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Year 2023 Vol. 31 No 5

SCIENTIFIC PUBLICATIONS

E.A. TONEEV, R.F. SHAGDALEEV, O.V. PIKIN, A.A. MARTYNOV, O.V. MIDLENKO, G.R. CHUKANOVA

FREQUENCY AND INDICATORS OF PROLONGED PLEURISY DEVELOPMENT AFTER LOBECTOMY FOR LUNG CANCER

Ulyanovsk Regional Clinical Oncologic Dispensary,
Ulyanovsk State University, Ulyanovsk,
Moscow Research Institute of Oncology named after P.A. Herzen - branch. P.A. Herzen Oncology Research Institute - branch of FGBU "National Medical Research Center of Radiology",
Ministry of Health of Russia, Moscow,
Russian Federation

Objective. To identify prognostic factors associated with prolonged postoperative pleural effusion after lobectomy for lung cancer.
Methods. The study was conducted on the base of the surgical department of thoracic oncology of the State Budgetary Healthcare Institution «Oncology Clinical Dispensary» in Ulyanovsk. The analysis included patients who underwent lobectomy with ipsilateral mediastinal lymph node dissection from March 01, 2023, to November 10, 2023. A total of 111 surgical interventions were performed; 66 patients were excluded from the study. 45 patients were included in the study, 23 of whom had no prolonged pleural effusion, and 22 patients experienced prolonged postoperative pleural effusion. Characteristics of the study participants were assessed using a standardized protocol.
Results. The frequency of prolonged pleural effusion development was 22/45 (48.9%). In conducting a multifactorial analysis of the probability of prolonged pleural effusion development, two statistically significant indicators were identified: «neutrophil-leukocyte index on the 5th day» and «protein in drainage fluid on 2nd day.» Threshold values for these parameters were determined: for the protein in drainage fluid on the 2nd day – 32.1 g/L, for the neutrophil-leukocyte index on the 5th day – 2.889. Beyond these threshold values, the risk of developing prolonged pleuritis statistically increased (p<0.001).
Conclusion. The frequency of prolonged pleuritis development was 22/45 (48.9%). Multifactorial analysis revealed statistically significant criteria: the neutrophil-leukocyte index on the 5th day and the protein quantity in pleural fluid on the 2nd day. When these values exceed the threshold, the risk of prolonged pleuritis development in patients increases (p<0.001).

Keywords: prolonged pleurisy, lung cancer, lobectomy, lung resection
p. 351-361 of the original issue
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Address for correspondence:
432017, Russian Federation,
Ulyanovsk, 12, September st. 90,
Regional State Health Institution
Clinical Oncology Dispensary,
tel. +79084731198,
e-mail: e.toneev@inbox.ru,
Toneev Evgeniy A.
Information about the authors:
Toneev Evgeniy A., PhD, Thoracic Surgeon of the Surgical Department of Thoracic Oncology of the State Healthcare Institution Regional Clinical Oncology Dispensary of Ulyanovsk, Associate Professor of the Department of Faculty Surgery, Faculty of Medicine named after T.Z. Biktimirova, Institute of Medicine, Ecology and Physical Culture, Ulyanovsk State University, Ulyanovsk, Russian Federation.
https://orcid.org/0000-0001-8590-2350
Shagdaleev Roman F., Resident of the Department of Hospital Surgery, Anesthesiology, Resuscitation, Urology, Traumatology And Orthopedics, Faculty of Dentistry, Pharmacy and Postgraduate Medical Education, Institute of Medicine, Ecology and Physical Culture, Federal State Budgetary Educational Institution of Higher Education Ulyanovsk State University, Ulyanovsk, Russian Federation
https://orcid.org/0009-0004-0218-666X
Pikin Oleg V., MD, Professor, Head of the Thoracic Surgical Department, Moscow Oncological Institute named after. P.A. Herzen – Branch of the Federal State Budgetary Institution «National Medical Research Center of Radiology» of the Ministry of Health of Russia, Moscow, Russian Federation
https://orcid.org/0000-0001-6871-6804
Martynov Alexander A., Thoracic Surgeon, Head of the Surgical Thoracic Department of the State Healthcare Institution, Ulyanovsk, Russian Federation
https://orcid.org/0000-0003-4662-9886
Midlenko Oleg V., MD, Professor of the Department of Hospital Surgery, Ulyanovsk State University. Ulyanovsk, Russian Federation.
https://orcid.org/0000-0001-8076-7145.
Chukanova Gulfiya R., Physician of Clinical Laboratory Diagnostics, Head of Laboratory, State Health Institution Regional, Clinical Oncology Dispensary , Russian Federation
https://orcid.org/0009-0005-7020-8522

