Search

Objective: To analyze the development of surgical approaches for hepatic echinococcosis., Material and Methods: We have analyzed diagnosis and treatment of 349 patients with liver echinococcosis; 97 patients were treated at the Botkin Clinical Hospital for the period from 2009 to 2019 and 252 patients were treated in surgical hospitals of Moscow city for the period from 2014 to 2019., Results: General and specific postoperative complications, relapses and surgical approaches were assessed. The number of echinococcectomies performed in surgical hospitals of Moscow is 3 times higher compared to the Botkin Hospital. The number of liver resections is comparable in both groups. The number of pericystectomies is more than 2 times higher in the Botkin Hospital. PAIR technique was more common in surgical hospitals of Moscow., Conclusion: Evolution of surgical treatment from open echinococcectomy to anatomical liver resections and subsequent pericystectomy with PAIR technique becomes another round of evolutionary spiral in the development of surgical treatment of liver echinococcosis.

Objective: To analyze the influence of surgical sanation of patients with destructive tuberculosis on the prevalence of tuberculosis and mortality., Material and Methods: The strategy of treatment for new cases of destructive pulmonary tuberculosis was developed in the Perelman Department of Phthisiopulmonology and Thoracic Surgery of the Sechenov First Moscow State Medical University. This strategy was applied in the tuberculosis surgical department of the Tambov Regional Dispensary in 2013-2017. A register of patients with pulmonary destruction and bacterial excretion was developed and personal treatment plans were applied. Patients were divided into 3 groups depending on the treatment mode. The main group A consisted of patients who underwent surgical treatment. Surgery was not performed due to failure or discontinuation of treatment in the comparison group B. Group C included patients without indications or with contraindications for surgical treatment., Results: Treatment efficacy considering destruction cavities closure and abacillation was 97.2% in group A, 41.4% in group B and 39.8% in group C. Surgical approach for patients with destructive tuberculosis reduced the number of patients in the register by 3.3 times (from 516 to 158) within 4 years. A significant reduction of the bacillary core allows breaking the infection chain, that affects the main epidemiological indicators. Reduced incidence of tuberculosis is observed in short-term period, but even greater impact of this factor should be expected in long-term follow-up., Conclusion: Surgical approach in complex treatment of destructive pulmonary tuberculosis is valuable to improve efficacy of management of these patients and reduce mortality rate.

Aim: to estimate the effect of decompressive stented drainage of biliary anastomosis on incidence of biliary complications., Material and Methods: 294 patients aged from 5 months to 61 years (mean 13.8±0.81) were enrolled. They underwent liver fragments transplantation in the Department of Liver Transplantation of Petrovsky Russian Research Center of Surgery for the period from March 1997 to January 2016. Decompressive stented drainage tubes were used in 28 (9.5%) patients. Reconstruction without drainage was applied in 266 (90.5%) cases. In the group of biliobiliary reconstruction drainage was used in 18 out of 89 cases (20.2%), in the group of biliodigestive reconstruction - in 10 out of 202 cases (4.9%). Incidence of specific biliary complications was assessed., Results: There was significant direct correlation of stented drainage of biliodigestive anastomosis with various biliary complications including bile leakage (r= -0,1253; p=0.06), obturation of anastomosis (r=0.045; p=0.501), stricture of anastomosis (r= -0.0665; p=0.320), other strictures of intrahepatic bile ducts (r= -0.0291; p=0.664), hepatolithiasis (r=0.0857; p=0.199). However significant direct correation was observed between stented drainage and incidence of intrahepatic bile ducts strictures (r=0.2117; p=0.046) and anastomosis obturation (r=0.2330; p=0.028) in case of biliobiliary reconstruction. Significant correation with other biliary complications was absent (p>0.05)., Conclusion: Unconstrained stented drainage during primary biliary reconstruction is associated with increased incidence of biliary complications and should not be indicated routinely. Clear need for drainage should be determined in further investigations.

