Newborn pediatric surgery. Department of Surgery for Newborns and Premature Babies

Pediatric surgery is a specialized field of surgery for the treatment of conditions in children and adolescents. The goal of pediatric surgery varies depending on the procedure. In general, the goal of pediatric surgery is to correct some congenital condition, disease, traumatic injury, or other disorder in pediatric patients.

Pediatric surgery: description

Pediatric surgery is a branch of surgery that uses operative techniques in pediatrics. There are several different areas of pediatric surgery, these are:

• pediatric General Surgery,
• pediatric otolaryngology (ear, nose and throat),
• pediatric ophthalmology (eyes),
• pediatric urology (genitourinary system),
• pediatric orthopedic surgery,
• pediatric neurological (brain and spinal cord) surgery,
• pediatric plastic (restorative and cosmetic) surgery.

Child patients have special differences, both physical and psychological, from adults. Newborn children are a great challenge in terms of surgical treatment, as their structures and organ systems cannot cope with the physical stress of surgery.

Major problem areas in newborns include:

• cardiovascular system (heart),
• thermoregulation systems,
• lung function,
• kidney function,
• underdeveloped immunity,
• liver function,
• special requirements for drinking and nutrition.

A pediatric surgeon must take into account the special requirements unique to each small patient while performing the full range of surgical procedures. The following is an overview of the most common pediatric conditions that require surgery and are typically performed by a pediatric surgeon.

Prenatal surgery

A separate area of ​​pediatric surgery is prenatal or fetal surgery. These terms mean a branch of medicine that deals with surgical interventions on unborn children in the womb. Such operations are carried out in cases where intrauterine intervention significantly increases the chances of a positive outcome and improves the prognosis for the health of the child in the future.

Indications for intrauterine operations are developmental anomalies, which, after the birth of a child, are highly likely to lead to death in the early stages:

• heart defects,
• hydrocephalus,
• feto-fetal transfusion syndrome and others.

Fetal interventions are performed between 18 and 34 weeks of pregnancy. They are performed in two different ways:

1. open (at the same time, the anterior abdominal wall and uterus are dissected)
2. and fetoscopic (access to the fetus is carried out using endoscopic technology).

Surgical pathology in children at the prenatal stage in Moscow is treated in the Perinatal medical center, NCAGiP named after V. I. Kulakov, clinical hospital "Lapino".

Obstruction of the digestive tract

Blockage of the digestive tract is characterized by four groups of symptoms:

• bloating, bilious vomiting, polyhydramnios (excess amniotic fluid, more than 2000 ml) before birth,
• inability to pass meconium during the first 24 hours of life
• esophageal atresia,
• tracheoesophageal fistula - congenital deformity of the esophagus with severe respiratory failure and increased salivation, others Clinical signs include cyanosis, dyspnea, and cough.

Pyloric atresia

Pyloric atresia is a condition that occurs when the pyloric valve, located between the stomach and duodenum, does not open. Food cannot pass from the stomach, leading to vomiting gastric juice when trying to feed.

Intussusception

Intussusception accounts for 50% of all cases of intestinal obstruction in children from three months to one year. Eighty percent of cases are observed as early as the child's second birthday. The cause of intussusception is not known and it is more common in boys. Symptoms include sudden abdominal pain characterized by episodic screaming and kicking. 60% of sick children have vomiting and blood in the stool. Typically, bowel movements look like a jelly made up of mucus and blood mixed together. Gelatinous stools are the most common clinical symptom in children with intussusception.

Meconium ileus

Meconium ileus is associated with cystic fibrosis ( genetic disease), intestinal obstruction (colonic atresia), meconium syndrome and Hirschsprung's disease ( congenital disease related to the gastrointestinal tract).

Necrotizing enterocolitis

Necrotizing enterocolitis occurs in one to two percent of young neonatal patients intensive care. It is a life-threatening disease characterized by bloating, bilious vomiting, lethargy, fever, and rectal bleeding. In addition, sick children may show signs of hypothermia (temperature below 35.8°C), bradycardia (slow pulse), oliguria, jaundice, and shortness of breath (apnea). Survival in necrotizing enterocolitis, taking into account surgery, is 60-70% of patients.

Abdominal wall defects

These defects occur in one in five thousand babies born. More than 50% of such patients have serious genetic defects: of cardio-vascular system, musculoskeletal system, urogenital, as well as central nervous systems. The overall survival of children with omphalocele varies and depends on the size of the defect and other associated genetic abnormalities, as well as the age of the newborn. Many children with omphalocele are born prematurely, and approximately 33% of them do not survive.

Anorectal anomalies

There are many various types anorectal anomalies, characteristic of both boys and girls, as well as anomalies that are gender specific. Surgery for these cases is complex and should be performed by an experienced pediatric surgeon. Complications from these procedures can lead to permanent problems.

