Experience in the Treatment of Hemangioma in Children

The article reflects modern views on epidemiology, clinical manifestations, classification, principles of diagnostics and treatment of hemangiomas. The purpose of our study was the analysis of the results of different methods of treatment inof children with hemangioma over a ten-year period (from 2007 to 2017) at Irkutsk Regional Children Hospital. We have found a significant reduction in cases of invasive treatment in patients with this pathology. In 2017, inhemangioma was excised in 179 children, and in 2017, this method was used only in 28 patients. Since 2009 cryolysis of vascular neoplasms has not been performedcryolysis. Conservative treatment of hemangiomas include hormone therapy with prednisone as well as systemic and local treatment with beta-adrenergic blocking agents. At the same time, we showed that conservative treatment of hemangiomas is effective before surgery. That is confirmed by the clinical observation of the child with an extensive perineal hemangioma, who underwent the combined treatment using surgical cryodestruction and hormone therapy. This example shows that a good aesthetic result has been obtained only when using hormone therapy, while partial excision of hemangiomas resulted in a violation of the anatomy of the external genitalia, and cryodestruction resulted in an extensive hypertrophic scar on both buttocks. It is concluded that the reasons for the change in treatment tactics in children with hemangiomas are determined by the possibility of using non-invasive methods with obtaining the optimal result of treatment in both oncological and aesthetic terms

ENDOVIDEOSURGICAL TECHNOLOGIES IN THE TREATMENT OF RENAL CYSTS IN CHILDREN

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 lastedfor about26.6 ± 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, excellentfunctional and cosmetic result and allows to avoid a disease recurrence

Rare complications after thoracoplasty in children with congenital pectus excavatum

In this study we presented 4 rare postoperative complications at children after 202 cases of thoracoplasty concerning pectus excavatum deformity of the thorax in the period between 2002 and 2014. The operations were performed by the method proposed by D. Nuss. We revealed following complications: fracture of a body of sternum in the field of its joint with the handle in 1,5 months after operation; massive hemorrhage in a cavity of the fibrous capsule created around a metalwork in 2 years after performance of the thoracoplasty; incarceration of a portion of the latissimus dorsi muscle under "shoulder" of metal construction in 1,5 years after operation; violation of venous outflow at the level of a subclavian vein and a partial compression of a subclavial vein in the early postoperative period. We analyzed possible reasons, clinical symptoms, diagnostics, methods of treatment and offered methods of prevention of these complications

Rare Forms of Intestinal Obstruction 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

STAGED TREATMENT OF CHILDREN WITH POSTTRAUMATIC TRACHEOESOPHAGEAL FISTULA

The article presents the analysis of treatment of posttraumatic tracheoesophageal fistula caused by long staying of a flat battery in the esophagus lumen. The analysis cover treatment of two children at the age of 8 months and 1 year 3 months with a severe chemical burn of the esophagus because of long staying of a flat battery in the esophagus lumen. A principal clinical symptom of a disease was a dysphagia. The call for medical help was delayed - from 1 to 3 days. During the first esophagoscopy the excision of battery was done. A total necrosis of a front and lateral side of the esophagus in a cervical esophagus and a backside of trachea caused by the growth of atracheoesophageal fistula. A gastric fistula was performed for food supply. An emerged tracheoesophageal fistula led to the disturbance of breathing, which is why tracheostomy was urgently performed. The first child had a one-stage plastic operation of backside of trachea defect, the second child had a cycling off fragment of the esophagus, this had made it possible to pack off the trachea and stabilize the children's condition. In three months, the children had undergone a reconstructive plastic operation - retrosternal coloesophagoplasty with an extirpation of an esophagus stump. In this case, a backside of trachea was formed from the diverticulum of trachea (a segment of the esophagus after its disconnection)

TREATMENT OF SACROCOCCYGEAL TERATOBLASTOMA IN CHILDREN

The article presents the analysis of treatment of several cases of relatively rare malignant tumor in children - sacrococcygeal teratoblastoma. Over last fifteen years there were 8 children with this diagnosis treated in the Irkutsk State Regional Children's Clinical Hospital. Mean age was 1.5 years. All children were admitted to the hospital with stages III and IV of the disease. After the course of chemotherapy the surgical treatment was conducted from perineal section with obligatory coccygectomy. Four children recovered, three died, one child is having the course of postoperative chemotherapy