Substantiation of organ-preserving surgical treatment of children with nonparasitic spleen cysts
- Authors: Belyaeva A.V.1, Rozinov V.M.1, Polyaev Y.A.2, Belyaeva O.A.3, Bondar Z.M.3
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Affiliations:
- Institute of Clinical Surgery, Pirogov Russian National Research Medical University
- Russian Children’s Clinical Hospital Pirogov Russian National Research Medical University
- G.N. Speransky Municipal Children’s Clinical Hospital No. 9
- Issue: Vol 11, No 1 (2021)
- Pages: 17-26
- Section: Original Study Articles
- URL: https://journals.rcsi.science/2219-4061/article/view/123487
- DOI: https://doi.org/10.17816/psaic724
- ID: 123487
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Abstract
BACKGROUND: The urgency of surgical treatment of children with nonparasitic spleen cysts is determined by the lack of consensus in the professional community, lack of regulatory documents governing the treatment of these patients, frequency of postoperative complications, and unfavorable outcomes.
AIM: This study aimed to improve the efficiency and safety of organ-preserving minimally invasive interventions in children with nonparasitic spleen cysts based on the development of a multifactorial preoperative planning system and substantiation of an algorithm for choosing the optimal surgical strategies.
MATERIALS AND METHODS: Results of surgical treatment of 60 children aged 2–18 yrs with nonparasitic spleen cysts are presented. The spleen cyst volume varied from 3 ml to 1000 ml (Me 50 ml). Preoperative examination included clinical examination, laboratory diagnostics, ultrasonography, computed tomography or magnetic resonance imaging, and angiography of the spleen vessels. The range of surgical technologies included percutaneous puncture (n = 2) and percutaneous puncture drainage (n = 28), followed by sclerosing of the cyst with 96% ethyl alcohol, combined interventions, supplemented by superselective embolization of the spleen arteries feeding the pathological formation (n = 15), laparoscopic fenestrations of cysts with physical de-epithelialization of the inner lining (n = 14), and laparoscopic resection of the spleen pole (n = 1).
RESULTS: The analysis of postoperative complications was carried out depending on the chosen technology of surgical treatment. The follow-up period of 44 patients varied from 6 mon to 3 yrs, which made it possible to reveal the regularities of the reduction of residual cyst cavities and the course of the regeneration processes with an objective assessment of the volumetric characteristics of the spleen. Obliteration of the residual cyst cavities was observed in 79.1% of the patients during the first month after surgery. Subsequent total obliteration of the residual cyst cavities was observed within 1 yr after surgery in 91.7% of children and residual pathological formations persisted in five patients, which accounted for 8.3% of clinical observations. The volume of residual cysts ranged from 1.2% to 10.0% of the initial value, which was regarded as a satisfactory treatment result.
CONCLUSION: Results of a retrospective multivariate analysis made it possible to develop an algorithm for substantiating surgical techniques, providing a radical cure for 95.5% of children with nonparasitic spleen cysts.
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##article.viewOnOriginalSite##About the authors
Anastasiya V. Belyaeva
Institute of Clinical Surgery, Pirogov Russian National Research Medical University
Author for correspondence.
Email: avbelyaeva1@gmail.com
ORCID iD: 0000-0002-4899-904X
SPIN-code: 1968-4120
researcher
Russian Federation, 1 Ostrovityanova st., Moscow, 117997Vladimir M. Rozinov
Institute of Clinical Surgery, Pirogov Russian National Research Medical University
Email: rozinov@inbox.ru
ORCID iD: 0000-0002-9491-967X
SPIN-code: 2770-3752
Dr. Sci. (Med.) Professor
Russian Federation, 1 Ostrovityanova st., Moscow, 117997Yrii A. Polyaev
Russian Children’s Clinical Hospital Pirogov Russian National Research Medical University
Email: polyaev@inbox.ru
ORCID iD: 0000-0002-9554-6414
Dr. Sci. (Med.), Professor
Russian Federation, 1 Ostrovityanova st., Moscow, 117997Olga A. Belyaeva
G.N. Speransky Municipal Children’s Clinical Hospital No. 9
Email: belyaeva300@rambler.ru
ORCID iD: 0000-0001-9738-9603
Cand. Sci. (Med.)Russian Federation, 1 Ostrovityanova st., Moscow, 117997
Zoya M. Bondar
G.N. Speransky Municipal Children’s Clinical Hospital No. 9
Email: z.bondar2018@icloud.com
ORCID iD: 0000-0001-6211-7851
Cand. Sci. (Med.)
Russian Federation, 1 Ostrovityanova st., Moscow, 117997References
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