Gastroschisis

Gastroschisis is a congenital anomaly in the development of the anterior abdominal wall, in which intestinal loops and other organs fall out through a hole in it. The cause of the disease is unknown. Amniotic fluid irritates the baby's intestines and causes infection. The problem can be detected with ultrasounds during pregnancy. Some pediatric surgeons and obstetricians recommend C-section however, neonatal patients typically require surgery, tube feeding for three to four weeks, and hospitalization for several weeks. Currently, the survival rate for children with gastroschisis is over 90%.

congenital diaphragmatic hernia

congenital diaphragmatic hernia can be diagnosed in the fourth month of pregnancy by ultrasound. Of infants with congenital diaphragmatic hernia, 44-66% have other congenital anomalies as a result of malformations. Anatomically, patients with congenital diaphragmatic hernia have a defect between the chest and abdomen. Through it, the contents of the abdominal cavity enters the lung cavity. The incidence is approximately one in two thousand newborn babies, in boys it is more common than in girls.

pyloric stenosis

Pyloric stenosis is an obstruction in the intestine due to the larger than normal size of the pylorus muscle fibers (lower opening of the stomach). Pyloric stenosis is a common hereditary disorder that affects men more than women and occurs in one in 700 births. Typical symptoms of pyloric stenosis include progressive vomiting after a feeding attempt. Gastric vomit usually begins during the second and third weeks of life with an increase in their strength and frequency. In this case, as a rule, the child cannot gain weight, and the number of bowel movements and the speed of urination decreases.

A physical examination is usually a great help in establishing a diagnosis. A thorough examination of the abdominal cavity and palpation usually allows you to determine the disease in 85% of cases.

Gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a common condition in infancy, and usually begins on the child's first birthday. The largest group of patients with symptomatic GERD are those who have neurological disorders. Symptoms often include vomiting, lung infections, and delayed gastric emptying. Chance of a favorable outcome when all necessary procedures is more than 90%.

Meckel's diverticulum

Meckel's diverticulum occurs in about two percent of children. Obstruction symptoms are more common in children early age and bleeding is more common in patients after four years of age.

Intestinal polyps

Intestinal polyps are usually present in children between the ages of four and fourteen and are usually inflammatory. The most common symptom of intestinal polyps is rectal bleeding. The diagnosis can be made by sigmoidoscopy, this analysis allows visualization of 85% of polyps.

Acute appendicitis

Acute appendicitis is a relatively common surgical condition, and is diagnosed in 28% of pediatric patients. The classic clinical symptom of acute appendicitis is pain in the right mid-abdomen, accompanied by anorexia, nausea, and vomiting. The pain is constant and becomes more intense and localized. In patients with acute appendicitis usually available elevated level white blood cells.

Inflammatory Bowel Disease

In some cases (about 25%), inflammatory diseases intestines occur in individuals younger than 20 years. Inflammatory bowel disease can be of two types - Crohn's disease and ulcerative colitis.

The diagnosis of inflammatory bowel disease is usually based on the presentation clinical symptoms, results laboratory tests, endoscopy and radiological results. Approximately 50-60% of patients have diarrhea in the stool, severe cramps, and abdominal pain.

Newborn jaundice

Newborn jaundice is commonplace, and the result of an immature system incapable of some basic biochemical reactions. Jaundice that persists for more than two weeks is not normal and can be caused by more than 30 possible disorders.

Biliary atresia

Biliary atresia is a disease that causes inflammation of the ducts of the bile system, leading to fibrosis of these ducts. The frequency of biliary atresia is one in fifteen thousand newborns. Time is of the essence here, and most patients need to be operated on before two months of age. Approximately 25-30% of patients receiving early surgery have long-term successful outcomes. Some patients may require a liver transplant, and 85-90% of these patients survive.

Cholelithiasis

Biliary obstruction in infants and young children is usually caused by pigment stones from blood disorders. Removal of the gallbladder (laparoscopic cholecystectomy) is the only solution.

Injuries

Accidents are the leading cause of death in children aged one to fifteen. More than half of these deaths are due to road traffic accidents, falls from bicycles, drownings, burns, child abuse, birth injuries. Head trauma is the most common condition associated with traumatic death. The treatment of trauma in children differs significantly from the treatment of trauma in adult patients. Children demand special attention regarding the regulation of temperature, blood volume, metabolic rate and other requirements.

Inguinal hernia

Inguinal hernia is the most common disorder requiring surgery in the pediatric age group. Right-sided inguinal hernia is more common in men (60% of cases). The incidence is higher in full-term newborns (3.5-5%). An inguinal hernia can lead to a herniated scrotum.

Denial of responsibility: The information provided in this pediatric surgery article is intended to inform the reader only. It cannot be a substitute for the advice of a health professional.

Significant advances in neonatal surgery have become possible since the emergence of specialized wards, departments, and then centers for the provision of surgical care newborns, which employ specially trained pediatric surgeons, pediatricians, anesthesiologists and nursing staff.

