卷 27, 编号 1 (2023)

Introduction. Currently, the conservative treatment of ileocecal intussusception (ICI) has proven its effectiveness; indications for surgical treatment are increasingly narrowing and do not depend on disease duration and child’s age. And yet, there are situations when conservative treatment is ineffective, and surgical intervention is a must.

Purpose. To analyze reasons leading to ineffective conservative treatment of ileocecal intussusception in children and, accordingly, to specify current indications for surgical treatment.

Material and methods. 160 children with ICI, who were treated in the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) in Moscow from 2011 to 2021, were taken in the trail. Boys prevailed and amounted to 67.5% (108), girls – to 32.5% (52). Average age of patients was 2.9±2.02. 81.2% (130 children ) were older than one year. If the disease was diagnosed for the first time and if there were no complications, patients with ICI had hydrocolonoscopy (HCS), regardless of child’s age and disease duration. If HCS was ineffective, laparoscopy was done. Laparoscopy was also made in case of disease recurrence. If laparoscopic disinvagination was ineffective or impossible, laparotomy was performed. In case of effective laparoscopic disinvagination but in disease relapse and in the absence of intra-abdominal anatomical problems in the postoperative period, colonoscopy was made to rule out intraluminal anatomical pathologies. In the present trial, the researchers assessed causes of ineffective HCS: anatomical problems including volumetric lymphadenopathy, invaginate necrosis and disease relapses. Types of surgical intervention and their effectiveness were also analyzed. Additionally, the authors compared studied parameters obtained in the hospital earlier when HCS protocol (n=160; 2011–2021) and laparoscopic disinvagination protocol were used (n =40, 2007–2010).

Results. Surgical intervention by HCS protocol was made in 9.4% (15); HCS effectiveness was as high as 90.6%. Laparoscopy was performed in 6 children (3.75%) after ineffective HCS and in 9 children (5.6%) after disease relapse. Laparoscopic disinvagination was effective in 60.0% of cases (9) from the surgical group; laparoscopy was changed for laparotomy in 6 patients (40%). Anatomical problems accounted for 73.3% (11) in the surgical group and for 6.9% in the study group, respectively. In the rest of patients (4–26.7%), ineffectiveness of conservative disinvagination was caused by severe lymphoid hyperplasia of the ileocecal angle. In early disease relapses, 42.9% of such patients had anatomical problems. In the surgical group, invaginate necrosis was registered in 20% (3), and bowel resection with anastomosis was made in 26.7% (4); in the study group, these indexes were 1.9 and 2.5%, respectively.

Conclusion. The basic reason for ICI conservative treatment failure was an anatomical problem which is a leadpoint of disease pathogenesis that causes both intussusception necrosis and intussusception relapses. Currently, the main indications for surgical ICI management are ineffectiveness of conservative treatment and ICI relapses regardless of child’s age and disease duration.

Introduction. Polytrauma (PT) in children is an important medical and social issue because it leads to a high percentage of disability and mortality in pediatric population. Destruction of the muscle mass in patients with PT causes traumatic rhabdomyolysis (TR) in 85% of cases. Such patients develop endogenous intoxication called “toxic-resorbtive state” (TRS) which is caused by the absorption of tissue degradation products into the systemic circulation.

Purpose. The aim of the present study was to analyze publications on the diagnostics and treatment of “toxic-resorbtive state”, including extracorporeal techniques.

Material and methods. We searched PubMed, Web of Science, Scopus, MEDLINE, eLibrary, and RSCI databases and found about 1800 references and 268 articles. We selected 38 articles for reviewing in traumatology, intensive care and extracorporeal methods.

Results. In the acute period of injury, TRS is complicated by the acute kidney injury (AKI) in 5–25% of cases. Mortality in TRS is up to 20%; the leading cause of death is multiple organ failure. TRS markers are myoglobin, creatine phosphokinase lactate, LDH, AST and others. TRS therapy is aimed to prevent and to treat AKI. Continous renal replacement therapy (CRRT) for treating TRS allows to remove myoglobin, CPK and LDH from the circulation and to reduce mortality by half.

Conclusion. In TRS management, there are no unified approaches to CRRT indications, regimens, session duration, and choice of optimal filters. In the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, a trial is planned aiming to assess CRRT effectiveness and safety of TRS treatment in children with polytrauma injuries.

Introduction. The cutaneous larva migrans syndrome is a common disease in the tropical zone. But in the countries with a different climate , like in Russia, this pathology is rarely met; thus, practicing physicians have not enough experience and knowledge about this disease .

Clinical observation. The authors describe their experience in treating cutaneous larva migrans syndrome in a one-year old child. After studying literature sources, the authors understood that they were facing a typical clinical picture of this pathology. It was an interesting fact that neither patient, nor her parents travelled outside Russia. The authors also demonstrate the effectiveness of the prescribed treatment.

Conclusion. The above observation underlines that sporadic cases of larva migrans syndrome are quite possible at the territory of Russia. The effectiveness of Albendazole for managing this pathology in young children was also confirmed.

Introduction. One-day surgery in pediatrics is the most preferred form of elective surgical care for children. However, today issues of laparoscopic surgical interventions in children in a one-day hospital unit remain debatable, since these interventions often require tracheal intubation which increases risks of anesthetic complications at early postoperative period.

Material and methods. From 2017 to 2021, 2401 laparoscopic interventions were performed on patients with varicocele, inguinal hernia and non-palpable testicular syndrome in the short-stay department of Morozovskaya Children’s City Clinical Hospital. Average age of patients was 7 years (range 1–18 years). 910 laparoscopic herniorrhaphies, 1412 laparoscopic testicular vein ligations and 79 diagnostic laparoscopies were performed. The department has developed a unique algorithm of anesthesia for laparoscopic surgeries in children in a short-stay unit.

Results. There were no anesthesia-related complications or other intraoperative complications. Restoration of independent motor activity in patients is registered in 1.5–2 hours after surgery. Average length of stay in the department is 7.1 hours (6–8 hours).

Conclusion. Thus, currently, modern high-tech laparoscopic surgeries are carried out in short-stay surgical departments, while previously they were performed only in round-clock surgical departments. The researchers could achieve such successful results because of an original algorithm of safe anesthesia which has been developed in the department. This anesthetic support is highly effective for laparoscopic interventions in children with elective surgical pathologies in a short-stay hospital.

Introduction. Bronchogenic cysts is a rare congenital malformation of the tracheal tree that develops because of violated differentiation of the foregut on week 5–8 of embryogenesis. This disease is often complicated with respiratory failure due to trachea compression; heart failure may develop as well due to of heart and large main vessels compression. One of the most serious complications is erosion of the vessel wall and massive bleeding from main vessels.

Clinical observation. A 7-month-old child with cough and stridor was admitted to the surgical thoracic department of National Medical Research Center for Children’s Health in Moscow. Examination revealed a bronchogenic cyst which caused compression stenosis of the trachea. The patient successfully survived thoracoscopy. This technology promoted adequate visualization of the formation and of the adjacent anatomical structures what allowed to isolate the formation in a precise manner. So, the cyst was completely removed without any pathological immature tissue left. In this particular case, there was a high risk of perforation of the trachea posterior wall at surgery and at early postoperative period. Such complication could require intraoperative conversion with circular resection of the trachea using high-frequency jet ventilation with Twin Stream apparatus, or the patient had to be transferred to extracorporeal membrane oxygenation so as to provide an adequate surgical intervention.

Conclusion. In a multidisciplinary medical center, there has been performed a successful surgical treatment of a 7-month-old child with a large bronchogenic cyst that compressed the trachea using minimally invasive modern technologies.

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