. Despite the similarity of the clinical picture and the MRI data, the features of the foci of RO were found in all children, which determined the need for an individual approach to therapeutic tactics. All children required surgical treatment, which was performed in the Department of Traumatology and Orthopedics of the N.F. Filatov DGKB in different volumes in each case: from transchondral osteoperforations and fixation of an osteochondral fragment with a screw to debridement of a fragmented focus with removal of osteochondral fragments.

Results. All 3 clinical cases are united by atypical localization of the focus in the posterior lateral condyles of the femurs, the clinical course of the disease in the form of a low-intensity long-term pain syndrome, as well as the results of MRI of the knee joint. Most researchers adhere to the classical multifactorial etiological theory of dissecting osteochondritis, according to which the main mechanism of the origin of the lesion is mechanical overload of the subchondral bone with subsequent disruption of blood supply in it at the border with the secondary point of ossification of the femoral epiphysis. However, there is also data in the literature on congenital ossification disorder in the cartilaginous part of the growth zone of the secondary ossification point as the morphological basis of dissecting osteochondritis. The presented clinical cases cast doubt on the generally accepted model of primary damage to the subchondral bone as the only possible cause of the formation of the focus of RO, since patients have, among other things, signs of impaired ossification of the secondary ossification point of the femoral condyle, in one of whom a violation of ossification of the secondary ossification center was also determined in the patella in the form of patella bipartita.

Conclusion. Inspite of all similarities connecting these cases there is still lack of data to judge about separate type of the OCD because every separate type of disease usually have particular morphological basis. There is a need of partial biopsy of these lesions to confirm or refute our hypothesis of posterior condylar separation being separate type of OCD. However these cases undoubtedly require particular managementwith special attention to timing of appropriate diagnostic procedures and surgical management to perform in time prior to osteochondral fragment separation. In case of the absence of any complaintswith particular MRI appearance of fragmented bone in the lesion with impaired ossificationindividual treatment planneeds to be defined.

Russian Journal of Pediatric Surgery. 2022;26(5):276-286
pages 276-286 views

Management of the spontaneous pneumothorax in children

Belov S., Cyleva Y., Grigoryuk A.

摘要

Introduction. Emphysematous changes in the lung tissue are the main cause of pneumothorax in children. To restore the lung function is one of the most challenging tasks in pediatric surgery.

Purpose. To confirm the effectiveness of videothoracoscopy in the treatment of children with spontaneous pneumothorax.

Material and methods. A retrospective analysis of case histories of 12 patients with spontaneous pneumothorax was made. Outcomes of treatment were monitored in patients during their stay in the hospital. Time of air release cessation, expansion of the lung, complications and length of stay in the hospital were analyzed.

Results. In the first group of patients (n=7) only the drainage technique was used; aerostasis was achieved by the end of the second week (14.3±1.5 days). The drainage was in place till the air leakage was eliminated. The length of patient's stay in the hospital was 20.3±2.3 days. In the second group (n=5), the resection intervention was made. The complete lung expansion was achieved on the first day. Lung hermeticism was achieved by 4.2±1.3 day (p<0.05). There were no any bronchopulmonary complications. The length of stay in the hospital was 14.1±1.1 days (p<0.05).

The advantage of the thoracoscopic technique applied for the treatment of spontaneous pneumothorax is in creating conditions for faster elimination of the source of air leakage, in accelerating functional recovery and in shortening the length of patient's stay in the hospital. The combination of thoracoscopic lung resection with pleurectomy in children can significantly reduce the risk of pneumothorax recurrence.

Conclusion. To eliminate the prolonged air release in case of confirmed bullous changes in the lungs, when minimally invasive techniques are ineffective, surgical treatment in the form of video-assisted thoracoscopic resection can be applied early, even with the first episode of pneumothorax.

Russian Journal of Pediatric Surgery. 2022;26(5):287-290
pages 287-290 views

Appendicular-intestinal fistula caused by magnetic foreign bodies in a 2-year-old child

Timerbulatov V., Sagitov R., Timerbulatov S., Bykovsky I., Timerbulatov M.

