Novosti
Khirurgii

O.A. KUDELICH ¹, G.G. KANDRATSENCA ¹, M.P. POTAPNEV ²

APPLICATION OF PLATELET-RICH PLASMA IN SEVERE ACUTE EXPERIMENTAL PANCREATITIS

Belarusian State Medical University ¹,
Republican Research & Production Center for Transfusiology & Medical Biotechnologies ², Minsk,
Republic of Belarus

Objective. To determine the effect of regional application of platelet-rich plasma on the systemic manifestations of severe acute experimental pancreatitis in rats.
Methods. This experimental study was carried out on 42 adults Wistar rats. Acute experimental pancreatitis (AEP) was induced by the introduction of a 0.3 ml of 5% solution of nonionic polyethylene glycol octylphenol ether detergent into the caudal part of the pancreas. The animals were randomly divided into 4 groups: Group I (n=6) - intact animals, Group II (control group) (n=12) – rats with AEP without treatment, Group III (n=12) - rats with AEP treated: anesthesia + infusions of 0.9% sodium chloride solution (saline), Group IV (n=12) - rats with AEP treated: anesthesia + infusions of saline + regional application of platelet-rich plasma (PRP). Animals were taken out of the experiment by euthanasia on the 3rd and 7th day. The hematological parameters, markers of systemic manifestation of the pathological process (pancreatic amylase, ASAT, ALAT, urea, creatinine), markers of endogenous intoxication (lipid peroxidation activity, nitric oxide level), markers of systemic inflammatory response (C-reactive protein, tumor necrosis factor-alpha, interleukin-6) have been evaluated.
Results. The application of PRP in the early stages of severe AEP favorably affects the change of the number and size of platelets, helps to reduce the content of free radical oxidation products, enzymes and endogenous intoxication elements, which are key links in the pathogenesis of severe acute pancreatitis. The cytoprotective effect of using PRP in the early stages of AEP on the prevention of cytolysis of hepatic and other body cells was revealed.
Conclusion. Experimental studies have revealed the ability of regional application of PRP in the early stages of AEP in rats to have a systemic positive effect, which allows considering it as a promising agent for pathogenetic treatment.

A.A. SEMAGIN ², O.P. LUKIN ^{1, 2}, A.A. FOKIN ¹

ADVERSE CARDIOVASCULAR EVENTS IN PATIENTS UNDERGOING EMERGENCY PERCUTANEOUS CORONARY INTERVENTION AFTER CORONARY ARTERY BYPASS GRAFTING

Federal State Budgetary Educational Institution of Higher Professional Education
«South Ural State Medical University» of the Ministry of Health of the Russian Federation ¹,
Federal State Budgetary Institution «Federal Center for Cardiovascular Surgery»
of the Ministry of Health of the Russian Federation ², Chelyabinsk,
Russian Federation

Objective. To study the rate of long-term mortality and major adverse cardiovascular events within 10 years in patients undergoing emergency endovascular myocardial revascularization in the early postoperative period after planned coronary artery bypass surgery.
Methods. From 2011 to 2020 8801 patients underwent isolated coronary artery bypass grafting in the Federal State Budgetary Institution «FTSSSH» of the Ministry of Health of the Russian Federation in the city of Chelyabinsk. Due to signs of acute myocardial ischemia, 196 (2.23%) patients underwent emergency coronary angiography. Inclusion criteria in the study were as follows: patients (n=60; 0.68%) with a stable form of cardiac ischemia, who underwent emergency stenting due to acute grafts dysfunction after elective coronary artery bypass grafting based on coronary angiography. Exclusion criteria: patients who underwent urgent coronary artery bypass grafting, patients from the endovascular treatment group (n=6/10%) who deceased in the clinic within 30 days, patients with whom contact was lost after their discharge from the hospital (n=14/23,3%). Mortality has long been used as a primary end point for randomized controlled trials in critical care; cardiovascular events was considered as the secondary endpoint. To conduct a comparative analysis by random number generation, group II (n=60) consisting of patients with an uncomplicated postoperative period was formed. The exclusion criteria were just the same (deceased in the clinic n=1/1.6% and loss of communication after discharge from the hospital n=6/10%). After application of exclusion/inclusion criteria, group I included 40 patients and group II 53 patients. To ascertain patient reports of problems after discharge the telephone interviews have been conducted.
Results. When comparing the long-term total mortality rate in patients of group I (106.3±5.9 months) and group II (87.5±3.8 months), no statistically significant differences were found (p=0.737) in the incidence of major adverse cardiovascular events in Group I and Group II. There were also no statistically significant differences in vascular events in group I and group II, 111.5±4.8 months and 87.8±4.2 months, respectively (p=0.582). When conducting a multivariate Cox regression analysis in group I, this study shows that increasing age in 1 year significantly contribute to a fatal outcome in 1,361 fold (p=0,015), a decrease in LV EF by 1% - by 1/0.854 fold (p=0.012), with an increase in time from the first result of the analysis of Troponin I to stenting procedure for 1 hour by 1.029 folds (p=0.023).
Conclusion. When comparing long-term mortality rate and adverse cardiovascular events in the group of patients undergoing emergency stenting with the control group, no statistically significant difference was found. Factors that increase the risk of lethality in the long-term period in the stenting group were: the patient’s age, left ventricular ejection fraction in the preoperative period, the time elapsed from the results of the first Troponin I test to stenting procedure.