Treatment outcome largely depends on timely diagnosis, identifying and correctly assessing the first symptoms of the disease in maternity hospital. Due to late diagnosis (within 1-2 days after the onset of the first symptoms of the disease), the newborn develops severe complications: aspiration pneumonia with atelectasis, intestinal necrosis and peritonitis, irreversible changes in homeostasis, etc.

Neonatal surgery is 80% emergency surgery. The causes of emergency conditions may be malformations of various organs and systems and acute purulent surgical infection. All emergency conditions and diseases that cause them can be divided into three large groups, identified on the basis of the leading clinical syndrome.

In the children's department of the maternity hospital, for the recognition of surgical pathology, it is important to correctly assess changes in the behavior and condition of the child in dynamics (anxiety, refusal of the breast, vomiting, regurgitation, weight loss, respiratory failure) and the use of all possible research methods in these conditions.

In addition to a thorough examination of the child, identifying symptoms of intoxication, dehydration, hypoxia, auscultation and percussion, palpation of the abdomen, gastric sounding, rectal examination, direct laryngoscopy, sounding of the nasal passages should be applied. Difficulty in passing the probe through the esophagus should suggest that the child has esophageal atresia. The detection in the stomach of a large amount of contents with pathological impurities (bile, greens) indicates intestinal obstruction. Probing of the stomach, in addition to diagnostic, has a therapeutic value - pathological contents that cause intoxication, gas are removed from the stomach, which increases the excursion of the diaphragm, improves breathing. Probing allows you to measure the amount of pathological losses and adequately replenish them.

The assessment of pathological symptoms in newborns should be approached especially carefully. So, characterizing such a symptom as vomiting, it is necessary to take into account the following shades: the time of appearance (hours, days of the child's life), the relationship with feeding, the nature of the manifestation (regurgitation, regurgitation, vomiting "fountain"), the nature of the vomit (unaltered milk, curdled , with an admixture of bile, greens, "coffee grounds", "fecal" vomiting), assessment of the dynamics of the symptom (increases over time or decreases). In some cases, based on the assessment of the qualitative characteristics of this symptom, it is possible to determine the level and nature of intestinal obstruction and the degree of urgency of surgical treatment.

Changes in the stool should also be carefully evaluated: the appearance of a fairly abundant meconium stool during the first day after birth is the norm. Prolongation of the appearance, change in the quantity, color, consistency and qualitative composition of feces is a pathology.

Purulent surgical infection in newborns also has its own distinctive features. Peculiarities immunological reactions(rapid exhaustion of humoral immunity, incompleteness of phagocytosis), anatomical physiological features the structures of the skin, fiber, bones and other organs and systems contribute to the rapid generalization of the process. Therefore, such, at first glance, mild purulent diseases, such as mastitis, lymphadenitis, abscesses, should be treated in a hospital. This is especially important for children born prematurely, from unfavorable pregnancies and childbirth.

When a diagnosis of a surgical disease is established, preoperative preparation begins already in the maternity hospital, which includes gastric probing, proper transportation of the patient, choice of volume and nature additional methods studies aimed at clarifying the surgical diagnosis and the degree of homeostasis disturbance. The main component of this preparation is symptomatic therapy to correct these disorders and prevent infection.

It is necessary to transport newborns in specialized transport equipped with a portable incubator. During transportation, therapeutic measures are carried out: mucus is sucked out of the mouth and nose, and oxygen is given. It is necessary to observe the temperature regime (the temperature in the flask is 28-30°C).

When organizing specialized departments and wards, one should adhere to a strict epidemiological regime, including the separation of clean and purulent patients, the allocation of a special operating room, thorough hand washing, change of gowns, treatment of the premises, equipment in contact with patients, etc.

An x-ray examination of a newborn always begins with a plain x-ray. Attention is drawn to the degree and uniformity of gas filling of the stomach and intestines, the symmetry of the arrangement of organs. chest, the contours of the diaphragm, the presence of pathological formations in the chest and abdominal cavities.

Only in cases where a survey study does not help the diagnosis, they resort to contrasting the gastrointestinal tract. As a contrast agent, a suspension of barium sulfate or iodolipol is more often used. Before the study, gastric contents are aspirated, then barium sulfate is given (1 teaspoon of an aqueous suspension of a creamy consistency in 30-50 ml breast milk). Children in serious condition are injected with a contrast agent through a tube. X-rays and fluoroscopy are performed, depending on the alleged pathology, after 20 minutes, 2 hours and further, up to 24 hours. If necessary, the study begins with the study of the esophagus. An exception for the use of a contrast agent is esophageal atresia (due to the possibility of it getting into the tracheobronchial tree).

During surgery, you should be especially careful with tissues, use special tools, atraumatic needles.

The key to the success of the operation is carefully carried out preoperative preparation and intensive care in postoperative period.

