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Khirurgii

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Year 2018 Vol. 26 No 6

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

O.P. CHUDAKOV 1, XIE XUKAI 1, O.A. YUDZINA 2, L.V. BUTSKO 1

MORPHOLOGICAL ASPECTS OF OSSEOINTEGRATION IN CASE OF EXPERIMENTAL CORRECTION OF TRAUMATIC DEFECTS OF FACIAL SKULL AND CEREBRAL CRANIUM BONES WITH THE HELP OF PURE TITANIUM

Belarusian State Medical University 1,
City Clinical Pathoanatomical Bureau 2, Minsk,
The Republic of Belarus

Objective. To assess the osseointegration process in reconstructive surgeries of traumatic defects of the facial skull and cerebral cranium bones with the help of pure titanium implants in experiment.
Methods. Experimental researches were conducted on same-sex rabbits (males) of «Chinchilla» breed (n=40). Three series were created: the first main (surgeries on lower jawbone), the second main (surgeries on frontal bone), the third comparative (without implanting). In two main series the defects of mandibular ramus bone and frontal bone were modeled. We implanted perforated plates of pure titanium into defected areas. Total time of experiment amounted to 3, 7, 14, 30, 90, 180 days and 24 months. The following aspects were studied: safety, biological inertness, local and general reaction of the body tissue to titanium implant, morphological characteristics of osteogenesis in «bone-implant system», factor of implant fixation in the reparative osteogenesis.
Results. Trombogenic safety of pure titanium for myocardium and kidneys was demonstrated; parts of corroded titanium were not found in bone tissue of lower jaw and frontal bone and in a new bone graft. Pure titanium does not cause any immune reaction. In reparative osteogenesis one proved the absence of joint capsule, new bone implant fibrosis and important role of biological fixation of the implant; and also a possibility to predict the complication development in the «bone-implant» system was established. The perforated pure titanium implant used in the process of reparative osteogenesis activates the formation of new bone graft, facilitates all stages of bone tissue transformation: inflammation, osteoblast proliferation, collagenogenesis and ossification.
Conclusions. Research results of general reaction of the organism to pure titanium in «bone-implant» system prove its bio-inertness, ensuring biological fixation during implantation into the body due to the ingrowth of the bone regenerate into the perforation holes of the titanium plates without connective tissue fibrous layer.

Keywords: defect of facial skull and cerebral cranium bone, reconstructive surgery, titanium implant, osseointegration, "bone-implant" system, reparative osteogenesis process
p. 645-654 of the original issue
References
  1. Stupak VV, Mishinov SV, Sadovoy MA, Koporushko NA, Mamonova EV, Panchenko AA, Krasovsky IB. Modern materials used to close defects of the bones of the skull. Sovr Problemy Nauki i Obrazovaniia. 2017;(4). [Electronic resource]. [cited 2018 Nov 23]. Available from: https://www.science-education.ru/pdf/2017/4/26626.pdf (in Russ.)
  2. Kubrakov KM, Karpuk IIu, Fedukovich AIu. Rekonstruktivnaia alloplastika defektov kostei cherepa titanovymi implantatami. Novosti Khirurgii. 2011;19(1):72-76. ttp://www.surgery.by/pdf/full_text/2011_1_13_ft.pdf (in Russ.)
  3. Cabraja M, Klein M, Lehmann TN. Long-term results following titanium cranioplasty of large skull defects. Neurosurg Focus. 2009 Jun;26(6):E10. doi: 10.3171/2009.3.FOCUS091
  4. Iriyanov YM, Chernov VF, Radchenko SA, Chernov AV. Plastic efficiency of different implants used for repair of soft and bone tissue defects. Bull Exp Biol Med. 2013 Aug;155(4):518-21. https://link.springer.com/article/10.1007/s10517-013-2191-4
  5. Shah AM, Jung H, Skirboll S. Materials used in cranioplasty: a history and analysis. Neurosurg Focus. 2014 Apr;36(4):E19. doi: 10.3171/2014.2.FOCUS13561
  6. Levchenko ÎV. Modern methods of cranioplasty. Part 1. Neirokhirurgiia. 2010;2:5-13. https://elibrary.ru/item.asp?id=15133082 (in Russ.)
  7. Leventhal GS. Titanium, a metal for surgery. J Bone Joint Surg. 1951;33(2):473-74. http://www.implantdirect.co/eu/pdf/jbjs.pdf
  8. Kihara A, Morimoto K, Suetsugu T. Improved method using a bubble-free adhesion technique for the preparation of semi-serial undecalcified histologic sect ions containing dental implants. J Oral Implantol. 1989;15(2):87-94.
  9. Depprich R, Zipprich H, Ommerborn M, Naujoks C, Wiesmann HP, Kiattavorncharoen S, Lauer HC, Meyer U, R Kübler N, Handschel J. Osseointegration of zirconia implants compared with titanium: an in vivo study. Head Face Med. 2008 Dec 11;4:30. doi: 10.1186/1746-160X-4-30
  10. Kozakiewicz M, Szymor P. Comparison of pre-bent titanium mesh versus polyethylene implants in patient specific orbital reconstructions. Head Face Med. 2013 Oct 29;9:32. doi: 10.1186/1746-160X-9-32
  11. Mishchenko ON, Kopchak AV, Krishchuk NG, Skiba IA, Chernogorsky DM. Computer simulation of the stress-strain state of the “bone - implant” system when the implants made from zirconium alloys. Sovrem Stomatologija. 2017;(2):62-68. http://www.mednovosti.by/journal.aspx?article=8068 (in Russ.)
  12. Sheng HS, Shen F, Wang MD, Lin J, Lin FC, Yin B, Zhang N. Titanium mesh implants exposure after cranioplasty in two children: involvement of osteogenesis? Chinese Neurosurgical Journal. 2017;3(8). doi: 10.1186/s41016-017-0072-9
Address for correspondence:
220116, The Republic of Belarus,
Minsk, Dzerzhinsky Ave.,83,
Belarusian State Medical University,
Department of Surgical Dentistry.
Tel. +375172052173,
e-mail: surgstom@bsmu.by,
Oleg P. Chudakov
Information about the authors:
Chudakov Oleg P., MD, Professor, Professor of the Department of Surgical Dentistry, Belarusian State Medical University, Minsk, Republic of Belarus.
http://orcid.org/0000-0003-4454-3093
Xie Xukai, Post-Graduate Student of the Department of Surgical Dentistry, Belarusian State Medical University, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-5196-4561
Yudzina Olha A., PhD, Associate Professor, Head of the Pathoanatomical Department, City Clinical Pathoanatomical Bureau, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-7623-0601
Butsko Liudmila V., PhD, Leading Veterinarian of the Experimental Biological Clinic (Vivarium), Belarusian State Medical University, Minsk, Republic of Belarus.
http://orcid.org/0000-0003-2028-4381

GENERAL & SPECIAL SURGERY

S.V. SHALASHOV 1, L.K. KULIKOV 2, A.L. MIKHAILOV 1, O.A. BUSLAEV 1, I.A. EGOROV 1, E.M. YURKIN 1, O.B. EREMENKO 1, V.E. SECRETAREV 2

COMPARATIVE ANALYSIS OF SUBMUSCULAR AND TC-REPAIR IN POSTOPERATIVE MIDLINE VENTRAL HERNIAS

Road Clinical Hospital at the Station of Irkutsk-Passenger 1,
Irkutsk State Medical Academy of Postgraduate Education 2, Irkutsk,
The Russian Federation

Objective. To investigate the treatment results of patients with the postoperative medial ventral hernias in the submuscular location of the mesh and TC-repair(two-cordlike).
Methods. The prospective study was carried out including 136 patients with postoperative mid-ventral hernias. Repair with submuscular mesh location was performed in 69 patients who made up the clinical comparison group (CCG). TC-repair surgery was applied in 67 cases. These are the patients of the main group (MG). In terms of 1 year and 2 years, the results of surgical treatment were evaluated in 62 patients from MG and 64 from CCG. Evaluation criteria were the duration of the operation and the number of postoperative complications, the timing of evaluation – one and two years.
Results. It was registered that the duration of the operation decreased significantly. During the operation in the CCG, the time of the operation made up 90.2±15.2 min (p <0.05). When using TC-repair surgery the duration was – 40.3±12.1 min. In the CCG, the complications occurred in 8 (11.6%) patients. In MG, in 3 cases (4.5%), seromas were formed, which were eliminated by a puncture method. One case of suppuration occurred in the CCG. It can be concluded that with the use of less traumatic TC repair, there is a decrease in the number of postoperative complications. Lethal outcomes are not registered. One recurrence was detected in the CCG, no late complications were noted. Relapse and complications in the later periods after surgery in the MG were not observed.
Conclusions. ÒC-repair, being an effective treatment method of patients with medial postoperative ventral hernias, has a number of serious advantages in comparison to submuscular techniques in patients with submuscular location of the mesh. TC-repair demands less time, it has less traumatism, which leads to the reduction of the postoperative complications number.

