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29MEDICAL SCIENCES
EFFECTIVENESS OF SURGICAL TREATMENT OF CONGENITAL LYMPHANGIOMAS OF THE
HEAD AND NECK IN CHILDREN
Yusupov Sh.,
Samarkand State Medical Institute Department ofpediatric surgery №1, head of the department, MD, DSc
Shamsiev A., Samarkand State Medical Institute Department of pediatric surgery №1, MD, DSc, professor
Shamsiev J., Samarkand State Medical Institute Department of pediatric surgery, anesthesiology and intensive care of postgraduate education, head of the department, MD, DSc, professor
Baymuradov N., Samarkand State Medical Institute Department of pediatric surgery №1, PhD, docent
Pulatov P.
Samarkand State Medical Institute Department of pediatric surgery №1, assistant Samarkand, Republic of Uzbekistan
ABSTRACT
Lymphangiomas are mature, benign tumors originating from the lymphatic vessels. Lymphangiomas can be external (cervical, cervical-axillary-thoracic) and internal (mediastinal, internal organs, retroperitoneal, pelvic). The most common are cervical lymphangiomas - from 74% to 82%. Due to the genetic relationship of lymphangiomas to blood vessels, in particular, to the venous system, their radical removal is difficult, where they are located close to the main vessels of the neck, axillary region, mediastinum and other localizations. There is no consensus on the question of the stage-by-stage excision of lymphangiomas. If no one has any doubts about the rationality of a single-stage surgical intervention. There are practically no works that raise the question of the cosmetological side of surgical interventions undertaken for the removal of lymphangiomas. Radical treatment of lymphangioma by surgical removal is possible only in 75% of cases.
Keywords: lymphangioma, children, sclerotherapy, surgical treatment.
Relevance. Lymphangiomas occur as a result of the vicious development of the lymphatic system in the embryo, starting from the 6-week gestation period. They belong to mature, benign tumors originating from the lymphatic vessels, Lymphangiomas can be external (cervical, cervical-axillary-thoracic) and internal (me-diastinal, internal organs, retroperitoneal, pelvic) [1]. The most common are cervical lymphangiomas - from 74% to 82%, cervical-axillary-thoracic lymphangiomas occur in 6% of patients, mediastinal localization-in 1016% of patients, in the abdominal organs-1-2%, retro-peritoneal location-y 1-2% of patients pelvic localiza-tion-y 1-2% of patients [2].
Due to the genetic relationship of lymphangiomas to blood vessels, in particular, to the venous system, their radical removal is difficult, where they are located close to the main vessels of the neck, axillary region, mediastinum and other localizations. In this regard, the lymphangiomatous tissue, which is difficult to remove and therefore remains on large vascular trunks, serves as a source of tumor recurrences, which occur from 6.4% [3].
In addition, there is no consensus on the question of the stages of excision of lymphangiomas. If no one doubts the rationality of simultaneous surgical intervention in the removal of intracavitary lymphangiomas, then there are 2 points of view regarding superficial
lymphangiomas, especially those with large sizes. One group of surgeons considers it expedient to remove the tumor simultaneously [4], while another group of surgeons adheres to the stage-by-stage operation [5]. There are practically no works that raise the question of the cosmetological side of surgical interventions undertaken for the removal of lymphangiomas [6]. Radical treatment of lymphangioma by surgical removal is possible only in 75% of cases [7].
Purpose of the research. Analysis of the results of various methods of surgical treatment of congenital lymphangiomas of the head and neck in children.
Materials and methods of the research. In the period from 1994 to 2020, 112 children with head and neck lymphangioma were operated on in 2 SamMI clinics. After a complete clinical and laboratory examination and adequate preoperative preparation, the patients were subjected to surgical treatment. Depending on the surgical tactics, they were divided into 2 groups: a control group of 98 patients operated on in the period from 1994 to 2015 - they underwent conventional conventional surgical treatment, which consisted in complete excision of lymphangioma within the surrounding healthy tissues, and a main group of 14 patients who received inpatient treatment in the period from 2016 to 2020, who received minimally invasive surgical treatment in the form of lymphangioma sclerotherapy. This
treatment tactic consisted of a lymphangioma puncture, which was performed under the control of ultrasound sonography. The contents of the lymphangioma were aspirated, then doxacycline was administered at a concentration of 10-20 mg / ml, followed by 4-fold (1 time per day) administration of doxacycline into the lym-phangioma cavity through the left cannulas. On day 4, the cannulas were removed, and a control ultrasound Dopplerography of the residual cavity was performed. In the multicameral form of lymphangioma, cannulas, under ultrasound control, were inserted into each separate cavity of the multicameral cyst.
Table 1
Indicators of the postoperative period in the operated patients of the control group
Localization of lymphangiomas Time constraints (days) Bed-days
lower body temperature being in intensive care
Neck area (n=34) 4,1±0,2 4,1±0,2 14,7±0,2
Head(n=9) 3,4±0,3 4,8±0,3 16,8±0,5
Submandibular area (n=52) 3,1±0,5 3,2±0,1 12,3±0,4
Parotid region (n=3) 4,3±0,3 3,4±0,8 12,4±0,4
Total (n=98) 3,7±0,3 3,8±0,4 14,1±0,4
Results of the research and their discussion.