摘要

EDITORIAL COMMENT. Gripped aggressive foreign bodies (magnetic balls) in the gastrointestinal tract require emergency actions to clarify their localization and to remove them. The conservative approach with four-day observation described in the article should not be used.

Introduction. Internal fistulas in foreign bodies of the digestive tract is a very rare complication.

This publication is aimed to describe a rare case of fistula formation between the vermiform process and the ileum caused by magnetic foreign bodies.

Clinical observation. As his parents said, a 2-year-old child swallowed magnetic balls; no clinical manifestations were noted. Plain radiography 3 days after the ingestion revealed foreign bodies (3) in the right lower quadrant of the abdomen. No foreign bodies were found on colonoscopy. Laparoscopy revealed a fistula between the appendix and the terminal ileum. The following steps were made: disconnection of fistula, appendectomy, suturing of fistula opening in the ileum.

Conclusion. One of the complications after swallowing magnetic foreign bodies may be formation of internal intestinal fistulas. In our observation, the fistula was between the appendix and the ileum. No similar observations were found in literature.

Russian Journal of Pediatric Surgery. 2022;26(5):291-294
pages 291-294 views

A case of the long time presence of a foreign body in esophagus in an infant

Akselrov М., Ivanov D., Dadasheva S., Sergienko T., Uzdimaeva S.

摘要

Introduction. Infants learn the world while playing through the taste of objects. If the parents neglect it, the object in the mouth can be swallowed. Foreign bodies in the esophagus are easily diagnosed, as a rule, since immediately after getting stuck they are manifested by salivation, choking, difficulty in passing food. If a foreign body passed into the esophagus being unnoticed, in 20% various complications develop, such as esophagitis, stenosis, organ perforation, esophageal-tracheobronchial fistula, mediastinitis, aortoesophageal fistula, cervical spondylitis.

Material and methods. The article presents a clinical case of the long time presence of a large foreign body in the esophagus of an infant which was simulating respiratory disorders. The child was admitted to a surgical hospital with suspected congenital tracheoesophageal fistula because when swallowing liquid food he did not manifested any complaints typical for foreign bodies in the esophagus: pain in the neck and sternum with irradiation to the interscapular region, difficulty or inability to swallow, urge to vomit, hypersalivation. Mom and doctors were inclined to find other reasons for cough and wheezing which were intensified when the child was eating. The authors discuss features of extraesophageal manifestations of a foreign body in the esophagus as well as diagnostic and therapeutic tactics in such cases.

Conclusion. Even small children can swallow large foreign bodies. While taking anamnesis, especially in children of the first year of life, a doctor should think not only about the syndrome of bronchial obstruction, but also about possible presence of a foreign body in the esophagus if wheezing and coughing attacks appear during meal. Diagnostic algorithm should include X-ray and endoscopic examinations which are effective and minimally invasive and which allow to remove a foreign body, even if it is in the esophagus for a long time.

Russian Journal of Pediatric Surgery. 2022;26(5):295-298
pages 295-298 views

CLINICAL PRACTICE. GOLDEN ARCHIVE

Perforation of the esophagus complicated with deep phlegmon of the neck, circular necrosis of the internal jugular vein and massive bleeding in a child of 11 years

Bessarabov V., Kuznetsov V.

摘要

A description of a rare clinical case of massive erosive bleeding from the external jugular vein against the background of neck phlegmon developed as a result of damage to the esophagus by glass is presented. The therapeutic and diagnostic errors at the stages of medical care are considered in detail.

Russian Journal of Pediatric Surgery. 2022;26(5):299-303
pages 299-303 views

HISTORY OF PEDIATRIC SURGERY. JUBILEE

Alexey Borisovich Okulov (on the 85th anniversary of his birth)

摘要

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Russian Journal of Pediatric Surgery. 2022;26(5):304-305
pages 304-305 views

Sergey Pavlovich Yatsyk (on the 50th anniversary of his birth)

摘要

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Russian Journal of Pediatric Surgery. 2022;26(5):306-307
pages 306-307 views

Mikhail Alexandrovich Akselrov (on the 50th anniversary of his birth)

摘要

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Russian Journal of Pediatric Surgery. 2022;26(5):308
pages 308 views
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