Keywords: postoperative midline ventral hernia, hernia repair, synthetic mesh, retromuscular repair, ÒC-repair
p. 655-662 of the original issue
References
  1. Charyshkin AL, Frolov AA. Gernioplasty problems at patients with postoperative ventral hernias Ul'jan Med-Biol Zhurn. 2015;(2):39-46. https://www.old.ulsu.ru/images/stories/antipoviv/ulsubook/2015/2_2015.pdf. (in Russ.)
  2. Lembas AN, Tampej II, Ivanchenko VV, Baulin AV, Zjul'kin GA. O lechenii posleoperacionnyh ventral'nyh gryzh. Klin Medicina. 2010;(1):56-57. https://cyberleninka.ru/article/n/o-lechenii-posleoperatsionnyh-ventralnyh-gryzh (in Russ.)
  3. Rastegarpour A, Cheung M, Vardhan M, Ibrahim MM, Butler CE, Levinson H. Surgical mesh for ventral incisional hernia repairs: Understanding mesh design. Plast Surg (Oakv). 2016 Spring;24(1):41-50. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4806756/
  4. Bringman S, Conze J, Cuccurullo D, Deprest J, Junge K, Klosterhalfen B, Parra-Davila E, Ramshaw B, Schumpelick V. Hernia repair: the search for ideal meshes. Hernia. 2010 Feb;14(1):81-87. Published online 2009 Dec 11. doi: 10.1007/s10029-009-0587-x
  5. Ilker Murat Arer, Hakan Yabanoglu, Huseyin Ozgur Aytac, Ali Ezer, Kenan Caliskan. Long-term results of retromuscular hernia repair: a single center experience. Pan African Medical Journal. 2017;27:132. doi: 10.11604/pamj.2017.27.132.9367
  6. Parshikov VV, Petrov VV, Romanov RV, Samsonov AA, Samsonov AV, Gradusov VP, Baburin AB. Kachestvo zhizni pacientov posle gernioplastiki. Med Al'm. 2009;1(6):100-103 http://www.medalmanac.ru/uploads/shared/old/archive/year2009/number_one/surgery/1537/parshikov.pdf. (in Russ)
  7. Bogdan VG, Varikash DV. Posleoperacionnye ventral'nye gryzhi: sovremennye aspekty patogeneza. Voen Medicina. 2017;(4):78-82. http://rep.bsmu.by:8080/handle/BSMU/17219 (in Russ.)
  8. Vichová B, Oravský M, Schnorrer M. Scar hernia repairs using a mesh--the sublay technique. Rozhl Chir. 2008 Mar;87(3):138-40. [Article in Slovak]
  9. Schumpelick V, Junge K, Rosch R, Klinge U, Stumpf M. Retromuscular mesh repair for ventral incision hernia in Germany. Chirurg. 2002 Sep;73(9):888-94. doi: 10.1007/s00104-002-0535-0 [Article in German]
  10. Schumpelick V, Klinge U, Rosch R, Junge K. Light weight meshes in incisional hernia repair. J Minim Access Surg. 2006 Sep;2(3):117-23. http://www.journalofmas.com/text.asp?2006/2/3/117/27722
  11. Schumpelick V, Klinge U, Junge K, Stumpf M. Incisional abdominal hernia: the open mesh repair. Langenbecks Arch Surg. 2004 Feb;389(1):1-5. doi: 10.1007/s00423-003-0352-z
  12. Kurzer M, Kark A, Selouk S, Belsham P. Open mesh repair of incisional hernia using a sublay technique: long-term follow-up. World J Surg. 2008 Jan;32(1):31-6; discussion 37. doi: 10.1007/s00268-007-9118-z
  13. Egiev VV, Ljadov KV, Voskresenskij SN, Rudakova MN, Chizhov DV, Shurygin SN. Atlas operativnoj khirurgii gryzh. Moscow, RF: ID Medpraktika-M; 2003. 228 p. http://www.booksmed.com/hirurgiya/1486-atlas-operativnoj-xirurgii-gryzh-egiev.html. (in Russ.)
  14. Parshikov VV, Fedaev AA. Abdominal wall prosthetic repair in ventral and incisional hernia treatment: classification, terminology and technical aspects (Review) STM. 2015;7(2):138-52. doi: 10.17691/Stm2015.7.2.19. (in Russ.)
  15. Petri A, Sjebin K. Nagljadnaja statistika v medicine. Leonov VP, per. s angl. Moscow, RF: GJeOTAR-MED; 2003. 144 p. http://www.biometrica.tomsk.ru/Medstat_small.pdf (in Russ.)
  16. Korenkov M, Paul A, Sauerland S, Neugebauer E, Arndt M, Chevrel JP, Corcione F, Fingerhut A, Flament JB, Kux M, Matzinger A, Myrvold HE, Rath AM, Simmermacher RK. Classification and surgical treatment of incisional hernia. Results of an experts' meeting. Langenbecks Arch Surg. 2001 Feb;386(1):65-73. doi: 10.1007/s004230000182
Address for correspondence:
664013, The Russian Federation,
Irkutsk, Obraztsov Str., 27,
Road Clinical Hospital
At the Station of Irkutsk-Passenger,
Surgical Unit,
tel. mob: +7(950)069 35 67,
e-mail: Sersha62@gmail.com,
Sergey V. Shalashov
Information about the authors:
Shalashov Sergey V., PhD, Surgeon of the Surgical Unit, Road Clinical Hospital at the Station of Irkutsk-Passenger, Irkutsk, Russian Federation.
https://orcid.org/0000-0002-2771-6418
Kulikov Leonid K, MD, Professor of the Surgery Department, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russian Federation.
https://orcid.org/0000-0003-2632-0355
Mikhailov Alexander L., Surgeon of the Surgical Unit, Road Clinical Hospital at the Station of Irkutsk-Passenger, Irkutsk, Russian Federation.
https://orcid.org/0000-0001-8406-5730
Buslaev Oleg A., PhD, Deputy Chief Physician for Surgery, Road Clinical Hospital at the Station of Irkutsk-Passenger, Irkutsk, Russian Federation.
https://orcid.org/0000-0001-8948-4897
Egorov Ivan A., Head of the Surgical Unit, Road Clinical Hospital at the Station of Irkutsk-Passenger, Irkutsk, Russian Federation.
https://orcid.org/0000-0001-9970-0901
Yurkin Evgeniy M., Surgeon of the Surgical Unit, Road Clinical Hospital at the Station of Irkutsk-Passenger, Irkutsk, Russian Federation.
https://orcid.org/0000-0001-8569-6657
Eremenko Oleg B., Head of the Resuscitation Unit, Road Clinical Hospital at the Station of Irkutsk-Passenger, Irkutsk, Russian Federation.
https://orcid.org/0000-0002-9666-1190
Sekretarev Vadim E., Clinical Intern, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russian Federation.
https://orcid.org/0000-0002-1230-1981

V.V. BOIKO 1, K.L. GAFT 1, E.S. PROTSENKO 2, N.A. REMNYOVA 2

MORPHOMETRIC INDICATORS OF PULMONARY TISSUE DESTRUCTIVE INDEX IN PATIENTS WITH DIFFERENT FORMS OF BULLOUS EMPHYSEMA COMPLICATED BY SPONTANEOUS PNEUMOTHORAX

V.T. Zaytsev Institute of General and Urgent Surgery 1,
V.N. Karazin Kharkiv National University 2, Kharkiv,
Ukraine

