卷 27, 编号 2 (2023)

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   Introduction. Currently, the most successful option for treating benign hematological diseases of the spleen in children is splenectomy.
   Material and methods. In the article, the authors present their 25-year clinical experience in performing laparoscopic splenectomy in children with various diseases of the spleen. They discuss different techniques for surgical treatment of spleen diseases, features of preoperative preparation, current literature data.
   Results. The accumulated experience in laparoscopic surgeries for spleen removal, application of modern electrosurgical equipment and instruments for extracting tissues from the abdominal cavity have significantly reduced surgical time, improved cosmetic outcomes and quality of life of patients in the postoperative period. Somatostatin, prescribed right before the surgery and at the early postoperative period, prevents development of pancreatitis and erosive bleeding from the stump of the spleen pedicle in the vast majority of patients.
   Conclusion. The obtained catamnestic data demonstrate that laparoscopic surgery for spleen removal has its advantages. It is a safe, little-traumatic, effective and cosmetically good option for surgical spleen management in children.

   Introduction. A comparative study on the effects of osmotic diuretics (OD) at parameters of water-electrolyte metabolism in children with brain injury was conducted. The researchers analyzed these effects depending on the treatment algorithm whether it was done by the Protocol or by generally accepted indications.

   Material and methods. 51 case-histories of children with severe, combined TBI were taken for the analysis. The patients were treated with osmotic diuretics (OD) to relieve intracranial hypertension (ICH). All patients were divided into two groups: Group 1 ( studied group) – 25 children enrolled prospectively. In this group, OD were administered according to the Protocol. Group 2 (control group) – 26 children (retrospective group). In this group, OD was administered according to the accepted clinical recommendations.

   Results. As it has been revealed, OD in the control group (Group 2) were used 8.7 % more often than in patients from Group 1 at Step 3 of the Protocol. In patients from Group 2, hypernatremia and hyperosmolarity had more persistent and pronounced type; such tendency persisted for the next 5–7 days of the study. However, there were no statistically significant differences between the groups in average values of sodium levels and osmolarity of blood plasma under ICH therapy. The conducted statistical analysis has shown that the lack of reliable differences is associated with a significant variance of analyzed indicators in Group 2. At the same time, we registered a statistically significant increase (p < 0.05) of unfavorable outcomes in Group 2 by 24.9 %.

   Conclusion. Regular and rationally frequent administration of osmotic diuretics leads to less persistent violations of water-electrolyte metabolism. A prerequisite for the effective management of traumatic ICP in children is monitoring the intracranial pressure (ICP) and cerebral perfusion pressure (CPP).

   Introduction. Pigmented nevi (PN) are formations in the skin layers which consist of accumulated melanocytes of various differentiation degrees and located in different layers of the skin. In modern society, this pathology causes serious medical and psychological problems; not infrequently , one can see unsatisfactory clinical and aesthetic outcomes. There is no any clear tactics which could take into account PN forms, location and child’s age.

   Purpose. To study modern problems and to outline prospects for treating various PN forms in children using the information obtained after literature search for the period 2005–2022.

   Material and methods. The authors made the literature search in domestic and foreign databases for the period 2005–2022. The following key words were used for the search: benign melanocytic skin lesions; pigmented nevus; laser radiation. 1627 literature sources were studied, 87 works were included in the review.

   Results. Despite of various techniques used for PN removal, unsatisfactory results are still noted in 41 % of patients with a complication rate of up to 50 %. After implementation laser scalpel for PN removal, complications in the form of hypertrophic and keloid scars were noted in 2–5 % of patients, postoperative hyperemia- in 21 % of cases, hyperpigmentation in 13 % and hypopigmentation in 34 %. The present review outlines advantages and disadvantages of various modalities used for removing PN. The authors also underline that the most promising ones are laser techniques in which laser light has a specific selectivity to pigmented tissues. The article has no information on parameters of laser irradiation which are required for treating definite forms of PN in children.