M.YU. PIKUNOV 1, A.A. PECHETOV 1, O.O. GOLOUNINA 2, E.V. BONDARENKO 2, Z.E. BELAYA 2

SURGICAL TREATMENT OF PATIENTS WITH ACTH-PRODUCING NEUROENDOCRINE TUMOR OF BRONCHOPULMONARY LOCALIZATION: THE EXPERIENCE OF NATIONAL MEDICAL RESEARCH CENTER FOR SURGERY NAMED AFTER A.V. VISHNEVSKY

National Medical Research Center of Surgery named after A. V. Vishnevsky of the Ministry of Health of the Russian Federation 1,
National Medical Research Center for Endocrinology 2, Moscow,
Russian Federation

Objective. To create a methodological scheme for effective surgical treatment of patients with bronchopulmonary ACTH-producing neuroendocrine tumors (NET), varying severity of hypercortisolism, with minimal risk of early postoperative complications.
Methods. The study included patients who underwent examination and surgical treatment of ACTH-producing NET of bronchopulmonary localization in the period from 2004 to August 2023. Demographic information about patients, anamnesis data, results of hormonal and instrumental studies at pre- and postoperative stages, long-term treatment results have been analyzed. The control follow-up period after surgery ranged from 6 months to 5 years.
Results. The study included 74 patients. The age at the time of diagnosis of the disease ranged from 21 to 76 years, in an almost equal ratio of men and women. Due to the severity of the condition, 3 patients were denied surgical treatment. 71 patients underwent surgery. Atypical lung resection was performed (n=27 (38%)), segmentectomy (n=19 (26.8%)), lobectomy (n=25 (35.2%)) with a radicality index of R0. Typical carcinoid was verified in 48 patients (67.6%), atypical carcinoid – in 23 (23.4%). Single metastases in remote mediastinal lymph nodes were detected in 8 patients. A decrease in blood cortisol 60 minutes after the removal of the tumor was noted in 90% of patients. No postoperative complication was reported. Repeated surgical intervention for 6 patients was performed after 12-36 months of follow-up. 60 months of follow-up later it was possible to obtain data from 46 patients. The lethality was 5 patients.
Conclusion. In the surgical treatment of patients with ACTH-producing pulmonary NET it is necessary to be guided by the scale of condition severity assessment, the data of radiation diagnostics, preoperative possible verification to select an adequate volume of surgical intervention. The analysis of this experience of surgical treatment does not differ from the indicators in other world clinics. Its advantage include the absence of postoperative complications.