Objective. To determine the lung destructive indices in patients with a local, diffused and generalized forms of bullous emphysema complicated by spontaneous pneumothorax to predict a risk of the spontaneous pneumothorax recurrence and to choose the most effective tactics of surgical treatment.
Methods. The morphometric investigation includes 253 lung tissue biopsies of patients with a generalized, diffused, and local form of bullous emphysema complicated by spontaneous pneumothorax. The destructive index (DI) was measured using an overlay on a micrograph (10×10 cm in size; a microscope magnification when shooting × 200) of the Avtandilov morphometric grid of 10×10 cm in size, consisting of 100 equidistant points. Micrographs with large bronchi and bronchioles, vessels, collapsed tissue and fibrosis were excluded from the study. The number of points trapped on the damaged (rupture) and intact alveolar wall was counted, and then the destructive index was calculated: DI=D/[D+N]×100%; where, D – damaged alveolar wall; N – intact alveolar wall. DI – 0-25% – a low risk of the spontaneous pneumothorax recurrence; 26-50% – a moderate risk; 51-75% – a high risk; 76% or more – a very high risk.
Results. In the control group, DI is 12.5%. The patients with a generalized form of emphysema have a very high risk of the spontaneous pneumothorax recurrence in the all of three zones of the lung (the damage zone [DI=97.2%], the risk zone [DI=89.7%] and the intact zone [DI=77, 4%]); the patients with a diffused form of emphysema – a very high risk in the damage zone [DI=95,7%] and a high risk in the risk zone [DI=66,2%]; the patients with a local form of emphysema – a very high risk in the damage zone only [DI=91,3%].
Conclusions. The lung destructive index is a reliable diagnostic and prognostic morphological criterion, which allows choosing the most effective tactics of surgical treatment of the bullous pulmonary emphysema.

Keywords: destructive index, bullous pulmonary emphysema, forms of pulmonary emphysema, spontaneous pneumothorax, videothoracoscopy
p. 663-668 of the original issue
References
  1. Toktokhoev VA, Budaev AE, Badmaev DD, Chepurnykh EE. Modern features of vats treatment of spontaneous pneumothorax as a complication of bullous lung emphysema: a systematic literature review. Biul VSNTs SO RAMN. 2016;1(4):162-67. https://cyberleninka.ru/article/n/sovremennye-osobennosti-videotorakoskopicheskogo-lecheniya-spontannogo-pnevmotoraksa-kak-oslozhneniya-bulleznoy-emfizemy-lyogkogo (in Russ.)
  2. Pogodina AN, Voskresenskii OV, Nikolaeva EB, Barmina TG, Parshin VV. Sovremennye podkhody k lecheniiu spontannogo pnevmotoraksa i spontannoi emfizemy sredosteniia. Atmosfera. Pul'monologiia Allergologiia. 2011;(1):45-51. https://cyberleninka.ru/article/n/sovremennye-podhody-k-lecheniyu-spontannogo-pnevmotoraksa-i-spontannoy-emfizemy-sredosteniya. (in Russ.)
  3. Zhestkov KG, Barskii BG, Atiukov MA, Pichurov AA. Natsional'nye klinicheskie rekomendatsii po lecheniiu spontannogo pnevmotoraksa. S-Petersburg, RF; 2014. 24 p. http://www.ks-gs.ru/sites/default/files/doc /thoracic-surgeon-kr003.pdf (in Russ.)
  4. Vanderschueren RG. The role of thoracoscopy in the evaluation and management of pneumothorax. Lung. 1990;168(Suppl):1122-25. doi: 10.1007/BF02718252
  5. MacDuff A, Arnold A, Harvey J. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010 Aug;65 Suppl 2:ii18-31. doi: 10.1136/thx.2010.136986
  6. Ezhemenskii MÎ, Desiaterik VI, Mikhno SP, Miroshnichenko VM. The medical videothoracoscopy for treatment of spontaneous pneumothorax. Vestn Neotlozh i Vosstanov Meditsiny. 2013;14(3):336-38. http://old.iurs.org.ua/images/bulletin_of_urgent_and_recovery/vnvm%2014_3_2013_final.pdf (in Russ.)
  7. Iablonskii PK, Atiukov MA, Pishik VE, Bulianitsa AL. Choice of treatment for the first episode of primary spontaneous pneumothorax. Vestn SPbU. Ser 11: Meditsina. 2010;(1):118-29. http://vestnik.spbu.ru (in Russ.)
  8. Saito K, Cagle P, Berend N, Thurlbeck WM. The “destructive index” in nonemphysematous and emphysematous lungs. Morphologic observations and correlation with function. Am Rev Respir Dis. 1989 Feb;139(2):308-12. doi: 10.1164/ajrccm/139.2.308
Address for correspondence:
61018, Ukraine,
Kharkiv, Balakirev Drive, 1,
V.T. Zaytsev Institute of General
and Urgent Surgery,
Department of Urgent Surgery,
Tel.: +38 066 776-58-50,
e-mail: stankoavtomat@mail.ru,
Konstantyn L. Gaft
Information about the authors:
Boiko Valery V., MD, Corresponding Member, Professor, Director of V.T. Zaytsev Institute of General and Urgent Surgery, Kharkiv, Ukraine.
https://orcid.org/0000-0002-0527-0451
Gaft Konstantyn L., PhD, Surgeon, V.T. Zaytsev Institute of General and Urgent Surgery, Kharkiv, Ukraine.
https://orcid.org/0000-0002-0288-6488
Protsenko Elena S., MD, Professor, Head of the Department of General and Clinical Pathology of the Medical Faculty, V.N. Karazin Kharkov National University, Kharkiv, Ukraine.
http://orcid.org/0000-0001-6998-9783
Remnyova Natalia A., PhD, Associate Professor of the Department of General and Clinical Pathology of the Medical Faculty, V.N. Karazin Kharkov National University, Kharkiv, Ukraine.
http://orcid.org/0000-0002-6027-2601

O.I. NABOLOTNYI, Y.M. HUPALO, O.E. SHVED, V.G. GURIANOV

SURGICAL TREATMENT OF NON-SAPHENOUS VARICOSE VEINS OF LOWER LIMBS IN WOMEN WITH PELVIC CONGESTION SYNDROME

Scientific and Practical Center for Preventive and Clinical Medicine, Kiev,
Ukraine

Objective. To evaluate the effectiveness of endovascular interventions in the treatment of non-saphenous varicose veins of lower limbs in women with pelvic congestion syndrome.
Methods. The treatment analysis of non-saphenous varicose veins of the lower limbs combined with the pelvic congestion syndrome was conducted in 25 women. The main group consisted of 10 patients with non-saphenous varicose veins, pelvic varices and clinically expressed pelvic congestion syndrome. In this group, patients underwent pelvic phlebography with embolization of the left ovarian vein and miniphlebectomy of non-saphenous varicose veins. Control group included 15 patients with non-saphenous varicose veins, pelvic varices and with poorly expressed or absent clinic of pelvic congestion syndrome. In this group only miniphlebectomy of non-saphenous varicose veins was performed. The results of treatment were evaluated within 2 years. The incidence of varicose vein recurrence and pelvic pains was evaluated.
Results. During the a 2-year observation in 8 patients (80% (95%CI=46%-99%)) of the main group, the clinical symptoms of pelvic congestion syndrome regressed or significantly decreased. In 2 patients a chronic pelvic pain recurred to the intensity of the pre-hospital period. Relapses of varicose veins of the lower limbs were not observed. During a 2-year follow-up period, 1 (6.7%) patient of the control group had a recurrence of non-saphenous varicose in the lower limbs and 1 (6.7%) patient had relapse in the system of the great saphenous vein. In 2 (13%) patients, the intensity of pelvic pain increased.
Conclusions. The embolization of the left ovarian vein in patients with pelvic congestion syndrome, according to the study data, is effective in 80% of cases. Conducting the hybrid interference in case of varicose veins of the lower limbs and pelvic congestion syndrome is effective method for correction of pathological phlebohemodynamics in patients with chronic diseases of the lower limb and pelvic veins.