   Conclusion. Further research is needed to optimize existing and to develop new laser light techniques for treating various PN forms which should bring a significant improvement in outcomes.

   Introduction. Venous malformation is a congenital vascular disease of venous blood flow system which is met in ratio 1–2 cases per 10 000 population. The clinical picture depends on the diameter of affected vessels, their extension and on possible complications. The disease is diagnosed both at birth and later. It has a slowly progressing course. Among current techniques applied for treating skin venous malformations, the most promising one is laser transdermal coagulation with wavelength 1064 nm.

   Material and methods. The article describes two clinical cases of external venous malformation treated with Nd:YAG transdermal laser coagulation using Aerolase laser device, Micropulse technology, pulse duration 650 microseconds.

   Results. The technique of transdermal Nd:YAG laser coagulation on the Aerolase apparatus has been used in our department since February 2021 to the present. In total, for the period from 2021 to May 2023, 98 patients with venous malformations of various localization were treated with this method. In all clinical cases, a stable positive result was achieved, consisting in a decrease in the number of pathological vessels and the area of the lesion, or its complete disappearance. According to the results of treatment, no complications were observed.

   Conclusion. Laser coagulation of pathological venous vessels of external location is an effective and safe modality for treating children of any age.

   Introduction. Torsion of the appendix is an extremely rare pathology in both adults and children. In this article, the authors report about two cases of appendix torsion which were revealed intraoperatively.

   Case description. Clinical observation 1: A 2-year-old boy was admitted to the surgical department with suspected acute appendicitis. On examination, the entire abdominal region was painful, the symptom of passive muscle defense was noted on the right. Ultrasound examination revealed changes in the appendix. Intraoperatively, torsion of the appendix was detected. Laparoscopic appendectomy was performed. The postoperative course was uneventful. Clinical observation 2: A 5-year-old boy was admitted to the surgical department with complaints of abdominal pain. Physical examination revealed the clinical picture of acute abdomen. At ultrasound examination, signs of altered appendix were seen. During diagnostic laparoscopy, torsion of the appendix was detected. Laparoscopic appendectomy was performed. The postoperative course was uneventful.

   Conclusion. The discussed two clinical cases indicate the necessity to include torsion of the appendix in the list of diagnoses for differential diagnostics in case of acute abdomen.

   EDITORIAL COMMENT. This clinical observation presents an effective application of elements of the abdominal damage-control tactics after postoperative intra-abdominal bleeding relapse under developed coagulopathy and previously underestimated liver damage during surgery. If an “unstable” patient with prolonged internal bleeding is admitted, it is recommended to apply this tactics in the primary surgical intervention with liver packing which would prevent postoperative bleeding and further development of coagulopathy. After patient’s hemodynamics is stabilized, it is necessary to make a complete patient’s examination so as to timely detect all associated injuries.

   Introduction. Closed trauma of abdominal organs in children in some cases is accompanied by severe complications or death. At the same time, liver injury occupies a leading place in the structure of the abovementioned pathology. Currently, in case of severe injuries of the abdominal organs accompanied by unstable hemodynamics and with a high risk of unfavorable outcomes after radical surgical intervention, surgeons prefer to apply the damage control technique in such patients.

   Material and methods. The authors discuss a case of successful management of a child injured in a traffic accident. He had multiple closed liver injuries of class III and hemorrhagic shock of degree 3. The DAMAGE CONTROL technique was applied during relaparotomy after intra- abdominal bleeding relapse developed.

   Results. In this given case, the damage control technique has promoted a successful outcome after staged surgical treatment without any complications in the immediate and late postoperative periods.

   Conclusion. In case of abdominal cavity trauma in children having hemorrhagic shock and prolonged bleeding from liver wounds, the damage control technique promotes stabilization of patient’s state, arrests bleeding and gives precious time to finish surgical intervention in more favorable situation for both patients and surgeons.

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