S.G. GAVRILOV, I.S. LEBEDEV, A.V. VASILIEV, N.YU. MISHAKINA

RATIONALE OF VENOUS OBSTRUCTION STENTING

Savelyev University Surgical Clinic, Pirogov Russian National Research Medical University, Moscow,
Russian Federation

Objective. The aim of this study is to substantiate the expediency of using stenting in patients with chronic venous obstruction, based on literature data and real clinical practice.
Methods. A systematic search of current literature on the application of various stents in the treatment of chronic thrombotic and non-thrombotic obstruction of the iliac veins was conducted by browsing the Pubmed, MEDLINE и Google Scholar.
In addition to clinical efficacy, economic aspects of the application of venous stenting in the treatment of chronic venous obstruction have been studied. Clinical observations are presented demonstrating the possibilities of iliac vein stenting in patients with post-thrombotic disease, a combination of May-Turner syndromes and pelvic congestion syndrome.
Results. Currently, both classical and special venous stents are used for stenting of large veins. The latter have greater flexibility and radial strength, and their use is not accompanied by such complications as stent occlusion of the contralateral common iliac vein and conical narrowing of the ends of the stent. The literature data indicate the high efficiency of stenting in restoration of the iliac vein lumen in thrombotic and non-thrombotic obstructions of the iliac veins, and stent patency ranges from 79 to 100% within 1-3 years. The authors report on the relief of edematous and pain syndromes, and healing of trophic ulcers in 70-100% of patients. Studies comparing the cost of venous stenting and standard conservative treatment indicate that the use of endovascular intervention is accompanied by a significant reduction in the economic costs of the treatment, a reduction of expenditures of a medical institution, and a decrease in the period of temporary disability among patients. Clinical observations presented in the study are based on the real clinical practice of the authors of this work and confirm the literature data.
Conclusion. The application of venous stenting is an effective and safe method of restoring the patency of the main veins, which can relieve the clinical manifestations of chronic venous insufficiency and pelvic venous congestion syndrome. This method is also accompanied by a decrease in economic costs in the treatment of patients with chronic venous obstructions.

S.I. PIMANOV ¹, I.A. LIUTSKO ², S.V. MALASHENKA ³, K.V. MOSKALEV ¹, SAKR ALI ¹, P.P. LAKISAU ³, V.A. DUBNIAK ¹

XANTHOGRANULOMATOUS CHOLECYSTITIS: A RARE DISEASE WITH ATYPICAL ASSYMPTOM COURSE

Vitebsk State Medical University ¹,
Vitebsk Regional Clinical Hospital ²,
Vitebsk Regional Clinical Pathological Bureau ³, Vitebsk,
Republic of Belarus