Keywords: non-saphenous superficial varicose veins of the lower limbs, pelvic congestion syndrome, pelvic phlebography, embolization, miniphlebectomy
p. 669-676 of the original issue
References
  1. Creton D, Hennequin L, Kohler F, Allaert FA. Embolisation of symptomatic pelvic veins in women presenting with non-saphenous varicose veins of pelvic origin - three-year follow-up. Eur J Vasc Endovasc Surg. 2007 Jul;34(1):112-17. doi: 10.1016/j.ejvs.2007.01.005
  2. Giannoukas AD, Dacie JE, Lumley JS. Recurrent varicose veins of both lower limbs due to bilateral ovarian vein incompetence. Ann Vasc Surg. 2000 Jul;14(4):397-400. doi: 10.1007/s100169910075
  3. Labropoulos N, Tiongson J, Pryor L, Tassiopoulos AK, Kang SS, Mansour MA, Baker WH. Nonsaphenous superficial vein reflux. J Vasc Surg. 2001 Nov;34(5):872-77. doi: 10.1067/mva.2001.118813
  4. Meissner MH, Moneta G, Burnand K, Gloviczki P, Lohr JM, Lurie F, Mattos MA, McLafferty RB, Mozes G, Rutherford RB, Padberg F, Sumner DS. The hemodynamics and diagnosis of venous disease. J Vasc Surg. 2007 Dec;46(Suppl S):4S-24S. doi: 10.1016/j.jvs.2007.09.043
  5. Steenbeek MP, van der Vleuten CJM, Schultze Kool LJ, Nieboer TE. Noninvasive diagnostic tools for pelvic congestion syndrome: a systematic review. Acta Obstet Gynecol Scand. 2018 Jan 30. doi: 10.1111/aogs.13311.
  6. Meneses L, Fava M, Diaz P, Andía M, Tejos C, Irarrazaval P, Uribe S. Embolization of incompetent pelvic veins for the treatment of recurrent varicose veins in lower limbs and pelvic congestion syndrome. Cardiovasc Intervent Radiol. 2013 Feb;36(1):128-32. doi: 10.1007/s00270-012-0389-x
  7. Perrin MR, Labropoulos N, Leon LR Jr. Presentation of the patient with recurrent varices after surgery (REVAS). J Vasc Surg. 2006 Feb;43(2):327-34; discussion 334. doi: 10.1016/j.jvs.2005.10.05
  8. Gibson K, Minjarez R, Ferris B, Neradilek M, Wise M, Stoughton J, Meissner M. Clinical presentation of women with pelvic source varicose veins in the perineum as a first step in the development of a disease-specific patient assessment tool. J Vasc Surg Venous Lymphat Disord. 2017 Jul;5(4):493-99. doi: 10.1016/j.jvsv.2017.03.012
  9. Dabbs E, Nemchand JL, Whiteley MS. Suprapubic varicose vein formation during pregnancy following pre-pregnancy pelvic vein embolisation with coils, without any residual pelvic venous reflux or obstruction. SAGE Open Med Case Rep. 2017 Aug 8;5:2050313X17724712. doi: 10.1177/2050313X17724712. eCollection 2017.
  10. Beckett D, Dos Santos SJ, Dabbs EB, Shiangoli I, Price BA, Whiteley MS. Anatomical abnormalities of the pelvic venous system and their implications for endovascular management of pelvic venous reflux. Phlebology. 2017 Jan 1:268355517735727. doi: 10.1177/0268355517735727
  11. Kachlik D, Pechacek V, Musil V, Baca V. The venous system of the pelvis: new nomenclature. Phlebology. 2010 Aug;25(4):162-73. doi: 10.1258/phleb.2010.010006
  12. Geier B, Barbera L, Mumme A, Köster O, Marpea B, Kaminsky C, Asciutto G. Reflux patterns in the ovarian and hypogastric veins in patients with varicose veins and signs of pelvic venous incompetence. Chir Ital. 2007 Jul-Aug;59(4):481-88.
Address for correspondence:
01014, Ukraine,
Kiev, Verkhnaya Str., 5,
Scientific and Practical Center
For Preventive and Clinical Medicine,
Scientific Department of Minimally Invasive Surgery,
Tel.: +380978430155,
e-mail: oleh.nabolotnyi@gmail.com,
Oleh I. Nabolotnyi
Information about the authors:
Nabolotnyi Oleh I., Junior Researcher of the Scientific Department of Minimally Invasive Surgery, Scientific and Practical Center for Preventive and Clinical Medicine, Kiev, Ukraine.
https://orcid.org/0000-0002-4273-5799
Hupalo Yrii M., PhD, Leading Researcher of the Scientific Department of Minimally Invasive Surgery, Scientific and Practical Center for Preventive and Clinical Medicine, Kiev, Ukraine.
https://orcid.org/0000-0002-9467-115X
Shved Olena E., PhD, Senior Researcher of the Scientific Department of Minimally Invasive Surgery, Scientific and Practical Center for Preventive and Clinical Medicine, Kiev, Ukraine.
https://orcid.org/0000-0002-7652-9301
Gurianov Vitaly G., PhD, Associate Professor, Senior Researcher of the Scientific Departments of Medical Care Organization, Scientific and Practical Center for Preventive and Clinical Medicine, Kiev, Ukraine.
https://orcid.org/0000-0001-8509-6301

G.P. KOTELNIKOV, S.E. KATORKIN, E.A. KORYMASOV

CLINICAL AND PATHOGENETIC CONCEPT OF DIAGNOSTICS AND COMPLEX TREATMENT OF PATIENTS WITH COMBINED PATHOLOGY OF VENOUS AND MUSCULOSKELETAL SYSTEMS OF THE LOWER EXTREMITIES

Samara State Medical University, Samara,
The Russian Federation

Objective. To advance treatment effectiveness of patients with chronic venous insufficiency of the lower extremities through the introduction of the clinical and pathogenetic concept of diagnosis and treatment based on the correction of the functional state of the muscular-venous pump.
Methods. A prospective, controlled clinical trial of patients (n=452) with clinical classes C3-C6 was conducted. The analysis in the comparison group (n=224) made it possible to identify the causes of unsatisfactory results, to develop the concept of diagnosis and treatment of chronic venous insufficiency, which was prospectively applied in the main group (n=228).
In the postoperative period, biomechanical stimulation of the lower limb muscular-venous pump was used in the main group patients(n=186) to correct the spring, balancing, and jog functions of the feet under static and dynamic load, as well as locomotor reconstruction of the walking pathology. Stimulation was performed in the vertical position of the patient in the frequency range from 2 to 30 Hz with fifteen-minute duration of the stimulation session.
Treatment efficacy was assessed by the VCSS scale, indices of volumetric blood flow in the deep vein system, and malleolar extremity volume after surgical treatment and after 12 months.
Results. A combined lesion of the venous and musculoskeletal systems was revealed in 402 (88.9%) cases. The combination of surgical treatment and biomechanical stimulation resulted in the improvement in the evacuation function of the muscular-venous pump. In the course of treatment, the bioelectrical activity of the gastrocnemius muscle increased, the volume outflow of blood in the muscular system decreased, the gait parameters and kinematics of the joints approached the values of healthy individuals. After 12 months, with a total assessment of the treatment effectiveness, a statistically significant predominance of good (74.1%) and a decrease in unsatisfactory results from 19.2% (comparison group) to 3.1% in the main group were obtained.
Conclusions. Surgical treatment of chronic venous insufficiency should be complemented by a complex of surgical and rehabilitation measures aimed at stimulating the muscular-venous pump and correcting the pathology of the musculoskeletal system.