Keywords: ectopic ACTH-syndrome (EAS); neuroendocrine tumor (NET); hypercortisolism; bronchial carcinoid; surgical treatment; long-term results
p. 362-373 of the original issue
References
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Address for correspondence:
115093, Moscow, Russian Federation,
Bolshaya Serpukhovskaya, st. 27,
National Medical
Surgery Research Center,
Named after A.V. Vishnevsky,
e-mail: pikunov@ixv.ru,
Pikunov Mikhail Y.
Information about the authors:
Pikunov Mikhail Y., PhD, leading researcher at the Department of Thoracic Surgery, National Medical Research Center for Surgery named after. A.V. Vishnevsky» of the Russian Ministry of Health of Russian Federation. Moscow, Russian Federation.
http://orcid.org/0000-0003-0559-4461
Pechetov Alexey A., PhD, Head of the Department of Thoracic Surgery, National Medical Research Center for Surgery named after. A.V. Vishnevsky» of the Russian Ministry of Health of Russian Federation. Moscow, Russian Federation.
http://orcid.org/0000-0002-1823-4396
Golounina Olga O., Clinical Resident of the State Scientific Center of the Russian Federation, Federal State Budgetary Institution «National Medical Research Center for Endocrinology» of the Ministry of Health of Russian Federation. Moscow, Russian Federation.
https://orcid.org/0000-0003-2320-1051
Bondarenko Ekaterina V., PhD, Head of the Biobanking Group of the State Research Center of the Russian Federation, Federal State Budgetary Institution «National Medical Research Center for Endocrinology» of the Ministry of Health of Russian Federation. Moscow, Russian Federation.
https://orcid.org/0000-0003-2122-2297
Belaya Zhanna E., MD, Head of the Department of Neuroendocrinology and Osteopathy, Professor of the Department of Endocrinology of the Institute of Higher and Additional Professional Education of the State Scientific Center of the Russian Federation, Federal State Budgetary Institution «National Medical Research Center for Endocrinology» of the Ministry of Health of Russian Federation, Moscow, Russian Federation.
http://orcid.org/0000-0002-6674-6441

E.P. BURLEVA, A.V. PESHKOV, S.A. TYURIN, S.M. BELENTSOV, M.A. MATVEEVA, M.E. ONOKHINA, I.O. OSEEV

LOWER LIMB VARICOSE VEIN RECURRENCES: STRUCTURE AND TACTICAL DECISIONS (A START-UP STUDY)

Federal State Budgetary Educational Institution of Higher Professional Education
"Ural State Medical University", Ministry of Health of the Russian Federation 1,
"Olmed" 2,
"AngioLine" 3, Ekaterinburg,
Russian Federation

Objective. Analysis of the structure of recurrences of varicose veins (VV) of the lower extremities and surgical tactics of their treatment.
Material and Methods. A retrospective analysis of the medical documentation of two phlebological centers during the period from 2020 to 2013 was carried out. 566 cases of recurrent VV in 504 patients were detected (78.8% of women; 21.2% of men; average age – 44.5 years). 2 groups were formed. In the 1st group - 285 cases, the first intervention in the GSV basin was phlebectomy (FE)\stripping; in the 2nd group – 245 – endovasal thermal ablation interventions (EVTI) (RFQ-103, EVLC – 142). The analysis of the material was based on a new classification of VV recurrences (ESVS guidelines, 2022).
Results. The recurrences of the disease after EVTI were detected in 271 cases (7.4%): 159 cases after EVLC (9.5%), 112 cases after RFQ (5.6%). The percentage of recurrences after phlebectomies was 10.4%. According to the analysis of the structure of recurrences, the percentage of technical and tactical errors after EVTI was 2.2%, after FE – 1.6%. The main part of recurrences was associated with the progression of VV and neovascularization on the high. New vertical overflows on the thigh were registered in 169 cases (57.3%) after FE and in 77 cases after EVTI (28.4%). In the EVTI group, a significant part of recurrences accrues to horizontal reflux – 102 cases (37.6%), in the FE group – 65 cases (22.0%). Recurrences associated with changes in the SSV basin: after EVTI – 11.8%, after FE – 10.4%. In a comparative analysis of the results of EVLC and RFQ, the difference was only in the percentage of medical errors (2.5% vs. 1.6%, respectively). Reinterventions (n=370) were performed in patients with venospecific complaints, recurrence of varicose syndrome, the presence of new refluxes in large tributaries with drainage into recanalized GSV or into another venous structures. EVLC and different variants of sclerotherapy were used. During 1-year observation, there were no complications or additional interventions, occlusion of the target veins was achieved.
Conclusion. Regardless of the type of surgical intervention on the stem of GSV, VV recurs in about 10% of patients. The pathological mechanisms of restructuring of the venous bed of the limb after phlebectomy \ stripping and EVTI were different. The use of minimally invasive endovasal interventions was a justified tactic for the treatment of recurrent VV.