Isakov Yu. F. Children's surgery, 1983.

In its development, minimally invasive surgery in children has gone from adaptation to pediatric practice operations that are common in adults, such as, before the use of laparoscopy and for carrying out, which are found only in pediatric surgery, for example, reconstruction of esophageal atresia and tracheoesophageal fistula. This article focuses on pediatric surgery options commonly performed on adults, as well as some of the neonatal surgeries performed by pediatric generalist surgeons.

Children have specific anatomical and physiological features, which is important to keep in mind when performing laparoscopic operations. In newborns and young children abdominal wall elastic and the top of the bladder is located intraperitoneally, which makes the introduction of trocars potentially dangerous. Most newborns and many children have umbilical hernias, which can become convenient place for access to abdominal cavity, and after the operation, a hernia repair can be performed. The newborn's liver is usually proportionately large, and even minor trauma can result in profuse bleeding that is difficult to stop. All laparoscopic ports in neonates should be placed well below the level of the costal arch, and special care should be taken when retracting the liver.

Available for use are short endoscopic ports with a diameter of 3.4 and 5 mm, both disposable and reusable. In children, it is often necessary to install ports far from each other and at points that do not coincide with the points of installation of trocars during operations in adults, in order to avoid a “duel” of instruments in a small surgical field of a child. Many children operate through abdominal incisions rather than ports, with the exception of ports for a camera or large instruments. A wide range of operations on the gastrointestinal tract, biliary tract, adrenal glands, spleen and organs of the genitourinary system can be safely performed without the use of ports, which significantly saves money. Laparoscopic cameras and power sources for electrosurgery have a diameter of 3 to 5 mm, but ultrasonic coagulators usually have a diameter of at least 5 mm, and an endoscopic stapler requires a 10 mm port. The size of these instruments sometimes limits the minimum invasiveness that could be achieved in neonates.

In children, the mechanical and physiological effects of pneumoperitoneum, pleural cavity insufflation, and ventilation of one lung are usually enhanced. In the pneumoperitoneum state, children absorb proportionately more carbon dioxide than adults, and absorption and excretion of carbon dioxide depend on age. When insufflated for laparoscopic surgery in newborns, there is a decrease in systemic blood pressure, which can usually be corrected by an increase in fluid infusion, but the increase in the maximum concentration of CO 2 at the end of a quiet exhalation often cannot be returned to normal with increased ventilation, so it is maintained until the end of the operation. In newborns with immaturity or disruption of the cardiovascular system, the risk of developing side effects during a prolonged period of insufflation and warrant close monitoring in the perioperative period. Pneumoperitoneum causes reversible anuria in almost all newborns and oliguria in many children, and these urinary changes are independent of intraoperative infusion volume. Thus, in children during the maintenance of pneumoperitoneum, fluid therapy should not be strictly focused on the volume of urine excreted. Fortunately, the elastic abdominal wall allows many abdominal surgeries to be performed with an insufflation pressure of 5-10 mmHg, and many thoracic surgeries do not require insufflation at all. In all cases, insufflation pressure should be limited, with a maximum pressure of 12 mm Hg. in infants weighing less than 5 kg.

Many modern open operations characterized by acceptable cosmetic and excellent functional results. The advantages of laparoscopic and thoracoscopic operations in newborns and children must be evaluated according to modern criteria and take into account the disadvantages of laparoscopic operations, which can take longer, be more expensive and lead to undesirable physiological effects. As technologies become more sophisticated and surgeons become more experienced in performing laparoscopic procedures, many laparoscopic and thoracoscopic procedures are likely to become routine in pediatric surgery.

PEDIATRIC SURGERY- a branch of surgery that studies congenital and postnatal malformations in children, acquired diseases and injuries, the treatment of which requires surgical intervention or other methods of correction in surgical institutions.

The tasks of D. x. - the study of the pathogenesis of diseases, the development of principles and methods for their diagnosis and surgical treatment, based on the physiological and anatomical and topographic features of the growing body of a child in different periods his life, pediatric propaedeutics and general surgical principles. D. h., as well as surgery of adults, includes a number of sections (abdominal, thoracic, cardiovascular surgery, traumatology, orthopedics, urology, neurosurgery, etc.); its independent chapter is neonatal surgery. D. x. is closely connected with genetics, embryology, normal and patol, physiology, pharmacology, biochemistry, pediatrics, general surgery, anesthesiology, obstetrics, radiology, etc.