Keywords: chronic venous diseases, chronic venous insufficiency, musculoskeletal system, functional diagnostics, clinical analysis of movements, muscle-venous pump
p. 677-688 of the original issue
References
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Address for correspondence:
443079, The Russian Federation,
Samara, Karl Marx Ave., 165 b,
Clinics of Samara State Medical University,
Department and Clinic of Hospital Surgery,
tel.: +7 927 206 71 02,
e-mail: katorkinse@mail.ru,
Sergey E. Katorkin
Information about the authors:
Kotelnikov Gennady P., Academician of RAS, MD, Professor, Head of the Department of Traumatology, Orthopedics and Extreme Surgery named after Acad. of RAS A.F. Krasnov, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0001-7456-6160
Katorkin Sergey E., PhD, Associate Professor, Head of the Department and Clinic of Hospital Surgery, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0001-7473-6692
Korymasov Evgenii A., MD, Professor, Head of the Department of Surgery of the Institute of Vocational Education, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0001-9732-5212

YU.S. VINNIK, S.S. DUNAEVSKAYA, D.A. ANTUFRIEVA, V.V. DEULINA

INFLUENCE OF THE IMMUNE STATUS AND BLEBBING OF THE LYMPHOCYTES PLASMATIC MEMBRANE ON PERIPANCTREATIC INFILTRATES FORMATION IN SEVERE ACUTE PANCREATITIS

Krasnoyarsk State Medical University named after Prof. V.F.Voino-Yasenetsky, Krasnoyarsk,
The Russian Federation

Objective. To reveal the features of the immune status and blebbing of lymphocytes connected with the course of peripancreatic infiltrates in severe acute pancreatitis.
Methods. 86 patients with severe acute pancreatitis and peripancreatic infiltrates who came to Ia disease phase were studied. In 42 patients complete clearance of infiltrate was observed (the 1st group). 44 patients, in whom pseudocysts and purulent complications developed, made up the 2nd group.
On hospitalization, a cellular link of immunity (CD3+, CD4+, CD8+, CD16+, CD19+, CD25+, CD95+, CD72+, HLA-DR+) was estimated using the method of indirect immunofluorescence, phagocytes activity with flowing cytometry, interleukin-4, interleukin-6, interleukin-10 and tumor necrosis factor alpha – with the immunofermental analysis, the membrane state of lymphocytes – with phase and contrast microscopy. Presence of infiltrate was defined on the 14th day from the beginning of the disease.
Results. T-lymphocytes, NK-cells and CD25+ had a strong inverse correlation with unfavorable course. There is a strong direct correlation of CD95+ with unfavorable course. The immune regulatory index had a strong inverse correlation with unfavorable course of rS=-0.76, (p<0.001). Interleukin-6 was increased in both groups. There was the correlation of the tumor necrosis factor alpha with unfavorable course of rS=0.69, (p<0.001). Interleukin-10 was increased in the 1st group. In the 1st group the cells in the condition of the initial blebbing exceeded the norm in 2 times, in the 2nd group – in 3 times. The terminal blebbing in the 1st group was 4 times higher, in the 2ndgroup –in 8 times. Increase in the total blebbing happened due to a terminal blebbing in both groups.
Conclusions. The unfavorable course of peripancreatic infiltrates is followed by lymphopenia, decrease in relative population of T-helpers, NK-cells, CD25+, the increase in CD95+, expressed decrease in the immunoregulatory index, increase in interleukin-6, tumor necrosis factor alpha, increase in indicators of terminal and total blebbing of lymphocytes.

Keywords: pancreatitis, peripancreatic infiltrates, immunity, blebbing, lymphocyte, interleukin
p. 689-696 of the original issue
References
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Address for correspondence:
660077, The Russian Federation,
Krasnoyarsk, Partizan Zheleznyak Str., 1,
Krasnoyarsk State Medical University
Named after Prof. V.F.Voino-Yasenetsky,
General Surgery Department
Named after Prof. M.I. Gulman,
Tel. office: +963-191-29-70,
e-mail: Vikto-potapenk@yandex.ru,
Svetlana S. Dunaevskaya
Information about the authors:
Vinnik Yurii S., MD, Professor, Head of the General Surgery Department named after Prof. M.I. Gulman, Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk, Russian Federation.
http://orcid.org/0000-0002-8995-2862
Dunaevskaya Svetlana S., MD, Associate Professor of the General Surgery Department named after Prof. M.I. Gulman, Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk, Russian Federation.
http://orcid.org/0000-0003-2820-4737
Antufrieva Daria A., PhD, Assistant of the General Surgery Department named after Prof. M.I. Gulman, Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk, Russian Federation.
http://orcid.org/0000-0003-0190-7336
Deulina Vera V., Full-Time Post-Graduate Student of the General Surgery Department named after Prof. M.I. Gulman, Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk, Russian Federation.
http://orcid.org/0000-0002-7515-0500

TRAUMATOLOGY & ORTHOPEDICS

A.N. TKACHENKO 1, L.B. GAIKOVAYA 1, EHSAN ULHAQ 1, A.A. KORNEENKOV 2, I.I. KUSHNIRCHUK 2, D.S. MANSUROV 1, A.I. ERMAKOV 1

PREDICTION POSSIBILITIES OF LOCAL INFECTIOUS COMPLICATIONS AFTER METAL OSTEOSYNTHESIS OF LIMB LONG TUBULAR BONES

North-West State Medical University named after I.I. Mechnikov1,
Military Medical Academy named after S.M. Kirov 2, Saint Petersburg,
The Russian Federation

Objective. To improve the results of osteosynthesis of long tubular bones on the basis of working out and application of the mathematical forecast model to prevent the surgical site infection (SSI).
Methods. A retrospective analysis of data of 179 patients who underwent osteosynthesis of long tubular bones after the diaphyseal fractures was performed. The data were compared on patients who underwent osteosynthesis without SSI (the 1st group — 144 observations) with the data of the operated ones, where SSI was observed (the 2nd group — 35 cases). A prospective analysis included 117 cases of diaphyseal fractures of long tubular bones.
Results. 18 prognostic criteria for the development of SSI have been identified and evaluated in quantitative terms (gender, age, information about comorbidities, the type and location of a fracture, the type of metal construction, the operation theatre list, etc.). The developed method of SSI prognosis made it possible, on the basis of the total prognosis index, to single out among the patients with fractures of long tubular bones the risk group in respect of whom individual preventive measures were taken. In the study of immunological parameters, it is advisable to consider T/NK cells as a prognostic criterion for the development of SSI, the preoperative indicators of which in patients with SSI exceeded those in the group without SSI and amounted to 2.213×109/l and 1.397×109/l, respectively (p<0.01).
Conclusions. The developed method of SSI prediction and the use of individual preventive measures can significantly reduce the incidence of SSI compared with the group of retrospective studies.

Keywords: long tubular bones, diaphyseal fracture, osteosynthesis, surgical site infection, prognosis, risk factors
p. 697-706 of the original issue
References
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  2. Van den Berg J, Osei D, Boyer MI, Gardner MJ, Ricci WM, Spraggs-Hughes A, McAndrew CM. Open tibia shaft fractures and soft-tissue coverage: the effects of management by an orthopaedic microsurgical team. J Orthop Trauma. 2017 Jun;31(6):339-344. doi: 10.1097/BOT.0000000000000815
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  10. Hernigou J, Schuind F. Smoking as a predictor of negative outcome in diaphyseal fracture healing. Int Orthop. 013 May;37(5): 883-87. Published online 2013 Feb 8. doi: 10.1007/s00264-013-1809-5
  11. Wald A. Sequential tests of statistical hypotheses. Ann Math Statist. 1945;16(2):117-86. doi: 10.1214/aoms/1177731118
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  14. Nahm NJ, Moore TA, Vallier HA. Use of two grading systems in determining risks associated with timing of fracture fixation. J Trauma Acute Care Surg. 2014 Aug;77(2):268-79. doi: 10.1097/TA.0000000000000283
  15. Qu C, Pu C, Shang K, Dong N, Xing Y, Li X, Wang J. Reference intervals and its verification for leukocyte differential count in peripheral blood by CytoDiff flow cytometry. Zhonghua Yi Xue ZaZhi. 2015 Jul 14;95(26):2079-83. [ArticleinChinese]
Address for correspondence:
195067, The Russian Federation,
Saint-Petersburg, Piskarevsky Ave., 47,
North-West State Medical University
Named after I.I. Mechnikov,
Department of Traumatology,
Orthopedics and Military Field Surgery,
òel.: +7-911-215-19-72,
e-mail: altkachenko@mail.ru,
Aleksandr N. Tkachenko
Information about the authors:
Tkachenko Aleksandr N., MD, Professor of the Department of Traumatology, Orthopedics and Military Field Surgery, North-West State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russian Federation.
https://orcid.org/0000-0003-4585-5160.
Gaikovaya Larisa B., MD, Professor of the Department of Biological and General Chemistry, North-West State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russian Federation.
https://orcid.org/0000-0003-1000-1114.
Ehsan Ulhaq, Post-Graduate Student of the Department of Traumatology, Orthopedics and Military Field Surgery, North-West State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russian Federation.
https://orcid.org/0000-0002-9647-052X.
Korneenkov Aleksei A., MD, Professor of the Department of Medical Service Management Automation with Military Medical Statistics, Military Medical Academy named after S.M. Kirov, Saint Petersburg, Russian Federation
https://orcid.org/0000-0001-5870-8042.
Kushnirchuk Igor O., PhD, Associate Professor of the Department of Medical Service Management Automation with Military Medical Statistics, Military Medical Academy named after S.M. Kirov, Saint Petersburg, Russian Federation
https://orcid.org/0000-0002-6926-5360.
Mansurov Djalolidin Sh., Post-Graduate Student of the Department of Traumatology, Orthopedics and Military Field Surgery, North-West State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russian Federation.
https://orcid.org/0000-0002-1799-641X.
Ermakov Aleksei I., Physician of the Central Clinical and Diagnostic Laboratory, North-West State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russian Federation.
https://orcid.org/0000-0003-3435-5881.