Keywords: varicose veins of the lower extremities, endovasal laser coagulation, radiofrequency ablation, phlebectomy\stripping, reñurrences, classification, tactics
p. 374-382 of the original issue
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  17. Burleva EP, Tiurin SA, Peshkov AV. Ctripping vs endovazal’nye termoablatsionnye vmeshatel’stva pri varikoznoi bolezni: 5-letnie kliniko-gemodinamicheskie rezul’taty randomizirovannogo issledovaniia. Khirurg.2022;(9):28-40. doi: 10.33920/med-15-2205-04 (In Russ.)
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  20. Mouton W, Heim D, Janzen J. Neovascularization of saphenous veins. J Vasc Bras. 2019 May 7;18:e20190030. doi: 10.1590/1677-5449.190030
  21. Labropoulos N, Bhatti A, Leon L, Borge M, Rodriguez H, Kalman P. Neovascularization after great saphenous vein ablation. Eur J Vasc Endovasc Surg. 2006 Feb;31(2):219-22. doi: 10.1016/j.ejvs.2005.06.030
Address for correspondence:
620102, Russian Federation,
Ekaterinburg, Volgogradskaya st, 189,
MAU GKB No. 40
Tel: 8 912 600 300 8.
e-mail: e.p.burleva@gmail.com
Burleva Elena Pavlovna
Information about the authors:
Burleva Elena P., MD, Professor of the Department of Surgery, Endoscopy and Coloproctology of the Ural State Medical University, Cardiovascular Surgeon, Professor, Honored Doctor of the Russian Federation, Yekaterinburg, Russian Federation.
http://orcid.org/ 0000-0003-1817-9937
Peshkov Andrey V., PhD, Cardiovascular Surgeon, Chief Physician of the Olmed Network of Medical Centers, Yekaterinburg, Russian Federation.
http://orcid.org/ 0000-0002-9246-0463
Tyurin Sergey A., PhD, Cardiovascular Surgeon, Chief Physician of the Olmed MC, Yekaterinburg, Russian Federation.
https://orcid.org/0000-0001-5125-4295
Belentsov Sergey M., MD, Professor, Cardiovascular Surgeon at the AngioLine MC, Yekaterinburg, Russian Federation.
https://orcid.org/0000-0002-3742-8954
Matveeva Marina A., Cardiovascular Surgeon MC «Olmed», Ekaterinburg, Russian Federation.
https://orcid.org/0009-0009-6184-872Õ
Onokhina Margarita E., Clinical Resident of the Department of Surgery, Endoscopy and Coloproctology, Ural State Medical University.
https://orcid.org/0000-0003-4912-7996
Oseev Ilya O., Student of the Faculty of Treatment and Prevention of the Federal State Budgetary Educational Institution of Higher Education “Ural State Medical University”, Ekaterinburg, Russian Federation.
https://orcid.org/0009-0000-1720-4649

REVIEWS

E.V. DENISENKO

RECTAL FISTULAS: CURRENT STATE OF THE PROBLEM, DIRECTIONS OF SURGICAL TREATMENT (LITERATURE REVIEW)

The Vitebsk Regional Clinical Specialized Centre,
The Vitebsk State Order of Friendship of Peoples Medical University, Vitebsk,
Republic of Belarus

Based on the literature data, an analysis of the current state of the problem of rectal fistulas is carried out in a comparative aspect: the causes of their occurrence, classification, and effectiveness of existing surgical treatment methods. The text database of medical and biological publications PubMed (based on the section «biotechnology» of the National Library of Medicine of the USA) was used through NCBI-Entrez access. The analysis of more than 450 sources of special medical literature was performed. Despite the presence of a huge number of techniques, both invasive, characterized by a high incidence of incontinence, and minimally invasive, the use of which is associated with a high risk of recurrence, diverse indicators of their effectiveness indicate that still the problem of rectal fistula and requires further search for more effective treatment methods.