Research methods in D. x. (X-ray, instrumental, biochemical, electrophysiol., pathomorphol, etc.) have distinctive features due to the age, condition of the patient and the nature of the pathology. Unlike adults, the diagnosis of surgical diseases in children, especially in the neonatal period, infancy and in the first years of life, presents serious difficulties due to disabilities active participation of the patient in the study of anamnesis and objective examination, as well as the small size of anatomical structures. predominance common symptoms diseases over local increases the need to use objective research methods that contain the most informative indicators and are accompanied by minimal trauma. The principles of surgical treatment of children are constantly being improved (performing the vast majority of operations and painful manipulations under anesthesia, adequate compensation for blood loss, prevention of dehydration and hyperhydration, gentle handling of tissues during surgical interventions, etc.). It is also necessary to take into account a number of factors - the possibility of damage to growing and developing structures, high reparative abilities of tissues and the rapid exhaustion of compensatory mechanisms, reduced resistance to infection, growth and differentiation of organs and systems.

In the 19th century surgical care for children was provided in hospitals for adults or in children's therapeutic departments. The first Russian manuals on surgery (I. F. Bush, 1807), operative surgery (X. X. Salomon, 1840), pediatrics (S. F. Khotovitsky, 1847) contain chapters describing a number of surgical diseases in children and methods of their treatment. Despite the active participation of general surgeons in providing surgical care to children, leading domestic pediatricians - N. A. Tolsky, N. F. Filatov, K. A. Raukhfus - spoke out for the need to open surgical departments in children's bats.

In Paris, the first children's surgical department was organized in the middle of the 19th century. in a pediatric hospital. In England in the 60s. 19th century out "Lectures on pediatric surgery" Johnson (A. W. Johnson), approved by the London Medical. about-vom, monograph " Surgery diseases of infants and children”, written by Holmes (T. Holmes), which were among the first teaching aids according to D. x. in Europe. In 1909 the first in the USA "the Textbook on children's surgical diseases" written by S. W. Kelley was published.

In our country, the first department of pediatric surgery was opened in St. Petersburg in 1869 in a children's hospital on the initiative of the famous pediatrician K. A. Raukhfus. In Moscow in 1876 the office of children's surgery in Vladimirsky-tse (now B-tsa of I. V. Rusakov) opened; in 1897 - in the Sofiyskaya hospital (now the B-ts named after N. F. Filatov) and in 1903 - in the Morozovskaya hospital (now the Children's clinic, the hospital No. 1). In total, before the Great October Socialist Revolution in Russia, there were 15 pediatric surgical departments in 10 cities. In 1910-1919. the first domestic manual on pediatric surgery by D. E. Gorokhov “Pediatric Surgery, Selected Chapters” is published in 4 volumes.

After the Great October Socialist Revolution, a new stage in the development of D. x begins. Specialized traumatology, orthopedic, burn departments for children are opened. In 1922 in Petrograd in Soviet clinical in-those for improvement of doctors the department of D. x is organized, a cut until 1927 was in charge of F. K. Weber, and later - N. V. Schwartz. In the Scientific and Practical Institute for the Protection of Motherhood and Infancy, a clinic for pediatric orthopedics and surgery is opened, which was headed by R. R. Vreden from 1925 to 1934, who made a great contribution to the development and study of many issues of surgery of the musculoskeletal system in children .

In Moscow in the 20s. the center of D. x. was the department of surgery childhood in the 1st Children's wedge, b-tse, a cut was headed by T. P. Krasnobaev. His closest assistants were S. D. Ternovsky and A. N. Ryabinkin. In this department, issues of organizing a pediatric surgical service, treating pyloric stenosis, appendicitis, hematogenous osteomyelitis, and pleural empyema were developed. great place in the works of T. P. Krasnobaev is occupied by the problem of treating osteoarticular tuberculosis in children. For the monograph on osteoarticular tuberculosis (1950), T. P. Krasnobaev was awarded the State Prize.

In 1931 in the 2nd MMI the department of D. x. From 1943 to 1960, this department was headed by S. D. Ternovsky, who created the school of domestic pediatric surgeons. S. D. Ternovsky and his students developed the most urgent problems of childhood surgery: issues of emergency and purulent surgery, orthopedics, thoracic surgery, esophageal surgery, and anesthesiology. For the first time in the country, a neonatal surgery center is being organized in this clinic. Students of S. D. Ternovsky - M. V. Volkov, S. Ya. Doletsky, L. A. Vorokhobov, V. M. Derzhavin, E. A. Stepanov, A. G. Pugachev, N. I. Kondrashin and others continued to develop the problems of this school. Since 1966, the department has been headed by Yu. F. Isakov.

In Leningrad, the department of D. x. pediatric in-that, to-ruyu was organized by R. R. Vreden, since 1959 it has been headed by G. A. Bairov. The staff of this department deals with the issues of surgery of the esophagus, malformations of newborns, urology, intestinal obstruction, anesthesiology in children.

A big role in preparation of experts on D. x. belongs to the departments of D. x. in-t of improvement of doctors. In Moscow, such a department was organized at the TsIU in 1956 (V. A. Kruzhkov). Since 1959, this department has been headed by S. Ya. Doletsky. The department successfully works on the problems of neonatal surgery, thoracic surgery, urology, traumatology, hepatology.