Aim: to determine the indications and to evaluate early and long-term outcomes of total pancreatectomy for pancreatic cancer., Material and Methods: Treatment of 29 patients who underwent one- and two-stage pancreatectomy for different malignancies was analyzed., Results: Median of surgery duration and intraoperative blood loss was 280 min and 2200 ml respectively. Postoperative complications were observed in 9 (31%) patients. There were 2 (6.9%) deaths. 1- and 3-year overall actual survival was 61% and 16% respectively in case of ductal adenocarcinoma. Median was 18 months. Patients after surgery for primary multiple lesion (cancer of pancreatic body-tail and major duodenal papilla), pancreatic metastases of renal cancer, mucinous cystadenoma and neuroendocrine cancer are still alive. Follow-up periods are 4, 49, 49 and 65 months respectively., Conclusion: Total pancreatectomy is difficult intervention followed by severe metabolic disorders. However it can improve long-term survival with acceptable incidence of postoperative complications and quality of life if clear indications for surgery are present.

Aim: To analyze long-term surgical results in patients with aortic valve disease and concomitant mitral regurgitation (MR) depending on volume of valve surgery., Material and Methods: It was studied 5-year results in 71 patients with aortic valve disease and different degree of mitral regurgitation. Patients were divided into 3 groups. Control group included 40 patients after aortic valve replacement (AVR) and no mitral insufficiency. The 2nd group consisted of 16 patients after AVR and concomitant mitral regurgitation degree 2-3. The 3rd group - 15 patients after aortic and mitral valve replacement. Mortality in long-term postoperative period, quality of life, incidence of complications and echocardiography data were analyzed., Results: There was no significant improvement of mitral regurgitation after AVR. It was showed that persistent MR decreases remote survival and quality of life as well as deteriorates echocardiography data. Herewith these data in the 3rd group did not differ from the control group., Conclusion: Double-valve replacement may be advisable in patients with aortic valve disease and concomitant moderate MR because persistent MR deteriorates long-term, Results: However prolonged time of cardiopulmonary bypass, aortic cross-clamping, greater blood loss require comprehensive approach to advanced cardiac surgery.

Aim: To analyze the results of laparo- and thoracoscopy in patients with thoracic and abdominal trauma in conditions of emergency hospital., Material and Methods: For the period 2006-2013 we performed 56 laparoscopic and 15 thoracoscopic interventions in 67 patients with trauma. There were 80.6% of men and 19.4% of women aged 35±1.7 years. Abdominal, thoracic and thoraco-abdominal injuries were observed in 51 (76.1%), 14 (20.9%) and 2 (3%) patients. Abdominal or thoracic trauma alone was diagnosed in 41 (61.2%) cases and combined injury - in 26 (38.8%) patients. 37 (66%) interventions were performed laparoscopically. Conversion to laparotomy was observed in 19 (34%) cases. Mean volume of hemoperitoneum was 458 ml (range 100-1100 ml). In 11 (73.3%) patients thoracoscopic surgery was performed and conversion of access was applied in 4 (26.7%) cases., Results: No injuries of internal organs were observed in 19.6% and 13.3% of patients using laparo- and thoracoscopy respectively. So inadvisable open surgery was prevented although formal indications for laparo- and thoracotomy were present. In 25% and 20% of abdominal and thoracic damages respectively we avoided relatively unjustified laparo- or thoracotomy because of injuries were cured endoscopically. No one missed injury was observed. Postoperative complications were diagnosed in 5.6% of cases. Mortality rate was 15.6% in case of severe combined trauma. Mean hospital stay was 23.2 days (range 3-105)., Conclusion: Endoscopic techniques are perspective in treatment of thoracic and abdominal trauma. It allows to avoid inadvisable laparo- and thoracotomy in some cases and to improve results of treatment.

Surgery as being a preferential method of treatment of patients with cholangiocarcinoma is associated with high complications and mortality levels while demonstrating poor long-term outcomes. Optimization of preoperative management and improvement of the results of surgical treatment for patients with proximal extrahepatic bile duct carcinoma. From January 1998 to December 2013 surgical treatment was performed in 36 patients (19 males, 17 females) with Klatzkin's tumor, from whom 10 patients obtained postoperative chemotherapy. Bismuth-Corlette type III-IV tumor stage was determined in 30 (83.3%) patients. Portal vein resection was performed in 13 (36.1%) patients. 27 (75.5%) patients underwent R0 resection. Postoperative mortality rate consisted 16.7%, complications were revealed in 87.1% of cases. 6 (16.7%) patients required additional surgery and interventional procedures were performed in other 20 (55.5%) patients to fix postoperative complications. Overall 5-year survival rate in R0-resection group was 40.1%, median - 29 months. In postoperative chemotherapy group overall 3-year survival rate was 66.7% which was twice higher than in surgery group but the difference was not statistically significant (p=0.35). The improvement of short-term outcomes of surgical treatment for patients with Klatzkin's tumor requires optimization of preoperative management and detailed adherence of surgical techniques. Combination of surgery with postoperative chemotherapy showed the trend to improvement of overall survival.