Xanthogranulomatous cholecystitis is a rare form of inflammation of the gallbladder, the characteristic morphological feature of which is thickening of the wall, its focal or diffuse destructive inflammatory process, followed by pronounced proliferative fibrosis, infiltration by macrophages, giant multinucleated and foamy cells, and xanthomas or ceroid cells are ultimately formed granulomas. The purpose of this work was to demonstrate the diagnosis and surgical treatment of a rare variant of gallbladder disease – xanthogranulomatous cholecystitis – in its atypical asymptomatic clinical course. A case of xanthogranulomatous cholecystitis is described. A 75-year-old patient was admitted in a planned manner for surgical treatment of a recurrence of an inguinal-scrotal hernia on the right. According to complaints, anamnesis and objective examination, there were no signs of gallbladder diseases. There were no pathological changes in the general blood test. An ultrasound examination revealed a pronounced thickening of the gallbladder wall and calculi in its cavity, as well as the presence of areas of reduced echogenicity in the gallbladder wall. Calculi were determined in the cavity of the gallbladder; the wall of the gallbladder was markedly thickened with the presence of areas of reduced echogenicity. There was no blood flow in the bladder wall according to color Doppler mapping. According to the results of computed tomography, thickening of the bladder wall was also recorded; however, it was not possible to make a differential diagnosis of xanthogranulomatous cholecystitis and gallbladder cancer. After cholecystectomy, an unexpected morphological finding was the presence of a pronounced inflammatory process with necrosis of the mucous membrane of the gallbladder wall. Probably, in rare cases, xanthogranulomatous cholecystitis with acute inflammation may be oligosymptomatic or asymptomatic.

R.Y. ALIYEV ^{1, 2}, А.М. JAFAROV ², K.M. MAMMADOV ², N.Y. BAYRAMOV ¹

ENDOBILIARY SURGERY OF MECHANICAL JAUNDICE OF TUMOR GENESIS

Department of Surgical Diseases-I Azerbaijan Medical University ¹,
Military Hospital of the Head Military-Medical Department of the State Security Service of the Republic of Azerbaijan ², Baku,
Republic of Azerbaijan

Objective. To present the results of minimally invasive biliary endo-interventions in patients who categorically refused radical, extended and palliative open surgeries, as well as inoperable and incurable patients with obstructive jaundice of tumor origin.
Methods. A multi-stage diagnostic process with the aim of final verification of the underlying disease and determination of its stage has been carried out. In patients (n=38) with inoperable malignant neoplasms of the hepatopancreatoduodenobiliary zone complicated by obstructive jaundice, the minimally invasive endoscopic interventions were performed: nasobiliary, percutaneous-transhepatic biliary drainage, endoprosthetics of the extrahepatic bile ducts and electro- (photo) destruction of the large papilla.
Results. In contrast to plastic prostheses, after the use of metal self-expanding prostheses, the incidence of displacement, deformation, migration and blockages has significantly decreased. It was established that the best long-term results were obtained when choosing the most optimal endo-intervention, depending on the quality of its implementation, in cases of using metal stents in patients with a low localization of the tumor process and smaller sizes, a shorter anamnesis of obstructive jaundice, without concomitant diseases and dysfunction of vital organs, in persons of middle (40-50 yrs.) and relatively elderly (51-65 yrs) age.
Conclusion. In patients who categorically refused radical, vast and palliative open surgeries, as well as inoperable and incurable patients, minimally invasive endoscopic and percutaneous biliary interventions should be the method of choice for obstructive jaundice of malignant origin.

I.A. MATVEEV ^{1, 2}, B.K. GIBERT ^{1, 2}, F.S. ALIYEV ¹, N.A. BORODIN ¹, A.I. MATVEEV ², L.A. MOROZOVA ³, N.N. POVARNIN ³, T.I. PAYUSOVA ⁴

STUDY OF THE ACQUISITION OF EXPERIENCE IN PERFORMING LASER VAPORIZATION OF HEMORRHOIDS

Federal State Budgetary Educational Institution of Higher Education "Tyumen State Medical University" of the Ministry of Healthcare of the Russian Federation ¹,
Tyumen Regional Clinical Hospital ²,
«NanoMed Plus» ³,
Federal State Autonomous Educational Institution of Higher
Education Tyumen State University ⁴, Tyumen,
Russian Federation

Objective. To study the set of experience of laser vaporization in the treatment of chronic hemorrhoids by the method of constructing learning curve
Methods. Based on 90 isolated LV performed by one surgeon, the process of gaining experience by constructing learning curves was studied. The criteria of mastery were the duration of the operation, the intensity of the pain syndrome, the frequency of postoperative bleeding.
Results. The duration of the period of mastering the experience, determined by the regression method, based on the time of the intervention, depending on the goal, was 4, 23 and 66 operations. On the basis of postoperative bleeding with the task of reducing their frequency by 2 times, performed by the CUSUM test, the period of LV development was 36 operations.
Discussion. The results of the study made it possible to explain the reasons for the differences in the duration of the experience of laser transmucous vaporization of hemorrhoids, depending on the chosen model for constructing the learning curve, the sign of experience, and the goals set for achieving it. The most objective way to study the experience of LV is CUSUM analysis of the frequency of postoperative bleeding
Conclusion. The use of various mathematical models and signs of experience allows you to build an objective graph of the learning curve and obtain the most reliable research results.