The current state of D. x. characterized by continuing specialization and development of various sections (newborn surgery, pulmonary surgery, heart and large vessel surgery, urology, proctology, etc.). Researches patofiziol received great development. problems - protection of the child from surgical trauma, correction of homeostasis in the pre- and postoperative period, development of a set of problems of the pathogenetic, diagnostic and therapeutic plan associated with surgical infection. The solution of these problems requires complex research" with the participation of biochemists, physiologists, anesthesiologists, immunologists, etc.

In the postwar years, D. x. received further development in connection with qualitatively new conditions that immeasurably expanded its capabilities (modern intratracheal anesthesia with artificial lung ventilation, widespread introduction into the wedge, the practice of antibiotics, which contributed to the progress of pediatric thoracic surgery). In lung surgery, a great deal of experience in anatomical resections has been accumulated, and a sparing economical principle has been developed.

The indications, the technique of surgical interventions for malformations (congenital cysts, congenital localized emphysema, sequestration, etc.), acute purulent processes(staphylococcal destruction, bronchiectasis). P. A. Kupriyanov, A. P. Kolesov, S. D. Ternovsky, V. I. Geraskin, S. Ya. Doletsky, S. L. Libov, A. G. Pugachev, E A. Stepanov, MN Stepanova and others. Fundamentally new methods of treatment are being developed, for example, isolated removal of the affected bronchi (with the preservation of the parenchyma and blood vessels) in bronchiectasis, artificial sealing of the bronchial system by temporary occlusion of the affected bronchi in pyopneumothorax and pneumothorax. The undoubted achievements of the post-war period include surgery for congenital heart defects in children; its beginning in our country was laid by A. N. Bakulev, E. N. Meshalkin, V. I. Burakovsky. Surgical correction of congenital heart defects and large vessels in children of early age is successfully carried out. infancy(V. I. Frantsev, Ya. V. Volkolakov and others). Progress has also been made in esophageal surgery.

Methods of surgical correction for congenital malformations - esophageal atresia, achalasia, congenital stenoses, malformations accompanied by gastroesophageal reflux have been developed and successfully applied (G. A. Bairov, Yu. F. Isakov, E. A. Stepanov, etc.) . The issues of creating an artificial esophagus are being widely studied, with the most widespread retrosternal plastic surgery of the esophagus from the colon, and issues of diagnosis and surgical treatment of tumors and mediastinal cysts have been developed.

In the field of abdominal surgery, a number of studies on the treatment of peritonitis, correction of malformations went. - kish. tract in the * neonatal period (with congenital intestinal obstruction), malformations of the biliary tract, etc.

New methods of surgical interventions for congenital and acquired liver diseases in children - hron, hepatitis, portal hypertension, liver injuries (V. G. Akopyan) have been developed and introduced into the wedge, practice.

In pediatric urology, reconstructive and plastic surgery on the ureters bladder, urethra. The method of a hemodialysis at acute and hron is implemented. kidney failure.

Much attention is drawn to the problems of surgical correction for malformations of sexual development.

Large sections D. x. are pediatric traumatology and orthopedics. Domestic surgeons have studied in detail and developed the principles of fracture reposition in children, indications for their surgical treatment. Improved diagnosis and tactics of treatment of children with severe traumatic brain injury. New methods of conservative and surgical treatment of congenital hip dislocation, pectus excavatum, torticollis, clubfoot, hand malformations, diagnosis and treatment of bone tumors in children have been developed (S. D. Ternovsky, N. G. Damier, M. V. Volkov, A. P. Biezin, N. I. Kondrashin, M. V. Gromov, etc.).

One of the main in D. x. is the problem of purulent surgical infection. Scientific research and organizational and practical measures are being developed in three main areas: the impact on the macroorganism, on the causative agent of infection and the purulent focus.

Improving the organization of surgical care for children, diagnostic methods, the use of methods of infusion therapy and correction of homeostasis, the use modern antibiotics, improvement of surgical technique contributed to a significant improvement in the results of treatment of children with acute appendicitis and peritonitis, especially at a younger age, with acute hematogenous osteomyelitis, acute purulent diseases of the lungs and pleura. New possibilities of protection and treatment of patients against an infection give gnoto-biol. methods (local gnotobiol. isolation, abacterial surgery, general isolation), first used in the USSR in the pediatric surgery clinic of the 2nd MMI.

Great contribution to the development of D. x. introduced by foreign scientists: in the USA - Gross (R. Gross), Potts (W. Potts), Swenson (O. Swenson); in Switzerland - Coffin (M. Grob); in Germany - Oberniedermayer (A. Oberniedermayer); in the GDR - Meissner (F. Meissner); in England - Brown (J. J. Brown), Nixon (N. Nixon), O'Donnell (V. O'Donnell), White (M. White), Dennison (W. Dennison); in France - Fevre (M. Fevre), Duhamel (V. Duhamel); in Czechoslovakia - Tashovsky (V. Tasovsky); in NRB - D. Arnaudov; in Poland - Kossakovsky (I. Kossakowski) and others.

