No abstract

1 Иркутская государственная медицинская академия последипломного образования -филиал ФГБОУ ДПО РМАНПО Минздрава России, Иркутск; 2 ОГАУЗ «Ангарская детская больница № 1», Ангарск; 3 ГБУЗ «Иркутская областная детская клиническая больница», Иркутск Актуальность. Частота заболевания, высокий процент неудовлетворительных результатов после торакопла-стики по поводу воронкообразной деформации грудной клетки являются причиной дальнейшего поиска но-вых технических приемов оперативного лечения. Цель исследования: улучшение результатов лечения воронкообразной деформации грудной клетки у детей. Материал и методы. Анализируются результаты торакопластики у 230 детей с воронкообразной деформацией грудной клетки. Применялись две методики операций: классическая торакопластика по Nuss (у 114 детей) и ее авторская модификация (у 116 детей), предусматривающая торакоскопию с обеих сторон, надсечение хрящей деформированных ребер и эндоскопическое продольное частичное рассечение кортикальной пластинки груди-ны путем создания подкожной эмфиземы в проекции грудины. Результаты. Установлено, что статистически значимого различия по продолжительности выполнения опера-ции, ее травматичности в анализируемых группах не выявлено. Частичный рецидив заболевания развивается у детей, перенесших торакопластику в возрасте до 7 лет, независимо от используемого метода торакоплас-тики. Выводы. Авторский метод торакопластики наиболее эффективен у детей с ригидной формой грудной клетки в возрасте старше 14 лет, так как позволил уменьшить давление грудино-реберного комплекса на металлокон-струкцию и самой пластины на опорные ребра, что облегчало выведение грудины в физиологическое положе-ние, предупреждало деформацию/пролежни опорных ребер.Ключевые слова: воронкообразная деформация грудной клетки, Nuss-технология, авторский способ кор-рекции. TREATMENT OF FUNNEL CHEST IN CHILDREN

The article analyzes two rare cases of acquired intestinal obstruction in children. In the first child at the age of 2 years, who suffered a retrosternal total coloesophagoplasty for extended post-burn chemical esophageal stenosis, early postoperative adhesive intestinal obstruction appeared on the 8th day of the postoperative period, which was eliminated laparoscopically. The next day, against the background of drug stimulation of the intestine, a small intestinal invagination developed, diagnosed with ultrasound examination. Relaparotomy and disinvagination were performed.The second patient, the 15 years old girl, who had suffered from closed abdominal injury and a pancreatic injury, manifested the signs of high partial intestinal obstruction a day after the trauma occurred. Initially, its cause was considered to be hematoma of the omental bursa. Fibrogastroduodenoscopy (FGDS) and X-ray diagnostics did not reveal the cause of intestinal obstruction, but after FGDS procedure the patient’s condition improved within 3–4 days, and then the clinical signs of small bowel obstructive adhesion confirmed by X-ray and laparoscopy. With laparoscopy in the middle section of the small intestine, a hyperinflate “whitish” section about 12 cm long, dense in palpation, was identified, which was the cause of obstruction. Through minilaparotomic umbilical access from the abdominal cavity, a loop of the jejunum with a foreign body inside was exteriorized. With transverse enterotomy trihobezoar 10×4×4 cm was removed from the lumen, which moved from the stomach and led to obstruction of small intestine. The outcome of the treatment was good in both cases.

Introduction. Endoscopic inguinal herniorrhaphy in children has become widespread, but there are no comparative results of using various technologies for its implementation. Material and methods. The results of 1136 laparoscopic herniorrhaphies in children for inguinal hernia throughout the period from 2006 to 2016 were analyzed. The first group (GL1) comprised 812 patients who underwent laparoscopic suturing of an inguinal hernia with intracorporeal purse-string suture. The second group (GL2) included 324 children, who were treated with the subcutaneous endoscopically assisted ligation (SEAL) technology - single-ported transcutaneous herniorrhaphy with laparoscopic assistance. Children were operated most often at the age from 1 year to 7 years. The average age of patients in the first group amounts of 4.6 years, in the second group - 4.5 years. All herniorrhaphies were performed standardly, with the use of the same instrumentation. Results. There were revealed such advantages of the use of the SEAL method as the time of training of beginning surgeons to the technique of endoherniorrhaphy is shorter by 2.5 times at the preclinical stage of training, at the stage of assisting and bringing the independent technique of its implementation to perfection; the duration of the operation is shorter due to the exclusion of the time for the introduction of the second/third port and the imposition of an intracorporeal node that presents the greatest difficulty for beginning surgeons; the number of intra- and early postoperative complications do not differ in both groups. The number of relapses is greater in GL2 children with large inguinal and scrotal hernias. The duration of hospitalization in groups did not differ. Conclusion. The use of SEAL technology is economically more profitable due to the relative simplicity of technique of herniorrhaphy and the minimal use of the number of endoscopic instruments. In large inguinal and scrotal hernias, it is more appropriate to use the traditional technique of imposing intracorporeal suture.

The constant expansion of treatment methods' range of cysts of kidneys-from the puncture to video and endoscopic resections-became a motivation to further improvement of low-invasive surgical techniques. The article presents the method of endovideotechnology treatment of solitary renal cysts. A laparoscopic resection of renal cysts with the treatment of the remaining lining of argon-plasma coagulation was performed in 32 children aged from 3 months to 17 years. Three trocars were used during the main stages of operation; they were set up depending on cyst's location. The sizes of cysts varied from 3 to 11 cm. Sometimes the fourth trocar was used for the retraction of liver and spleen and for the overviewing the remaining part of the cyst situated on the superior posterior part of kidneys. The operation lasted for about 26.6 ± 2.3 minutes in average, there weren't any conversions and intraoperative complications. One 7-years-old patient had a complication in the early postoperative period: disruption of the calyx. The article focuses on the features of operational equipment depending on the location of cysts in kidneys. The transperitoneal resection of prime renal cysts with an ablation of the internal wall of a cyst with argon-plasma coagulation gives high percent of effectiveness, rapid rehabilitation of children, excellent functional and cosmetic result and allows to avoid a disease recurrence.