ONCOLOGY

F.SH. AKHMETZYANOV 1, 2, V.I. EGOROV 1, 2, A.I. FOMIN 3, A.V. KOKSHIN 1

PROGNOSTIC MODEL OF COLORECTAL ANASTOMOSIS SUTURES FAILURE

Kazan State Medical University 1,
Tatarstan Regional Clinical Cancer Center2, Kazan
I. N. Ulianov Chuvash State University3, Cheboksary,
The Russian Federation

Objective. To work out a multifactorial prognostic model for the development of inconsistency of colorectal anastomosis sutures after sphincter-saving operations on the rectum for cancer.
Methods. The work is based on the study of 145 patients who were subject to low and ultra-low intra-abdominal resections of the rectum for cancer; there were 65 males, 80 females. The average age of patients was 66.1±10.81 years, there were 95 patients (76.6%) over the age of 60 and 54 (37.3%) over 70. The following parameters were analyzed: gender, age, body mass index, anesthesia assessment according to ASA, concomitant diseases, tumor stage, tumor level from the anus, volume of operation, anastomosis level from the anus, postoperative complications. The multifactorial prognostic model of the development of the anastomosis sutures failure is based on the binary logistic regression method.
Results. The colorectal anastomoses sutures failure has developed in 23 patients (15.9%). No patient was reoperated because of the formation of an intestinal stoma. The following statistically significant factors of the inconsistency of the colorectal anastomosis sutures were obtained: the anastomosis level from the anus, the level of the tumor to the anus, the body mass index, the presence of coronary heart disease, the status of anesthesia in ASA (p <0.001, p=0.002, p=0.035, p<0.001, p=0.037, respectively). Based on the information about the influence of various factors on the incidence of the sutures failure of colorectal cancer, a prognostic model was designed that was transformed into a computer program to simplify the use in the practice of a doctor.
Conclusions. The developed multifactorial prognostic model and its implementation in the form of a simple computer program enables physicians to assess the risk of development of the colorectal sutures failure on the basis of several statistically significant factors and apply appropriate measures to prevent postoperative complications after low and ultra-low rectal resections for cancer.

Keywords: colorectal cancer, colorectal anastomosis, anastomosis leakage, prognosis, software
p. 707-714 of the original issue
References
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Address for correspondence:
420012, The Russian Federation,
Kazan, Baturin Str., 49,
Kazan State Medical University,
Department of Oncology,
X-ray Diagnostics and Radiotherapy,
Tel. office: +7 927 429 96 71,
e-mail: drvasiliy21@gmail.com,
Vasiliy I. Egorov
Information about the authors:
Akhmetzyanov Foat Sh., MD, Professor, Head of the Department of Oncology, X-ray Diagnostics and Radiotherapy, Kazan State Medical University, Head of the Tatarstan Regional Clinical Cancer Center, Kazan, Russian Federation.
http://orcid.org/0000-0002-4516-1997
Egorov Vasiliy I., PhD, Assistant of the Department of Oncology, X-ray Diagnostics and Radiotherapy, Kazan State Medical University, Oncologist of the General Oncology Unit of Tatarstan Regional Clinical Cancer Center, Kazan, Russian Federation.
http://orcid.org/0000-0002-6603-1390
Fomin Aleksey I., Applicant for Master’s Degree of the Faculty of Informatics and Computer Science, I. N. Ulianov Chuvash State University, Cheboksary, Russian Federation.
http://orcid.org/0000-0003-0771-5044
Kokshin Alexander V., Post-Graduate Student of the Department of Neurosurgery, Kazan State Medical University, Kazan, Russian Federation.
https://orcid.org/0000-0003-4985-2960

NEUROSURGERY

P.S. REMOV 1, 2, M.V. ALIZAROVICH 1, 2

FEATURES OF X-RAY DIAGNOSTICS OF CENTRAL DISTROPHIC STENOSIS OF THE SPINAL CANAL

Gomel State Medical University 1,
Gomel Regional Clinical Hospital 2, Gomel,
The Republic of Belarus

Objective. To assess the x-ray anatomic parameters of the spinal canal at the lumbosacral level and to suggest the method for their application in the diagnosis and surgical treatment of central dystrophic stenosis.
Methods. 64 patients operated on because of the degenerative-dystrophic pathology of the lumbosacral spine were included in the study. The main group consisted of patients with the combination of herniated intervertebral disc and central dystrophic stenosis of the spinal canal. The control group included patients with herniated discs without stenosis. The anteroposterior, interarticular ligamentous parameters, the area of the dural sac, and thickness of the ligamentum flavum were investigated. The method of determining of the surgical decompression dimension for cases of central stenosis of the spinal canal has been developed.
Results. The study revealed a statistically significant difference between the groups in the anteroposterior, interarticular ligamentous distance and dural sac area. Isolated hypertrophy of the ligamentum flavum with anteroposterior size value of 12 mm and more was the most common cause of dystrophic stenosis (38.2%). There was a strong correlation between interarticular ligamentous distance and area of the dural sac (in the main group – rs=0.72 at p<0.00001; in the group of control – rs=0.70 at p<0.00001). Cases of thickening of the ligamentum flavum more than 4 mm are noted both in the stenotic segments, and in the segments with herniated discs without stenosis.
Conclusions. Interarticular ligamentous distance has confirmed its diagnostic significance and the possibility of using as a criterion for a deficiency of free space in the spinal canal in cases of hypertrophy of the ligamentum flavum and/or articular processes. The fact of thickening of the ligamentum flavum does not in all cases indicate the presence of its compressive effect on the dural sac and is not sufficient to establish the diagnosis of dystrophic stenosis. The developed measurement procedure according to the 7 specified plans allows performing a reasonable, selective resection of the elements of the posterior support complex in cases of combination of herniated disc and central dystrophic stenosis.

Keywords: central dystrophic stenosis, interarticular ligamentous distance, ligamentum flavum, articular processes, area of dural sac, intervertebral fissure
p. 715-725 of the original issue
References
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  12. Hermansen E, Moen G, Barstad J, Birketvedt R, Indrekvam K. Laminarthrectomy as a surgical approach for decompressing the spinal canal: assessment of preoperative versus postoperative dural sac cross-sectional areal (DSCSA). Eur Spine J. 2013 Aug;22(8):1913-19. doi: 10.1007/s00586-013-2737-1
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Address for correspondence:
246000, The Republic of Belarus,
Gomel, Lange Str., 5,
Gomel State Medical University,
Department of Neurology and Neurosurgery
With the Course of Medical Rehabilitation,
Mob. tel. :+375 44 597 04 76,
E-mail: neuro_ugokb2013@mail.ru,
Pavel S. Remov
Information about the authors:
Remov Pavel S., Assistant of the Department of Neurology and Neurosurgery with the Course of Medical Rehabilitation, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0003-2194-5233
Alizarovich Mikhail V., PhD, Associate Professor of the Department of Neurology and Neurosurgery with the Course of Medical Rehabilitation, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0001-6060-5720

REVIEWS

S.V. SHKODKIN 1, 2, Y.B. IDASHKIN 1, K.A. BOCHAROVA 2, V.N. DMITRIEV 2, A.V. LYUBUSHKIN 2, A.A. NEVSKY 2

TRANSURETERO URETEROSTOMY: CURRENT STATE OF THE PROBLEM AND ITS PLACE IN ONCOLOGICAL UROLOGY

Belgorod Regional Clinical Hospital of Saint Joasaph 1,
Belgorod National Research University 2,
The Russian Federation

Objective. To estimate the possibilities of transureteroureterostomy in the surgical treatment of the invasive bladder cancer.
The article analyzes the publications dealing with transureteroureterostomy in various pathologies. Positive results of using this approach in pediatric urology are shown. 94 observations of augmentation plasty of the bladder in children with unilateral ureterohydronephrosis and subsequent transureteroureterostomy were analyzed. Long-term effectiveness (for terms from 6 to 13 years) on 134 repeated plastics of the extended strictures of the ureter was proved. The incidence of anastomotic failure was 9.5%, and relapse of obstruction developed in 10% of patients. The elimination of the need for the intestinal reconstruction after radical cystectomy reduces the number of perioperative complications. It is shown that transureteroureterostomy does not have high morbidity and does not increase the number of urobiobstructive complications in comparison with Bricker ileal conduit. The authors highlight the most important technical aspects of performing this type of urine derivation after cystectomy for the muscular-invasive bladder cancer.
Conclusions. Carrying out transureteroureterostomy and the formation of cutaneous ureterostomy after radical cystectomy does not increase the frequency of early postoperative complications and saves patients from bilateral urostomy.