K.F. CHERNOUSOV, R.V. KARPOVA, K.S. RUSSKOVA

PERCUTANEOUS MICROWAVE ABLATION OF A NON-PARASITIC SPLENIC CYST COMPLICATED BY PREVIOUS INTRACAVITAL BLEEDING. CASE REPORT

I.M. Sechenov First Moscow State Medical University, Moscow,
Russian Federation

Nonparasitic cysts of the spleen are a rare pathology. The need for their surgical treatment is due to the development of complications, including suppuration, hemorrhage into the cyst cavity and its rupture. A 28-year-old patient with a spleen cyst measuring 8x9x9 cm underwent repeated microwave ablation with prior drainage of the cavity with proteolytic enzymes. An obturation of residual cavity of the cyst occured, the postoperative period was uneventful. In case of previous hemorrhage into the cyst cavity, 24 hours before MVA, the cavity should be drained in order to lyse the blood clot using proteolytic enzyme preparations.

K.I. SERGATSKIY ^{1, 2}, V.I. NIKOLSKY ¹, M. ALJABR ¹, I.V. MALYAKIN ², E.O. SEMENOVA ¹, A.A. SHANINA ¹

CLINICAL OBSERVATIONS OF MALIGNANT TRANSFORMATION OF THE PILONIDAL CYST

Medical Institute FSEI HPE “Penza State University” ¹,
SBHI “Penza Regional Clinical Hospital Named by. N.N. Burdenko” ²,
Russian Federation

Objective. To provide clinical examples of pilonidal cyst malignant transformation and to give recommendations on implementing oncological alertness in patients with long-term carriage of the epithelial coccygeal tract.
Methods. This publication describes two clinical cases of malignant transformation of the epithelial coccygeal tract. The surgical tactic consisted of a wide excision of formations within healthy tissues, together with fistulous openings and infiltratively changed soft tissues and skin over them in a single block up to the sacral fascia.
Results. Healing occurred by secondary intention. Histological examination showed «tumor-negative» resection margins, indicating an R0 resection was performed. The treatment carried out allowed for a satisfactory clinical result.
Discussion. Physicians should be aware of the possible malignant transformation of pilonidal disease, despite the rarity of this kind of complication.
Conclusion. Recommendations are given for implementing oncological alertness in patients with long-term carriage of pilonidal cysts.

THE 50TH ANNIVERSARY OF ALEXEY EVGENIEVICH SHCHERBA

On May 9, 2023, Aleksey Evgenievich Shcherba, one of the leading surgeons of the Republic of Belarus, Doctor of Medical Sciences, Professor, Deputy Director for Surgery of the State Institution "Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology" celebrated his 50th anniversary.
A.E. Shcherba was born in Minsk in the family of doctors.
After finishing the secondary school No. 54 in Minsk, he entered Minsk State Medical Institute, from which he graduated with honors in 1996 and was referred to the clinical residency at the department of surgical diseases No. 2 of Minsk State Medical Institute on a specialty “Surgery”.

