Введение. Актуальность проблемы хирургического лечения детей с непаразитарными кистами селезенки определяется отсутствием консенсуса в профессиональном сообществе, дефицитом нормативных документов, регламентирующих лечение данного контингента больных, частотой послеоперационных осложнений и неблагоприятных исходов. Цель исследования. Повышение эффективности и безопасности органосохраняющих минимально инвазивных вмешательств у детей с непаразитарными кистами селезенки на основе разработки системы многофакторного предоперационного планирования и обоснования алгоритма выбора оптимальной хирургической тактики. Материалы и методы. Представлены результаты оперативного лечения 60 детей от 2 до 18 лет с непаразитарными кистами селезенки. Объем кист селезенки варьировал от 3 до 1000 мл ( Ме 50 мл). Предоперационное обследование включало клинический осмотр, лабораторную диагностику, ультразвуковое исследование, компьютерную или магнитно-резонансную томографию, ангиографию сосудов селезенки. Спектр хирургических технологий составили чрескожные пункции (2), чрескожное пункционное дренирование (28), с последующим склерозированием кисты 96 % этиловым спиртом, комбинированные вмешательства, дополненные суперселективной эмболизацией артерий селезенки, питающих патологическое образование (15), лапароскопические фенестрации кист с физической деэпителизацией внутренней выстилки (14), лапароскопическую резекцию полюса селезенки (1). Результаты. Проведен анализ послеоперационных осложнений в зависимости от избранной технологии хирургического лечения. Длительность катамнестического наблюдения 44 пациентов варьировала от 6 мес. до 3 лет, что позволило выявить закономерности редукции остаточных полостей кист и течение процессов регенерации с объективной оценкой объемных характеристик селезенки. Облитерация остаточных полостей кист отмечена у подавляющего (79,1 %) большинства пациентов в течение первого месяца после операции. Последующая тотальная облитерация остаточных полостей кист наблюдалась в течение первого года после операции у 91,7 % детей, резидуальные патологические образования сохранялись у 5 пациентов, что составило 8,3 % клинических наблюдений. Объем резидуальных кист варьировал в диапазоне 1,2–10,0 % от исходного, что расценивалось как удовлетворительный результат лечения. Заключение. Результаты ретроспективного многофакторного анализа позволили разработать алгоритм обоснования хирургической тактики, обеспечивающий радикальное излечение 95,5 % детей с непаразитарными кистами селезенки.

В работе подведены итоги V Форума детских хирургов России, прошедшего в г. Уфе c 3 по 5 сентября 2019 года. Впервые ежегодное самое крупное научное событие отечественных детских хирургов было проведено вне столицы. На Форуме присутствовало свыше 600 делегатов, включая специалистов из 10 зарубежных стран и представителей всех федеральных округов РФ. Научная программа Форума была представлена симпозиумами (14), круглыми столами (4), видеосессией «Как я это делаю», мастер-классами (2) и конкурсом молодых ученых. Было проведено рабочее совещание по актуальным проблемам детской хирургии. На сообщении были проведены краткие результаты анализа организации Форума и научного содержания докладов.

The issue of surgical treatment of children with incarcerated inguinal hernias is presented. The evolution of views on the incarceration pathogenesis in the presence of a non-obliterated Nuck’s diverticulum with subsequent ischemia and threatening necrosis of internal organs in the hernia sac is reviewed. Authors who are in favor of early correction of inguinal hernias in young children present their arguments. Techniques of the strategy that allows for preliminary conservative invagination and subsequent delayed surgical reconstruction are presented. Detailed advantages of endosurgical interventions and possible complications in the treatment of children with incarcerated inguinal hernias including the reasons for blood flow reduction in the testes following hernioherniorrhaphy are presented.

Clinical observation of a 1.5-year-old with a hydrogel foreign object in the ileum causing an acute obturation intestinal obstruction was submitted.

Clinical observation of a 1.5-year-old with a hydrogel foreign object in the ileum causing an acute obturation intestinal obstruction was submitted.

The article stresses the evolution of views on the problem of treatment of children and adolescents with diaphyseal fractures of the shin bones and a set of actual medical technologies implemented in these patients. The views of authoritative followers of conservative therapy and supporters of medical schools adhering to the ideology of stable and functional osteosynthesis are reviewed. The basic tendencies of development of surgery of injuries in pediatrics are found and effective and safe methods of surgery of patients with instable diaphyseal fractures of the tibia on the basis of using the closed intramedullary osteosynthesis with the original blocking rod are substantiated.

The article is devoted to an actual problem of pediatric surgery - the treatment of patients with infected wounds on the stages of the skin recovery. The authors analyzed the results of treatment of patients with wounds of various etiologies and demonstrate the efficiency of the use of ultrasonic cavitation and dissection in comparison as a method of preparation of the wound surface to plastic skin closure.