Keywords: transureteroureterostomy, radical cystectomy, urine diversion, bladder cancer, ureterocutaneosostomy
p. 726-734 of the original issue
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Address for correspondence:
308007, The Russian Federation,
Belgorod, Nekrasov Str., 8/9, b. 8,
Belgorod Regional Clinical Hospital
Of Saint Joasaph,
Urology Unit,
Tel.: +79103207071,
e-mail: shkodkin-s@mail.ru,
Sergey V. Shkodkin
Information about the authors:
Shkodkin Sergey V., MD, Associate Professor, Urologist of the Urology Unit, Belgorod Regional Clinical Hospital of Saint Joasaph, Professor of the Hospital Surgery Department, Belgorod National Research University, Belgorod, Russian Federation.
https://orcid.org/0000-0003-2495-5760
Idashkin Yury B., Urologist of the Out-Patient Department, Belgorod Regional Clinical Hospital of Saint Joasaph, Belgorod, Russian Federation.
https://orcid.org/0000-0003-2318-9494
Bocharova Ksenia A., PhD, Associate Professor of the Department of Faculty Therapy, Belgorod National Research University, Belgorod, Russian Federation.
https://orcid.org/0000-0001-5540-924X
Dmitriev Vadim N., PhD, Associate Professor of the Department of Faculty Surgery, Belgorod National Research University, Belgorod, Russian Federation.
https://orcid.org/0000-0002-5523-5718
Lyubushkin Aleksey V., PhD, Clinical Intern of the Department of Faculty Surgery, Belgorod National Research University, Belgorod, Russian Federation.
https://orcid.org/0000-0002-3031-8947
Nevskyi Aleksandr A., Clinical Intern of the Department of Faculty Surgery, Belgorod National Research University, Belgorod, Russian Federation.
https://orcid.org/0000-0001-9560-8673

S.A. MARKOSYAN 1, N.M. LYSYAKOV 2

ETIOLOGY, PATHOGENESIS AND PROPHYLAXIS OF ADHESIONS IN ABDOMINAL SURGERY

National Research Ogarev Mordovia State University, Medical Institute1,
Mordovia Republican Center for Advanced
Training of Health Professionals 2, Saransk,
The Russian Federation

The review presents the data on the etiology and pathogenesis of intra-abdominal adhesions after abdominal surgical interventions. It has been shown that the main etiological preconditions for formation of adhesions and the development of adhesive intestinal obstruction are a peritoneal injury, intraabdominal bleeding, presence of infection and foreign bodies in the abdominal cavity, influence of various aggressive substances, local antibiotic therapy, and regional tissue ischemia. This leads to an increase in the amount of peritoneal fluid, the penetration of microorganisms into the abdominal cavity with disturbance of the metabolism of the peritoneum mesothelium and damage to the cellular membranes, tissue organization of fibrinous matrix, degranulation of lysosomal enzymes, the pituitary-adrenal insufficiency, and the development of hypercoagulation and postoperative paresis of the intestine. The situation is aggravated by the addition of an autoimmune or allergic component to the inflammatory process.
The main modern methods of adhesion prevention are described, taking into account the latest achievements in abdominal surgery, including the use of D-penicillamine, the drugs blocking the activity of collagen synthesis enzymes, anticoagulants of various actions, gels Polymers, proteolytic enzymes, antioxidants, hemostatics, hyperbaric oxygenation, as well as insufflation of carbon dioxide into the abdominal cavity. A special place is given to the use of synthetic absorbable suture materials, dynamic laparoscopy and laparoscopic adhesion.

Keywords: adhesions, abdominal cavity, intestinal obstruction, abdominal surgery
p. 735-744 of the original issue
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Address for correspondence:
430032, The Russian Federation,
Saransk, Ulyanov Str., 26 a,
Medical Institute, National Research Ogarev
Mordova State University,
Department of the Faculty Surgery with the
Courses of Topographic Anatomy and
Operative Surgery, Urology and Pediatric Surgery,
mob.tel. +79176990604,
e-mail: markosyansa@mail.ru,
Sergey A. Markosyan
Information about the authors:
Markosyan Sergey, MD, Associate Professor, Department of the Faculty Surgery with the Courses of Topographic Anatomy and Operative Surgery, Urology and Pediatric Surgery, National Research Ogarev Mordova State University, Medical Institute, Saransk, Russian Federation.
http://orcid.org/0000-0002-9876-4433
Lysyakov Nikita, PhD, Lecturer, Mordovia Republican Center for Advanced Training of Health Professionals, Saransk, Russian Federation.
http://orcid.org/0000-0002-5685-0982

V.V. PRISTUPA, N.K. KARALKOVA, E.A. KHADASEVICH

FEMTOSECOND LASER IN CATARACT SURGERY: TECHNOLOGICAL REDUNDANCY OR A NEW LEVEL OF POSSIBILITIES

Vitebsk State Medical University, Vitebsk,
The Republic of Belarus

This review presents modern data about the pros and cons of femtosecond lasers usage in cataract surgery. International scientific and medical databases “PubMed” and “Cochrane library” were used. The study showed that femtolaser assistance provides a new level of accuracy in different stages of the operation, which guaranties their standardization, unification and predictability. Using laser assistance in all patients, it is possible to get anterior-capsular holes of a given diameter within ±0.25 mm; if capsulorhexis is performed manually, such level of accuracy will be obtained only in 10% of the operated eyes. At the same time, it was found that despite the increase in the accuracy of the stages performed by femtosecond lasers, the differences in postoperative refractive indicators and visual acuity in patients who underwent phacoemulsification of cataracts with laser assistance are not higher than in the application of the standard technique. In addition, due to high cost of the equipment and lack of a significant effect in post-operative visual acuity, the widespread introduction of femtosecond lasers in cataract surgery is still doubtful. Despite the absent of consensus of experts about the clear advantages of laser assistance, this technique should be developed, for so that it provides opportunity to determine the influence of different stages on the final result of the operation and determine the direction of their further improvement and standardization of the stages creates the prerequisites for the use of ophthalmic robots.