After training in residency A.E. Shcherba started work as a surgeon at the emergency surgery department of the City Clinical Hospital No. 9 in Minsk. In 2006, without interrupting his practical activities, he defended his Ph.D. thesis on the topic: “Peculiarities of local treatment of necrotizing parapancreatitis” in the specialty 14.01.17 - “surgery” (under the supervision of Academician of the National Academy of Sciences, Prof. S.I. Tretyak).
The time of advancing of A.E. Shcherba as a practical surgeon and scientist coincided with the beginning of a new medical field development in our country - clinical transplantology. A.E. Shcherba became one of the main protagonists of a young team of like-minded enthusiasts, who were gathered by a new Head of the surgical service of the City Clinical Hospital No. 9 in Minsk, and now the director of the State Institution "Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology" acad. NAS, prof. O.O. Rummo.
A.E. Shcherba was in the team of specialists who performed the country's first liver transplant on April 2, 2008, and the second operation - on April 13. Great merit of Aleksey Evgenievich is that this operation from a unique one subsequently became accessible. He was entrusted to supervise the liver transplantation program and its development in the transplantology department founded in 2010 in the Republican Scientific and Practical Center "Transplantation of Organs and Tissues" on the basis of the 9th City Clinical Hospital, Minsk.
This activity helped to reveal fully the natural gift of A.E. Shcherba - surgical practice full of quests, based on enormous diligence and the broadest medical erudition, natural curiosity and the desire to “get to the very essence” in everything. Since that time Alexei Evgenievich has performed hundreds of operations; not only residents of our republic, but also patients from all countries of the former Soviet Union and many foreign countries began to turn to him for a consultation. At present, A.E. Shcherba is a recognized authority in the diagnosis and treatment of the liver and pancreas diseases, transplant surgery, oncology and immunosuppression not only in our republic, but also far beyond its borders. A special merit of A.E. Shcherba was the program of the pediatric liver transplantation, successfully implemented in our country.
As a team member of Belarusian specialists, Aleksey Evgenievich took an active part in the development of national programs for liver transplantation in adults and children in the fraternal republics - the Republics of Kazakhstan and Armenia, he selected, planned and performed operations in foreign patients, including patients from the countries with a highly developed medicine, such as Israel, Japan, USA, UAE. Also, the successful liver transplantation performed by the team of specialists led by O.O. Rummo to Israel statesman M. Dogan, in which A.E. Shcherba took an active part gained much international attention.
An incomplete list of scientific interests of A.E. Shcherba and his practical achievements are striking in their vastness: the development and implementation in clinical practice of modern surgical technologies for the treatment of patients with severe lesions of the liver, pancreas, liver transplantation, the use of cellular technologies, optimization of immunosuppression, the principles of selecting a recipient and allocating a donor organ, transplantation oncology, liver surgery and the principles of vascular isolation and blood saving, the principles of biliary reconstruction, liver pathology during pregnancy and trauma, the use of vascular allografts in hepatopancreatic surgery, portal hypertension syndrome.
In 2018, without discontinuing his practical work, A.E. Shcherba successfully defended his doctoral dissertation on the topic: "Prediction and complex treatment of postoperative dysfunction of the liver transplants" in the specialty 14.01.24 - "transplantation and artificial organs" (supervisor - Academician of the National Academy of Sciences, Prof. Rummo O.O.), and in 2023 he was awarded the title of professor.
It should be noted that the scientific activity of Alexei Evgenievich is marked by the desire for a deep pathophysiological elaboration of the studied problem. This allows the author to make highly reasoned conclusions and recommendations. And in daily practice, encyclopedic knowledge, experience and critical thinking allow him to use the same pathophysiological approach to choosing a treatment strategy and tactics for each patient, to logically justify his decisions during rounds, numerous consultations and discussions with colleagues.
Since 2018 up to the present, Shcherba A.E. has been Head of the surgical service of the State Institution "Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology" as deputy director for surgical work.
One Ph.D thesis has been defended under the supervision of A.E. Shcherba. The results of his scientific research are shown in more than 300 publications. He is the author and co-author of 10 patents of the Republic of Belarus and 1 Eurasian patent. Alexey Evgenievich has been actively teaching since the beginning of the organization of the department of transplantology of BelMAPO, since 2010 - as associate professor, and since 2018 as Professor of the department.
Achievements of A.E. Shcherba were marked bya number of government awards of the Republic of Belarus - for the work "Development and implementation of organ transplantation technologies in children and adults" in 2016 A.E. Shcherba, together with co-authors, was awarded the State Prize of the Republic of Belarus.
Alexei Evgenievich was awarded the title of "Excellent Health Worker of the Republic of Belarus", he was awarded the diploma of Minsk City Executive Committee, the medal of the Belarusian Orthodox Church of St. Euphrosyne of Polotsk, a badge "For Contribution to the Development of Healthcare in Kazakhstan".
In addition to the professional and scientific accomplishments A.E. Shcherba enjoys great respect and love not only among the staff of the State Institution "Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology", but also among all his colleagues - for his readiness to help immediately, take responsibility, for his innate tact, goodwill and respect in relation to subordinates, and to everyone who has ever addressed him.
Alexei Evgenievich meets his 50th birthday in the prime of his creative powers, full of energy and new ideas among like-minded people dedicated to the common goal.
The staff of the State Institution "Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology" is convinced that, despite all the achievements, Alexei Evgenievich is just entering the period of his creative rise. “The main matches have not been played...”, as Eduard Khil once sang.
The staff of the State Institution "Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology" heartily congratulates Alexei Evgenievich on his anniversary, wishes him health, creative success and well-being!