The article is devoted to an actual problem of pediatric surgery - the treatment of patients with infected wounds on the stages of the skin recovery. The authors analyzed the results of treatment of patients with wounds of various etiologies and demonstrate the efficiency of the use of ultrasonic cavitation and dissection in comparison as a method of preparation of the wound surface to plastic skin closure.

The results of monitoring of provision of Russian children with surgical specialists and specific beds in 2010-2015 in accordance with the period of healthcare reforms referred to as optimization are submitted. Tendencies in the country, federal districts and constituent units of the Russian Federation are stated. It is indicated that reduction in the number of specialists and surgical beds carried out without proper scientific substantiation doesn’t only contain risks of decreased availability of specialized medical aid rendered to children but also fails to correspond to the concept of national safety. The necessity of development of regulatory framework regulating territorial planning of the system of medical aid to children depending on geographical, demographic, transport and infrastructure peculiarities of the regions is substantiated.

The article stresses the evolution of views on the problem of treatment of children and adolescents with diaphyseal fractures of the shin bones and a set of actual medical technologies implemented in these patients. The views of authoritative followers of conservative therapy and supporters of medical schools adhering to the ideology of stable and functional osteosynthesis are reviewed. The basic tendencies of development of surgery of injuries in pediatrics are found and effective and safe methods of surgery of patients with instable diaphyseal fractures of the tibia on the basis of using the closed intramedullary osteosynthesis with the original blocking rod are substantiated.

Historical and actual aspects of diagnostics and classification of nonparasitic cysts in children, risk of splenectomy and a specter of surgical technologies ensuring organ preservation treatment are presented in the article. Vies of authoritative followers of traditional (open) surgeries, endosurgical interventions and navigation accesses to the pathological center are reviewed. Advantages of using of different types of energy alongside with mechanical influence for the purpose of surgical hemostasis, deepithelialization of the cystic cavity, slerotherapy of its walls are shown. Perspectives of combined minimally invasive surgeries combining endovascular occlusion of vessels, feeding the cystic wall and ultrasound-guided puncture and drainage intervention are determined.

The results of the study examining the effectiveness of negative pressure wound therapy in children with the wounds of soft tissues. 50 patients with wounds of different etiology were examined. In a half of clinical studies vacuum therapy was implemented whereas other patients used modern wound dressings (comparison group). The influence of negative pressure on the process of wound retraction was estimated based on the results of computer photoplanimetric studies. It is shown that vacuum therapy forms favorable conditions for the retraction of wound defects significantly exceeding the corresponding indicators of wound area reduction in patients from the group of comparison.

There is limited representation of pediatric aspects of the activity produced by the national services of emergency medicine in specialized literature. The article reveals the amount of children among the affected ones under various emergency conditions, pediatric anatomy and physiology, a rational way to render medical care to children in the system of medical and evacuation support, necessity and effectiveness of organizational forms of doctors’ involvement at different stages of medical evacuation. The data are prepared using the terms of modern directives.

The results of the study examining the effectiveness of negative pressure wound therapy in children with the wounds of soft tissues. 50 patients with wounds of different etiology were examined. In a half of clinical studies vacuum therapy was implemented whereas other patients used modern wound dressings (comparison group). The influence of negative pressure on the process of wound retraction was estimated based on the results of computer photoplanimetric studies. It is shown that vacuum therapy forms favorable conditions for the retraction of wound defects significantly exceeding the corresponding indicators of wound area reduction in patients from the group of comparison.

More than 1,000 people, including 125 children with severe burns, were suffered in man-made disaster in Bashkiria (1989). The results of the analysis of all stages of care for children were discussed in article. This experience was the basis of becoming a pediatric combustiology in disaster medicine.

Представлены статистические данные зарубежных и отечественных источников о детях, пострадавших в результате военных конфликтов и террористических актов. Рассматриваются организационные формы оказания медицинской помощи детям в чрезвычайных ситуациях и специфические проблемы лечебно-диагностической тактики в условиях вооруженных конфликтов, в первую очередь вопросы военно-полевой хирургии. На опыте работы в Чеченской Республике и в г. Беслане показана эффективность новой модели организации специализированной хирургической помощи детям - полевого педиатрического госпиталя.

The results of the analysis step of care to children, victims of the terrorist act in Beslan are presented. The basis of the success of medical interventions in large-scale terrorist attack (more than 1000 hostages) was proper planning, the All Russian Center for Disaster Medicine «Protection» (RCDM), using the methods of military surgery during triage and determination of rational volume of care at all stages and emergency evacuation. In the first day of medical assistance was provided to 300 children, 146 of them were evacuated to hospitals in Moscow and Rostov. Died 10 children. Effectiveness of medical evacuation support was provided through the interaction of all the medical services of the Ministry of Health of Russia and North Ossetia with the Russian Emergencies Ministry, the Ministry of Defence as well as the experience of pediatric brigade of RCDM in local armed conflicts.