Keywords: femtosecond laser, cataract surgery, phacoemulsification, lens nucleus, capsulorhexis, QALY
p. 745-757 of the original issue
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  28. Kankariya VP, Diakonis VF, Goldberg JL, Kymionis GD, Yoo SH. Femtosecond laser-assisted astigmatic keratotomy for postoperative trabeculectomy-induced corneal astigmatism. J Refract Surg. 2014 Jul;30(7):502-4. doi: 10.3928/1081597X-20140527-01
  29. Abell RG, Kerr NM, Howie AR, Mustaffa Kamal MA, Allen PL, Vote BJ. Effect of femtosecond laser-assisted cataract surgery on the corneal endothelium. J Cataract Refract Surg. 2014 Nov;40(11):1777-83. doi: 10.1016/j.jcrs.2014.05.031
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  31. Popovic M, Campos-Möller X, Schlenker MB, Ahmed IIK. Efficacy and safety of femtosecond laser-assisted cataract surgery compared with manual cataract surgery: a meta-analysis of 14567 eyes. Ophthalmology. 2016 Oct;123(10):2113-26. doi: 10.1016/j.ophtha.2016.07.005
  32. Chang DF. Does femtosecond laser-assisted cataract surgery improve corneal endothelial safety? The debate and conundrum. J Cataract Refract Surg. 2017 Apr;43(4):440-442. doi: 10.1016/j.jcrs.2017.04.019
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  34. Abell RG, Vote BJ. Cost-effectiveness of femtosecond laser-assisted cataract surgery versus phacoemulsification cataract surgery. Ophthalmology. 2014 Jan;121(1):10-16. doi: 10.1016/j.ophtha.2013.07.056
  35. Onukwugha E, McRae J, Kravetz A, Varga S, Khairnar R, Mullins CD. Cost-of-Illness Studies: An Updated Review of Current Methods. Pharmacoeconomics. 2016 Jan;34(1):43-58. doi: 10.1007/s40273-015-0325-4
  36. Ewe SY, Abell RG, Oakley CL, Lim CH, Allen PL, McPherson ZE, Rao A, Davies PE, Vote BJ. A comparative cohort study of visual outcomes in femtosecond laser-assisted versus phacoemulsification cataract surgery. Ophthalmology. 2016 Jan;123(1):178-82. doi: 10.1016/j.ophtha.2015.09.026
  37. Conrad-Hengerer I, Al Sheikh M, Hengerer FH, Schultz T, Dick HB. Comparison of visual recovery and refractive stability between femtosecond laser-assisted cataract surgery and standard phacoemulsification: six-month follow-up. J Cataract Refract Surg. 2015 Jul;41(7):1356-64. doi: 10.1016/j.jcrs.2014.10.044
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Address for correspondence:
210009, The Republic of Belarus,
Vitebsk, Frunze Ave., 27,
Vitebsk State Medical University,
Department of Ophthalmology,
Tel. +375 33 647-65-95,
e-mail: khodasevich2014@yandex.by,
Eugene A. Khadasevich
Information about the authors:
Pristupa Vadim V., PhD, Associate Professor of the Department of Ophthalmology, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0003-3496-7722
Karalkova Natallia K., PhD, Associate Professor, Acting Head of the Department of Ophthalmology, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0002-6172-6767
Khadasevich Eugene A., 5-Year Medical Student, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0002-0810-5005

CASE REPORTS

A.A. SUSHKO, E.V. MAHILEVETS, R.M. SALMIN, A.G. KALACH

COMBINATION OF SUPERIOR MEDIASTINAL NEUROFIBROMA AND PERICARDIAL CYST

Grodno State Medical University, Grodno,
The Republic of Belarus

The article presents a clinical case of the combined pathology of neurogenic mediastinal benign tumor and pericardial cyst. The study provides a summary of the etiology and pathogenesis of these diseases. As an example, the statistical data of clinics on the frequency of neurogenic mediastinal tumors and pericardial cysts among different age groups are used. The peculiarities of a clinical and x-ray picture and the stages of diagnosis are described. Thoracoscopic resection of the lung with a tumor and a pericardial cyst is found out to be effective as a surgical treatment.
The literature data as well as our own practical observation showed that the combination of benign neurogenic mediastinal tumor and pericardial cyst is a rare disorder with non-specific symptomatology, which is characterized by difficulties in diagnostics. High accuracy of the differential diagnosis with oncological pathology can be achieved by means of punch biopsy.
As the result of our own observations and literature review it has been established that thoracoscopic cyst and tumor removal with or without a resection of the lung is priority as less invasive and effective surgical treatment of this pathology.

Keywords: mediastinal neurofibroma, pericardial cyst, punch biopsy, thoracoscopy, lung resection, cyst removal
p. 758-764 of the original issue
References
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Address for correspondence:
230009, The Republic of Belarus,
Grodno, Gorky Str., 80,
Grodno State Medical University,
1st Department of Surgical Diseases,
Tel. mob.: +375 29 202 61 18,
e-mail: kalachalevtina@mail.ru,
Aliautsina G. Kalach
Information about the authors:
Sushko Aleksandr A., PhD, Associate Professor of the 1st Department of Surgical Diseases, Grodno State Medical University, Grodno, Republic of Belarus.
https://orcid.org/0000-0002-8147-6304
Mahilevets Eduard V., PhD, Associate Professor, Head of the 1st Department of Surgical Diseases, Grodno State Medical University, Grodno, Republic of Belarus.
https://orcid.org/0000-0001-7542-0980
Salmin Roman M., PhD, Assistant of the 1st Department of Surgical Diseases, Grodno State Medical University, Grodno, Republic of Belarus.
https://orcid.org/0000-0002-6625-8499
Kalach Aliautsina G., 6-Year Student of the Medical Faculty, Grodno State Medical University, Grodno, Republic of Belarus.
https://orcid.org/0000-0003-0121-111X

O.I. OKHOTNIKOV 1, 2, M.V. YAKOVLEVA 1, 2, O.S. GORBACHEVA 1, 2

IATROGENIC DAMAGE OF THE COMMON HEPATIC DUCT DURING LAPAROSCOPIC CHOLECYSTECTOMY, COMPLICATED BY FORMATION OF THE RIGHT-SIDED RETROPERITONEAL BILOMA

Kursk Regional Clinical Hospital 1,
Kursk State Medical University 2, Êursk,
The Russian Federation

The article presents the clinical observation of the diagnosis and treatment of the patient with iatrogenic damage of the common hepatic duct during the performance of video laparoscopic cholecystectomy without traditional clinical and laboratory signs of biliary iatrogenia using methods of minimally invasive x-ray surgery.
The results of the successive application of diagnostic puncture and drainage under the US-control of separated bile accumulations of the right retroperitoneal space and the pelvic cavity, antegrade cholangiography on the unexpanded ducts, revealed the intersection of the common hepatic duct with its partial clipping and transformed into percutaneous transhepatic cholangiostomy are shown. Subsequently, cholangiostomy drainage was intraoperatively transformed into external-internal biliary drainage, performed for biliodigestive anastomosis when hepaticoenterostomy was performed on the R-loop of the small intestine.
Iatrogenic damage of the bile ducts, not accompanied by concomitant disturbance of the bile outflow, can be difficult for timely diagnosis if the formation of the bile accumulation is retroperitoneal. Thus, ultrasound monitoring of patients undergoing video-laparoscopic cholecystectomy should be considered as a necessary routine instrumental examination, which allows detecting possible iatrogenic complications in time, including those not accompanied by traditional clinical and laboratory manifestations. Antegrade X-ray external surgical drainage of the biliary tree is an effective primary minimally invasive adjuvant intervention in relation to reconstructive surgery - gepaticojejunostomy.

Keywords: laparoscopic cholecystectomy, iatrogenic damage of bile ducts, ultrasound examination, biloma of retroperitoneal space, antegrade transhepatic cholangiostomy
p. 765-771 of the original issue
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Address for correspondence:
305047, The Russian Federation,
Kursk, Sumskaya Str., 45à,
Kursk Regional Clinical Hospital,
Department of X-ray Surgical
Diagnostic and Treatment Methods ¹ 2,
Tel.: +7 910 740 20 92,
e-mail oleg_okhotnikov@mail.ru,
Oleg I. Okhotnikov
Information about the authors:
Okhotnikov Oleg, MD, Professor, Head of the Department of X-ray Surgical Diagnostic and Treatment Methods ¹ 2, Kursk Regional Clinical Hospital, Professor of the Department of Radiation Diagnostics and Therapy, Kursk State Medical University, Kursk, Russian Federation.
http://orcid.org/0000-0002-6685-3183
Yakovleva Marina, PhD, Associate Professor of the Department of Surgical Diseases of the Faculty of Post-Graduate Education, Kursk State Medical University, Physician of the Department of X-ray Surgical Diagnostic and Treatment Methods ¹ 2, Kursk Regional Clinical Hospital, Kursk, Russian Federation.
http://orcid.org/0000-0003-3452-6652
Gorbacheva Olga, PhD, Head of the Department of General Surgery, Kursk Regional Clinical Hospital, Assistant of the Department of Surgical Diseases of the Faculty of Post-Graduate Education, Kursk State Medical University, Kursk, Russian Federation.
http://orcid.org/0000-0002-6642-1743
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