The effectiveness of treatment of lymphangiomas in children was evaluated by the following indicators: the course of the postoperative period, the presence or absence of suppuration of the residual cavity, the nature of wound healing, the patient's stay in the hospital (bed-day), the duration of temperature (day), ultrasound signs of suppuration and relapse of the disease. In the table below (table 1), we give an example of the results of surgical treatment of patients in the control group.
As can be seen from the table, on average, in the operated patients of the control group, the normalization of body temperature on average was 3-5 days, the stay in the intensive care unit was about 3-5 days, the
average stay of patients in the hospital was In contrast to the control group, in the main indicators were significantly lower, which Table 2.
Indicators of the postoperative period in the operated patients of the main group
12-17 days. group, these is shown in
Table 2
Localization of lymphangiomas Time constraints (days) Bed-days
lower body temperature lower body temperature
Neck area (n=4) 3,9±0,2 - 8,9±0,2
Head (n=3) 4,2±0,1 - 9,2±0,4
Submandibular area (n=5) 3,1±0,6 - 10,0±0,2
Parotid region (n=2) 3,5±0,8 8,3±0,5
Total (n=14) 3,7±0,4 - 9,1±0,3
Table 2 shows that the patients in the first group did not need to be in the intensive care unit after the operation, since the sclerosing drug was administered under local anesthesia, there were no side effects, and after the surgical treatment, they were transferred to the usual inpatient department. In this group of patients, the normalization of body temperature on average was 3-5 days, they were not in the intensive care unit, and most importantly, the duration of stay in the clinic did not exceed 10 days.
Despite the different treatment methods, there were no complications in the early postoperative period in the form of wound suppuration, disease recurrence, and suture divergence in both groups.
The study of long-term results is an objective criterion for evaluating the effectiveness of surgical treatment of patients with lymphangiomas. When checking the long-term results, the tasks of studying the state of health of patients were set. The evaluation criteria were the study of the following factors: clinical signs; the state of postoperative scars and the presence of a relapse of the disease. All the treated patients were under
dispensary supervision and were periodically examined in the clinic. The catamnestic examination was carried out in the period from 1 to 15 years.
We considered the long-term results to be good in those individuals who did not complain after the surgery, the general physical condition corresponded to their age, the postoperative scars do not rise above the skin surface, the latter are soft and painless on palpation, and there is no relapse of the disease.
We considered the results satisfactory in cases where patients complained of periodic pain in the projection of the postoperative scar, which rises above the surface of the skin, dense and slightly painful on palpation, and there is no relapse of the disease.
Unsatisfactory results were considered when patients complained of pain in the projection of the postoperative scar, the latter are rough, rise above the surface of the skin, soldered to the underlying tissues and deform the surrounding soft tissues, there is a relapse of the disease (table 3).
Table 3
Long-term results of surgical treatment of lymphagiomas
Groups Good Satisfactory Unsatisfactory Total
Main 12 (85,7%) 2 (14,3%) _ 14 (1QQ%)
Control 71 (72,5%) 21 (21,4%) 6 (6,1%) 98 (1QQ%)
Total 83 (74,1%) 23 (2Q,5%) 6 (5,4%) 112 (1QQ%)
As can be seen from Table 3, good results were achieved in the main group 12 (85.7%), than in the main group 71 (72.4%). The same results were noted when analyzing the satisfactory results of the treatment, in the main group they were 14.3% to 21.4% of the control group. It should be noted that unsatisfactory results were found in the control group - 5.4%, in the main group they were reduced to 0%.
Conclusions. Analysis of the results of surgical treatment of lymphangiomas of the head and neck showed that the generally accepted traditional method of treatment is quite effective, but requires the patient to be in the intensive care unit after surgical treatment, unlike in the main group, due to the fact that surgical treatment is performed under local anesthesia. The proposed minimally invasive treatment strategy for lym-phangiomas allows us to achieve good treatment results in the long-term period in 85.7% of patients and reduce the recurrence of the disease to 0%.
References
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ПЕРИОПЕРАЦИОННАЯ ДИНАМИКА «СТРЕССОВЫХ» ГОРМОНОВ ПРИ СИМУЛЬТАННЫХ ОПЕРАЦИЯХ У БОЛЬНЫХ С ГРЫЖАМИ ЖИВОТА
Курбаниязов З.Б.
Самаркандский государственный медицинский институт кафедра хирургических болезней №1, заведующий кафедрой, д.м.н., доцент,
Шербеков У.А.
Самаркандский государственный медицинский институт кафедра общей хирургии, заведующий кафедрой, к.м.н.,
Мардонов Б.А.
Самаркандский государственный медицинский институт, кафедра хирургических болезней №1, ассистент, Самарканд, Узбекистан
PERIOPERATIVE DYNAMICS OF "STRESS" HORMONES DURING SIMULTANEOUS OPERATIONS IN PATIENTS WITH ABDOMINAL HERNIA
Kurbaniyazov Z.,
Samarkand State Medical Institute department of surgical diseases №1, head of the department, MD, DSc, docent,
Sherbekov U., Samarkand State Medical Institute department of surgical diseases №1, head of the department, MD, PhD,
Mardonov B. Samarkand State Medical Institute department of surgical diseases №1, assistant, Samarkand, Republic of Uzbekistan