The results of the diagnosis and treatment of 117 patients with cervicothoracic injuries were analyzed. Different complications were observed in 51 (43.6%) cases. The main reasons contributing to the development of complications included late diagnosis of lesions of trachea and esophagus, acute blood loss, inadequate hemostasis during surgery.

The analysis of emergency surgical care in medical institution of Moscow for the last 20 years is presented in the article. There were 912 156 patients with acute appendicitis, strangulated hernia, perforated gastro-duodenal ulcer, gastro-duodenal bleeding, acute cholecystitis, acute pancreatitis, acute intestinal obstruction on treatment during this period. It was observed reduction overall and postoperative mortality. It was concluded that positive results are caused by development of material and technical base, transition on clock mode of diagnostic units, increase of patients? number hospitalized in department of intensive care for operation training and after it, using of modern diagnostic and therapeutic methods, edit documents regulating of health facilities activity according to medicine development.

The prospective study of postoperative venous thromboembolism after standard prophylactic measures among high risk patients was performed. The ultrasound lower limb veins investigation registered postoperative venous thrombosis in 32.7% of these patients, the proximal thrombosis was in 9.1%. Half of the cases demonstrated the isolated sural sinus thrombus and the overall sural sinus involvement was 83.3%. 50% of all thromboses were diagnosed within the first week after the operation. 86.1% of all cases were registered within 2 weeks after the surgery. Terms of anticoagulative drugs prescription showed no influence on the thrombosis incidence aiming the researched patients. The study demonstrated the high true incidence of postoperative venous thromboembolism after standard prophylactic measures among high risk patients and the leading role of the sural sinus in its initiation.

N.N. Burdenko surgery clinic have an experience of treatment of 342 patients with gastroenteropancreatic neuroendocrine tumors. Original algorithms of diagnosis, complex treatment and postoperative management were applied. We achieved 100% five-year survival rate after radical surgery and reduced postoperative complications 1.6 times.

232 cases of septic complications after penetrating thoracic injury were analyzed. All patients were divided into groups according to the injury mechanism and inhabitancy. Patients with medico-social deviations, as well as patients with hemocontact infections, mental insanity and social deviations were marked out. 75% of patients were reported to have any medico-social deviations. Among them the distributing was as follows: persons with no fixed abode (100%), women (91%), patients over 50 years (86.2%) and patients after knife thoracic injury (77.4%). Among patients with hemocontact infection the majority were incomers from the near-abroad countries (37%), victims of assault (20%) and patients aged 31-40 years (18.4%).

The retrospective analysis (2006-2010 yy) of treatment of 895 patients with gastroduodenal ulcer bleeding was conducted. Lethal outcome was registered in 220 (24.6%) patients, of them directly of the ulcer bleeding died 45 (5%). The Rockall score was used as universal prognostic instrument. Of 164 lethal outcomes, did not directly connected to the ulcer bleeding, the etiological distribution was as follows: multiple organ failure - 36% (n=59), cardiovascular diseases - 24.4% (n=40), inveterate oncology - 15.9% (26). Of 45 deaths from bleeding, only 4 patients died of the uncontrolled bleeding, whereas 18 (45%) died after the emergency surgery. Signs of hemorrhagic shock were registered in 60% of died patients (in comparison with 18% among the survived). Bleeding reccurrence was registered in 28.6% of died patients (in comparison with 11% among the survived). The use of the Rockall score confirmed its prognostic value: the mean score was 4.3±2.12 points among the survived patients, whereas among the died patients it was 7.16±2.35 points (p=0.001). Authors conclude, that the leading reasons of death, considering the bleeding itself, were the hemorrhagic shock and recurrent bleeding. Though, about 80% of patients are dying of reasons, do not directly connected to the bleeding episode, but of concomitant diseases (multiple organ failure, cardiovascular and oncologic diseases). The least, nevertheless, leads to the wrong formulation of the final diagnosis and incorrect interpretation of the etiology of death.