Keywords: fistulas, rectum, surgical treatment, current problem
p. 383 of the original issue
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Address for correspondence:
210604, Republic of Belarus,
Vitebsk, Maxim Gorky str., 90 A/1,
Vitebsk Regional Clinical Specialized Centre,
Surgical Department,
tel.: +375 (29) 899-06-21,
e-mail: eduard_denisenko@list.ru,
Denisenko Eduard V.
Information about the authors:
Denisenko Eduard Valeryevich, Surgeon, Vitebsk Regional Clinical Specialized Centre, Vitebsk, Republic of Belarus.
http://orcid.org/0009-0002-4265-9885

M.D. LEVIN

THEORETICAL BASIS OF NEW SURGICAL TACTICS FOR ANORECTAL DEFECTS WITHOUT VISIBLE FISTULAS

X-ray Department of the 1st City Clinical Hospital, Minsk,
Republic of Belarus,
Dorot. Medical Center for rehabilitation and geriatrics. Netanya,
Israel

Recently, the diagnosis and surgical treatment of anorectal malformations (ARM) is based on the idea of the absence of the anal canal in these patients. The caudal part of the intestine, called the fistula or rectal pouch, is removed during all pull-through procedure. Poor results from these surgeries (fecal incontinence 16.7% to 76.7%; chronic constipation 22.2% to 86.7%; urinary incontinence 1.7% to 30.5%; ejaculatory dysfunction 15.6% to 41.2%; and erectile dysfunction 5.6% to 11.8%) are explained by the congenital absence of the anal canal. In the previous articles, we proved that these patients have a normally functioning anal canal. This was confirmed by the European Consortium. This paper provides a theoretical justification for new surgical interventions that preserve all the elements of the anal canal to exclude severe complications during ARM correction. In newborns, we offer a perineal perforation (PPP) procedure by inserting a needle into an open anal canal. The opening of the anal canal is performed under X-ray control due to compression of the abdomen. As a result of simple manipulations, a tracheostomy tube is inserted into the rectum, which is removed after 7 days. Diastasis between the intestine and the skin heals without the formation of fibrous tissue since there are no sutures between the intestine and the skin. In the presence of a colostomy, we recommend the method proposed by Pakarinen and Rintala. The anal canal is visualized within the intestinal lumen using retrograde flexible endoscopy through a previously performed sigmoid mucosal fistula. Perforation of the skin and subcutaneous tissue is performed with a special endoscope needle. After the same manipulations as in PPP, a tracheostomy tube is inserted into the rectum. Fecal retention and defecation did not differ from the norm after the use of PPP in several patients. This work substantiates the opportunity for clinical trials of the proposed methods.

Keywords: anorectal malformations without visible fistula; anal canal; X-ray diagnosis; surgical treatment; perineal perforation procedure; colostomy
p. 397-404 of the original issue
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Address for correspondence:
4220200, Dorot,
Amnon ve-Tamar 1, Israil
State Geriatic Center, Netanya,
tel.: +972 538281393,
e-mail: nivel70@hotmail.com,
Levin Mikhail D.
Information about the authors:
Levin Mikhail D. MD, Radiologist, State Gerriatric Center (Djrot), Netanya, Israil.
https://orcid.org/0000-0001-7830-1944

CASE REPORTS

V.N. CHERNIAKOV, E.A. LENIVKO, A.Y. TOLSTIK

CURRENT ASPECTS OF DIAGNOSTICS OF BILE CHOLEDOCHAL CYSTS. CLINICAL CASE FROM PRACTICE

Brest City Emergency Hospital, Brest,
The Republic of Belarus

The article describes a rare clinical case from practice. Choledochal cysts (type 4a) was firstly diagnosed in a 64-year-old woman who had been experiencing periodic abdominal pain and a number of other unpleasant gastrointestinal symptoms for many years, the cause of which remained unknown. The patient’s admission to the emergency hospital was associated with a sharp increase of the pain syndrome intensity and the sudden development of jaundice. Despite the completely nonspecific clinical picture, using a complex of current visualization methods the cause of this condition was identified - cystic dilatation of the choledochal cyst and the presence of choledocholithiasis. The stages of a diagnostic search, which make it possible to clarify the location, morphological type, and size of the cyst, which is decisive for the choice of treatment tactics and management of such patients are described; the high efficiency of therapeutic and diagnostic endoscopic techniques, which are today the leading minimally invasive interventions in the elimination of choledocholithiasis is demonstrated.