Level of development of modern D. x. It has great importance for the practice of medicine and healthcare. Study and implementation in honey. practice of methods for early correction of malformations, performing surgical interventions in children of any age, determining optimal timing and conditions for operations are tasks of paramount importance.

The experience gained by D. x. is used to solve a number of other honey. problems, especially in the treatment emergency conditions not associated with surgical pathology.

Successes of modern D. x. largely due to the development of methods of anesthesia during surgery and in the postoperative period, principles and methods of intensive care, correction and maintenance of basic vital functions. Prospects for its development are associated with the study of the possibilities of using modern achievements (the use of laser energy and ultrasound, low temperatures, hyperbaric oxygenation, extracorporeal blood purification with the help of sorbents), the development of issues of fetal surgery, organ transplantation and the further development of the principles of abacterial surgery.

In our country, research institutions have been created in which topical problems of D. x are purposefully developed: research institutes of pediatrics and pediatric surgery M3 of the RSFSR, departments of pediatric surgery at the Research Institute of Pediatrics of the USSR Academy of Medical Sciences, the Moscow Regional Research Clinical Institute those to them. M. F. Vladimirsky and in research institutes of pediatrics of a number of union republics (Georgian SSR, Kirghiz SSR, etc.).

Specialized departments of children's cardiac surgery, pulmonology are available in a number of research institutes of the USSR Academy of Medical Sciences and M3 of the USSR.

In 1973, the All-Union Center for Pediatric Surgery, Anesthesiology and Intensive Care was established on the basis of the Department of Pediatric Surgery of the 2nd MMI.

D. x. represented in various international and national organizations. The British, Pacific, American Associations of Pediatric Surgeons, which include scientists and specialists from many countries, have been created and are functioning. In the USSR since 1965 the section of children's surgeons of All-Union about-va surgeons is organized. In 1952, a section of pediatric surgeons was formed at the Moscow, and in 1958 - at the Leningrad Scientific Society of Surgeons. In a number of socialist countries (GDR, NRB, Czechoslovakia) sections and about-va children's surgeons are created.

Special magazines on D. x. published in France, Italy, Germany, jointly by England and the USA. In our country scientific work according to D. x. are published in the journals "Surgery", "Bulletin of Surgery", "Clinical Surgery", "Pediatrics", "Problems of Maternal and Childhood Protection", "Anesthesiology and Resuscitation" and in other periodicals.

Questions D. x. widely discussed at numerous international and regional forums. In the USSR in 1965, 1969, 1974, 1976. All-Union conferences of pediatric surgeons were held. All-Union symposia are held annually on topical issues of D. x.

Teaching D. x. in the USSR is conducted in honey. in-takh on pediatric and to lay down. f-max. Specialization is carried out in the system of subordination and internship. Improvement of doctors is carried out at departments and courses of children's surgery in institutes of improvement of doctors.

In total, the country has 73 departments and courses of pediatric surgery in honey. in-takh, in-takh of improvement of doctors and high fur boots.

Bibliography: Bairov G. A. Emergency surgery of newborns, L., 1963, bibliogr.; about N, Urgent surgery of children, L., 1973; BiezinA. P. Children's surgery, M., 1964, bibliogr.; Voznesensky V. P. Urgent surgery of children's age, M., 1944; Pediatric Thoracic Surgery, ed. V. I. Struchkov and A. G. Pugacheva, M., 1975, bibliogr.; Dimitrov, etc. Pediatric surgery, trans. from Bulgarian, Sofia, 1960; Doletsky S. Ya. and Isakov Yu. F. Children's surgery, part 1-2, M., 1970; Doletsky S. Ya. and Nikiforova N. P. Development of pediatric surgery for 50 years, Surgery, No. 10, p. 88, 1967; Doletsky S. Ya., Gavryushov V. V. and HakobyanV. G. Surgery of newborns, M., 1976, bibliogr.; Multivolume Guide to Pediatrics, ed. Yu. F. Dombrovskoy, vol. 9, M., 1964; Ternovsky S. D. Surgery of children's age, M., 1959; Schwartz N. V. Surgery of children's age, M. - L., 1937; Arnaudov D., Lukanov A. and Velichkova D. Ostar surgically rooted in children's age, Sofia, 1961, bibliogr.; G r about b M. Lehrbuch der Kinderchirurgie, Stuttgart, 1957; Gross R. E. The surgery of infancy and childhood, Philadelphia-L., 1958; Lehrbuch der Chirurgie und orthopadie des Kindesalters, hrsg. v. A. Oberniedermayr, Bd 1-3, B., 1959; Meissner F. Kinderchirurgie Erkran-kungen, Bd 1, Lpz., 1965; N i x o n H. H. a. O’ D o n n e 1 1 B. The essentials of pediatric surgery, L., 1966; Pediatric surgery, ed. by W. T. Mustard, v. 1-2, Chicago, 1969; Pediatric surgery, ed. by O. Swenson, N.Y., 1969; Rickham P. P. a. Johnston G. H. Neonatale surgery, L., 1970; Vereanu D. Chirurgie infantila $i orthopedie urgente, Bucu-Regti, 1973.