51 patients with gastric cancer and severe concomitant ischemic heart disease (90.2%), valvular heart disease (5.9%), critical stenosis of the internal carotid artery (2%) or abdominal aortic aneurism (2%) were operated on during 1995-2011yy. Of them men were 41, women - 10; mean age was 65.1 years (51-82). The first stage of gastric cancer was diagnosed in 18 (35.3%) of patients, second, third and fourth in 12 (23.5%), 17 (33.3%) and 4 (7.8%), respectively. Radical tumor resection was achieved in 37 (72.5%), palliative operations were performed in 13 (25.5%) patients. 17.6% of patients were operated on stomach and vessels simultaneously. 82.4% received the stepwise treatment. Intra- and postoperative complications were registered in 47.1% (24 of 51 patients); of whom 5.9% (3 patients) ended lethally. Simultaneous operations showed the 55.6% complications and zero lethality rate, whereas stepwise treatment resulted in 45.2% complications and 7.1% lethality.

Surgical treatment was performed in 322 patients over 70 years with cancer of the stomach. Radical operation was made in 220 (68.3%) patients: subtotal distal resection -- in 137, subtotal proximal resection -- in 18, gastrectomy -- in 55, extirpation of the gastric stump -- in 10. Symptomatic and test surgeries were performed in 102 (31.7%) patients. Postoperative complications were seen in 16,1+/-2,1% cases, lethality was 6.8+/-1.4%. Complications after radical resections were seen in 16.4+/-2.5% patients, lethality was 5.0+/-1.5%. The rate of purulent complications was maximal (8.4%). Cardiovascular complications and coagulopathies (4.7%) were the main causes of lethal outcome (in 11 of 15 patients). Score scale of assessment of postoperative risk was developed. Five-years survival in stage I cancer of the stomach was 62.8%, stage II -- 42.6%, III -- 16.7%. Immediate and long-term results demonstrate necessity of radical surgical treatment of patients with cancer of the stomach over 70 years depending on the disease stage and risk factors.

From 1991 to 2002 10 patients with rabies were treated, all the patients died. Epidemiology, clinical picture, specific symptoms are described, rarity of this severe disease is noted. The necessity of urgent preventive vaccination immediately after bites is emphasized.

A total of 106 patients with surgical infection in maxillofacial region were studied. Clinical and laboratory diagnostic data on surgical infection and sepsis in maxillofacial surgery are presented. Integral indices of blood circulation, respiration, brain and liver metabolism, regarding severity of surgical infection were determined. Pathogenetically substantiated therapy of sepsis is proposed.

Analysis of postoperative mortality is carried out by the authors on the basis of studying case records, operation records, follow up lists of complicated patients, results of autopsy as well as clinico-anatomical conferences and personal cases of 418 operated patients. It was established that methodical and technical defects during the operation on the lungs contributed to lethal outcomes in 13.8% of all dead patients. Majority of methodical and technical defects in their basis resulted from errors in anatomical orientation. Among the causes of these defects of great importance are some elements of carelessness and inattentiveness in working with large vessels and in performing hemostasis. Prophylaxis of fatal defects during the operation is based on a good anatomical and surgical school, personal experience, knowledge and abilities of surgeons.

Gastric cancer is one of the most common diseases in patients over 70 years of age. It makes 14.4% of all malignant tumours, 15.7%--if oncohaematological cases are not included, and 19.8%--if oncohaematological cases and skin basaliomas are not considered. Most frequently the 1st stage of cancer was found in patients over 70 years of age (41.8%). The 4th stage of cancer is most commonly detected in patients of the oldest age group (34.5%). The program for early detection makes it possible to increase significantly timely diagnosis of gastric cancer (up to 80% in stages I and II). The screening program provides the detection of early stages of gastric cancer in 40.6% of the patients with the 1st stage of gastric cancer. 5-year survival is 30.2%, the corrected rate--40.3%. The rates of 5-year survival (both--observed and corrected) are the highest in patients with the 1st stage of the disease. The 5-year survival rate in patients aged 50-59 years is 65.5%; whereas in patients over 70--16.0% and 27.7% (observed and corrected, respectively).

