卷 26, 编号 6 (2022)

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Introduction. Malformations and diseases of the pancreas are associated with the risk of complications. Interventional endoscopy is one of the ways to solve this problem.
Material and methods. 24 patients (3–17 y.o.) were included in the study. 36 interventional endoscopic interventions were performed.
Results. Transpapillary interventions were performed in 10 patients, all of them had anomalies of the ductal system. Stenosis of the distal pancreatic ducts was detected in 3 cases, in which stenting of the Wirsung duct was performed. Virsungolithiasis was confirmed in 3 cases, in which an anomaly of the ducts in the form of an incomplete split gland was detected in 2 patients. Pancreas divisum was detected in 1 patient, which required sphincterotomy of the minor duodenal papilla. Transmural interventions were performed in 13 cases: puncture – in 7 patients with intra- or parapancreatic cystic formations; drainage – in 6 patients with pancreatic pseudocysts. One child with traumatic rupture of the pancreas had a combined intervention (transpapillary and transmural).
Discussion. The etiology of pancreatitis in children is associated with developmental anomalies and genetic factors. The leading pathogenetic factor in the development of complications is hypertension in the ducts of the gland. Traditional surgical interventions for pancreatitis are often traumatic and are accompanied by a high risk of complications. The introduction of minimally invasive techniques, such as interventional endoscopy, can solve the problem in some diseases of the pancreas.
Conclusion. Transpapillary interventions can effectively eliminate hypertension in the pancreatic ducts in case of their dilatation and virsungolithiasis. Transmural interventions can be used to clarify the etiology of pancreatic cysts, as well as to drain pancreatic pseudocysts.

Introduction. Recently, the prevalence of urolithiasis in pediatric population has been steadily increasing, but up to now there is no any universal technique for treating urolithiasis in children. Among many options for surgical treatment of upper urinary tract urolithiasis, remote lithotripsy occupies one of the leading positions.
Purpose. To highlight principles and mechanisms of remote lithotripsy, its indications and contraindications using a systemic review of modern literature for the period of 2001–2021.
Material and methods. A systematic review of foreign and domestic literature for the period of 2001–2021 was made. Key words for the search were : urinary stone disease, urolithiasis, remote (shock wave) nephrolithotripsy, fragmentation of stones. 64 full-text articles out of 1339 literature sources are included in the review.
Results. On analyzing the obtained results, it has been found out that one session of remote shock wave lithotripsy is effective in more than 90% of cases, if calculus dimensions are less than 20 mm and its density is less than 1200–1500 Hounsfield units. Location of the calculus also plays a role.
Conclusion. Remote shock wave lithotripsy is a reasonable option due to a number of facts, the main of which are non-invasive approach and a large percentage of favorable outcomes associated with cleaning the upper urinary tract from stones.

Introduction. Over the past decades, permanent venous access devices, in particular port systems and peripherally implanted central catheters, has been increasingly introduced in adult and pediatric oncology. As far as central catheters and permanent access devices are foreign bodies in basic veins, quite naturally that they are one more risk factor for thrombosis.
Material and methods. The authors searched literature data ( in Russian and English) for the period up to May 3, 2022 using public databases (Embase, Medline/PubMed, Researchgate, medrxiv.org, RSCI/eLibrary). The following keywords were used for the search: “port-system”, “peripherally implanted central catheter”, “totally implanted vascular access device”, “venous thromboembolism”, “VTE”, “venous thromboembolic complications”, “VTEC”, “catheter dysfunction”, “device malfunction”. Available preprints, articles with “in press” or “online first” status, and clinical cases were also included in the analysis.
Conclusion. This review discusses prevention, diagnostics and treatment of venous thromboembolic complications in cancer patients using similar implantable devices. In patients with catheter-associated thromboses, of practical interest are various diagnostic and curative algorithms, recommendations on the choice of vascular access, medicamentous therapy as well as variants of surgical intervention.

Introduction. Fecal incontinence of various origins still remains a complex medical and social problem that reduces both the quality of life and the chance of child’s full integration into the modern society. Antegrade enema, originally described by Malone, consists of creating an appendicostomy or neoappendicostomy of the ileum, which allows to irrigate the entire colon in order to empty the colon and rectum. As a result, children stay clean from 24 to 72 hours. Thus, surgical intervention can significantly improve the quality of life of children suffering of incontinence. Laparoscopic access minimizes surgical trauma and shortens rehabilitation period.
Purpose. To analyze the obtained outcomes after treating children with laparoscopic umbilical appendicostomy.
Material and methods. We report our own results obtained after performing laparoscopic umbilical appendicostomy in 3 children at the Federal Scientific and Clinical Center for Children and Adolescents, FMBA of Russia. Two children had neurological disorders of the pelvic organ; the third child suffered a severe combined injury, which led to the development of gross scarring changes in the sphincter area with a complete loss of its contractility. All children underwent laparoscopic umbilical appendicostomy. The article describes in detail all the stages of preoperative preparation and surgical intervention.
Results. The duration of surgery ranged from 60 to 80 minutes. An appendicostomy intubator was left for 1 month in all cases. Hospital stay ranged from 8 to 11 days. The catamnesis was traced for 3–7 months. Therapeutic effect was assessed by children’s parents as satisfactory; the child remained clean for 12–18 hours, which contributed to socialization and significantly improved the quality of life.
Conclusion. Performing laparoscopic umbilical appendicostomy is a relatively affordable technique. Our own experience has proven its effectiveness. Laparoscopic access minimizes surgical trauma, reduces rehabilitation time, and brings excellent cosmetic results. Malone surgery in children should be considered as a method of choice.

Objective. The primary tuberculosis infection in childhood is manifested as a common disease. The diagnostics of liver tuberculosis is still a little-studied problem due to the absence of clinical manifestations.
Purpose. To study clinical course, diagnostics and management of liver tuberculosis in children.
Material and methods. 5 children, aged from 5 days to 16 years, with liver tuberculosis were under the observation. To put diagnosis, the researchers used the following parameters: anamnesis, examination, laboratory and specific tests, ultrasound, radiological methods including CT, biopsy of the surgical material.
Results and discussion. Out of 5 children with liver tuberculosis, 3 had disseminated miliary pulmonary tuberculosis with liver damage; one had liver tuberculosis of the tuberculoma type and one had tumor-like liver tuberculosis. These three observations are described the article. In the diagnostics, basic indexes are CT of the abdominal organs, histological examination of the surgical material and positive Diaskin test.
Conclusion. An isolated tuberculous liver damage is a rare case. More often, several anatomical regions are simultaneously involved in the specific process.

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