What does the term " pediatric surgery "? This type of surgery is one of the branches of general surgery. The functions of this section of surgery is the correct diagnosis of a surgical disease, as well as surgical intervention. Pediatric surgery He also treats injuries in children. It is in this area of ​​medicine that the most the latest technology. Often seen among pediatric surgeons a tendency to share knowledge and experience, especially with doctors from other regions and countries. The training of personnel for work in this specialty is carried out especially carefully, since this profession is quite serious. Doctors of this specialty regularly hold All-Russian conferences. Every year in our country there are various symposiums, conferences surgeons and many other tutorials and meetings. This is very important point for the development of this direction.

Sections of Pediatric Surgery

Pediatric surgery , like general surgery, has many sections. Here is some of them:

I would like to note that only in pediatric surgery there is such a subsection as "surgery of newborns". And this is a very important and responsible subsection. In this area of ​​surgery, attention is focused on the age characteristics of the body. Any manipulation directly depends on the age of the child and on the characteristics of his body and his condition.

The structure of pediatric surgery is in close relationship with the following sciences:

And this is only a part of these sciences. This section of surgery is also associated with pharmacology, obstetrics, radiology, anesthesiology and other sciences.

Differences in pediatric surgery

Methods for examining children are fundamentally different from those with which adults are examined. Methods of treatment of children's surgical diseases are also different. The selection of anesthetic drugs during surgical interventions for children is very important. All operations are carried out very carefully, such operations are also called "sparing". Doctors try to avoid numerous postoperative scars. Therefore, incisions are made very carefully and in small quantities. Pediatric surgeons are especially sensitive to overhydration.

More attentive attitude to children, mandatory dosing medicines according to the age and body weight of the child - this is only part of the most important factors. Children demand heightened attention and constant surveillance. Their health needs constant monitoring.

The most advanced branch of all surgery

Currently, pediatric surgery does not stand still. It is developing and moving forward with incredible speed. This branch of surgery is considered the most developed of all areas. Surgeons actively use methods such as ultrasound examination, X-ray diagnostics, laser diagnostics in the diagnosis of a surgical disease. Hyperbaric oxygen therapy is widely used. Many pediatric surgeons are able to carry out such a method as extracorporeal blood purification. They use sorbents in this cleaning method. Fruit surgery is being actively developed. Surgeons carry out successful transplantation of organs and tissues of the child's body.

If we consider pediatric surgery in more detail, we can understand that it is a multidisciplinary science. In the modern world, children are operated on at any age stage. And all this is due to the fact that the equipment is being actively updated and purchased by city hospitals. The equipment is being improved all over the world. But, alas, the cost of professional devices very often exceeds conceivable limits. Therefore, not all children's hospitals are able to acquire them.

Early diagnosis of surgical diseases

Modern methods diagnostics allow to determine the disease on the most early stage its development. The latest ultrasound machines, computed tomography, magnetic resonance imaging, radioisotope diagnostics, angiography and many other diagnostic methods and methods are currently enjoying great success.

A big step was made by prenatal diagnostics, as well as perinatal. Anesthesiology currently allows you to perform surgical interventions immediately after the baby is born. The most important characteristic is the use of minimally invasive endosurgical techniques. When operating, special lighting and intraoperative magnification are used. Methods are used to reduce postoperative pain, the incidence of intestinal paresis is reduced, the affected organs are quickly restored. The child after the operation acquires physical activity much faster than before. The number of complications after surgery has significantly decreased. Children are treated in the hospital less than usual. And the cosmetic results after the operations have become much better. The number of scars was minimized, and this is a very important criterion in modern medicine.

All these advantages arose against the background of the use of the endoscopy method when performing operations among the children's contingent. Endoscopy is developing very actively in pediatric surgery, and in the operation of adults, laparoscopy has reached an active development at the moment. Endoscopic operations performed on children of all ages, even newborns. Endosurgery is moving forward and constantly evolving. Thanks to her, the methods of treatment and its quality have radically improved. Pediatric surgeons are real masters of their craft. They introduce their own unique methods of treating children. The breadth of application of these unique techniques is enormous and much greater than in adult surgery. Surgeons give joy to children, save them, and they even provide someone new life. We should be proud of the developments in modern pediatric surgery and hope that its development will not stop, but will continue with renewed vigor, methods of treating the most hopeless children will be developed and improved. the most complex operations. This is what modern pediatric surgery is striving for.