The authors present the analysis of the results of surgical treatment of 145 patients with recurrent rectal carcinoma in 1960-1990 at the State Scientific Centre of Proctology. A group of 304 patients who underwent radical operation for carcinoma of the rectum was also studied to determine the frequency of recurrences after radical surgery. It was found to be 30.9% (in 94 out of 304 patients). More than half of carcinoma recurrences (63.8%) were revealed in the first postoperative year and 85.1% in the first two years. The average term of their appearance was 13.4 months. A radical operation may be performed for a second time in only 22.3% of cases of recurrences. The study of factors considerably influencing the frequency of the recurrence made it possible to determine three groups of patients with various risks of the development and create a scheme of their regular medical examination. Repeated radical operations on the cavities were carried out in 90 patients with recurrences, in 55 patients local resection of recurrrent tumor was performed. The indications for repeated operations were elaborated. More than half repeated operations on the cavity (53.3%) were combined, extensive, and concomitant. The incidence of intraoperative (52.2%) and postoperative (62.2%) complications was significantly higher than in primary operations. The use of a complex of therapeutic and preventive measures usulted in relatively low postoperative lethality (6.7%). Five-year survival after repeated operations on the cavity was 29 +/- 5.5%, the frequency of repeated recurrences was 34.5 +/- 5.2%; the respective figures after local excision were 14.6 +/- 5.5 and 40.8 +/- 7%.

Some prognostic signs of surgical treatment of carcinoma of the lung are analysed. The stability and paramount importance of the integral clinical factor "extension of the tumor" is shown. The ultrastructural features of adenocarcinoma and squamous-cell carcinoma of the lungs influencing the disease prognosis were revealed. It is shown that electron microscopy allows differentiation of the tumor cells to be profoundly and precisely assessed. The results of the study unable a differentiated approach to the problems of postoperative therapy.

The article deals with 83 cases of carcinoma of the thyroid gland (CTG) which were recognized in 1973-1991 among the population during annual screening. The morbidity rate was 0.18 per 1,000 population, and increased by 3.4 times. Guidelines for Active Detection of Nodular Masses and Malignant Tumors of the Thyroid were elaborated. Their essence is as follows: during regular medical screening a group of individuals is distinguished in whom palpable abnormalities are found in the thyroid and focal changes are revealed in it by ultrasonic examination whose performance is recommended once every two years; the revealed group of individuals is subjected to complex examination for establishing the diagnosis, after which the tactics of their management are determined; a oncorisk group is formed to be kept under active observation. After introduction of the Guidelines into practice, recognition of CTG in stages I-II increased from 67.8 to 80%, which testifies to their effectiveness.

Growth of the specific fraction of individuals over 80 years of age among patients with lung carcinoma is illustrated by its incidence in Moscow. These patients account today for up to 8% of the total number of cases. Some of them may be successfully treated by operation. This was demonstrated in 11 cases. Recommendations on pre- and postoperative management of such patients are given. The authors emphasize that the patient's fate and the method of treatment should be prescribed only in an oncological medical institution.

Operations were performed on 3,313 patients for lung carcinoma in the Department of Surgery of the Lungs and Mediastinum of the National Research Center of Surgery, AMS USSR, from 1963 till 1.01.90. Among these patients 263 (7.9%) were treated by combined operations (resection of the lung together with part of the chest wall, trachea and its bifurcation, pericardium, diaphragm, superior vena cava, pulmonary artery, aorta, and atrium, and also with removal of metastatic lymph nodes of the contralateral lung). Three types of combined resections were carried out--vasculo-atrial, tracheo-bronchial, and parieto-diaphragmatic. Postoperative complications developed in 38.6% of patients. Intraoperative mortality was 1.5%, 13.9% of patients died after the operation. More than 5 years survived 21.8% of patients who underwent operation, more than 10 years 10.2%, and more than 15 years 5.6% of patients.

The article discusses a group of patients with rectal carcinoma who underwent radical operations at the Scientific Research Institute of Proctology in 1982-1983. The terms and frequency of rectal carcinoma recurrences are analysed and the factors influencing these indices are studied. The results made it possible to form a group with a risk of a recurrence among patients with carcinoma of the rectum and suggest new schedules of regular medical observation over these patients with consideration for the risk group.