Keywords: choledochal cyst, choledocholithiasis, jaundice, magnetic resonance tomography, endoscopic retrograde cholangiopancreatography
p. 405-410 of the original issue
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Address for correspondence:
224005, Republic of Belarus,
Brest, Lenin st., 15,
Brest City Emergency Hospital
tel.: +375 (29) 825-71-90,
e-mail: kate_len@mail.ru,
Lenivko Ekaterina A.
Information about the authors:
Chernyakov Vadim Nikolaevich, Endoscopist of the Highest Qualification Category, Head of the Endoscopic Department of the Brest City Emergency Hospital, Brest, Republic of Belarus.
https://orcid.org/0009-0005-2878-362X
Lenivko Ekaterina Aleksandrovna, Endoscopist of the First Qualification Category, Endoscopist of the Endoscopic Department of the Brest City Emergency Hospital, Brest, Republic of Belarus.
https://orcid.org/0009-0006-2282-1557
Tolstik Alexander Yurievich, Surgeon of the First Qualification Category, Surgeon of the First Surgical Department of the Brest City Emergency Hospital, Brest, Republic of Belarus.
https://orcid.org/0009-0002-9555-3793

A.Y. BADYOUKOV 1, V.M. BONDARENKO 1, N.V. KROTOVA 2

A CASE OF SUCCESSFUL TREATMENT OF BOTH KIDNEYS’ CYSTS WITH EXTRAVASAL COMPRESSION OF THE VENA CAVA INFERIOR

Vitebsk State Medical University, Department of Hospital Surgery with the Course of FPC and PC 1,
Vitebsk Regional Clinical Hospital 2, Vitebsk,
The Republic of Belarus

Objective. The purpose of this work is to demonstrate a clinical case of diagnosis and treatment of a patient with large cysts of both kidneys, one of which caused compression of the inferior vena cava.
Results. The case of a 66-year-old patient who was admitted for surgical treatment of the large cysts Bosniak II of both kidneys is described. A detailed study of the patient revealed a complication in the form of compression of the vena cava inferior by the kidney cyst, with moderate clinical manifestations. As a result of surgical treatment, surgical success has been achieved, both in terms of eliminating compression of the renal parenchyma and decompression of the inferior vena cava.
Conclusion. It is possible that the detection of large kidney cysts in patients on ultrasound should serve as an indication for a more thorough identification of complaints, a thorough physical examination, as well as a computed tomography with contrast or magnetic resonance imaging.

Keywords: renal cyst, clinical observation, injury of the renal parenchyma, vena cava inferior, laparoscopy
p. 411-418 of the original issue
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Address for correspondence:
210009, Republic of Belarus,
Vitebsk, Frunze Prospect, 27,
Vitebsk State Medical University,
Department of Hospital Surgery
with the Course of FPC and PC,
e-mail: aleksandrbad66@gmail.com,
tel.: +375295988859,
Badyoukov Aleksandr Y.
Information about the authors:
Badyoukov Aleksandr Y., Assistant of the Department of Hospital Surgery with the Course of FPC and PC, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0009-0004-6215-0407
Bondarenko Vladimir M., Associate Professor of the Department of Hospital Surgery with the Course of FPC and PC, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0009-0006-4458-103X
Krotova Natalya V. Radiologist, X-ray department, Vitebsk Regional Clinical Hospital, Vitebsk, Republic of Belarus.
https://orcid.org/0009-0009-5270-2147
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