spracticeХирургическая практикаSurgical practice (Russia)2223-2427АНО "Консорциум "Медицинская техника"10.38181/2223-2427-2022-2-5-14spractice-303Research ArticleСтатьиРАЗРАБОТКА ПЕРСОНАЛИЗИРОВАННОГО АЛГОРИТМА ВЫБОРА СПОСОБА ПЛАСТИКИ ДЕФЕКТА БРЮШНОЙ СТЕНКИ У ПАЦИЕНТОВ С ПАХОВЫМИ ГРЫЖАМИDEVELOPMENT OF THE TAILORED APPROACH IN INGUINAL HERNIA REPAIRhttps://orcid.org/0000-0002-6569-7078АгаповМ. А.AgapovM. A.

Агапов Михаил Андреевич – д.м.н., профессор кафедры хирургии ФФМ

ул. Ленинские Горы, д. 1, 119991, Москва

Mikhail A. Agapov – PhD, Professor of the Department of Surgery

Leninskie Gory St., 1, 119991, Moscow

getinfo911@mail.ruhttps://orcid.org/0000-0003-0352-2317КакоткинВ. В.KakotkinV. V.

Какоткин Виктор Викторович – врач-хирург, отделения хирургии №1 медицинского научно-образовательного центра

119192, Москва, Ломоносовский проспект, д. 27, корп. 10

Viktor V. Kakotkin – Department of Surgery №1 of the Medical Research Educational Center

Lomonosovsky Prospect, 27/10, Moscow, 119192

axtroz4894@gmail.comhttps://orcid.org/0000-0003-0352-2317ЮдинаВ. Д.YudinaV. D.

Юдина Виктория Дмитриевна – студентка 6 курса ФФМ

ул. Ленинские Горы, д. 1, 119991, Москва

Viktoria D. Yudina – student of the Faculty of Medicine

Leninskie Gory St., 1, 119991, Moscow

vita.yudina.biology@gmail.comhttps://orcid.org/0000-0002-6375-8164КадревА. В.KadrevA. V.

Кадрев Алексей Викторович – к.м.н., заведующий отделением ультразвуковой диагностики медицинского научно-образовательного центра

ул. Ленинские Горы, д. 1, 119991, Москва

Alexey V. Kadrev – PhD, Head of the Department of ultrasound diagnostics of the Medical Research Educational Center

Leninskie Gory St., 1, 119991, Moscow

akadrev@yandex.ruhttps://orcid.org/0000-0003-2330-4229ГармановаТ. Н.GarmanovaT. N.

Гарманова Татьяна Николаевна – к.м.н., доцент кафедры хирургии ФФМ

ул. Ленинские Горы, д. 1, 119991, Москва

Tatyana N. Garmanova – PhD, docent of the Department of Surgery

Leninskie Gory St., 1, 119991, Moscow

tatianagarmanova@gmail.comМосковский государственный университет имени М.В. Ломоносова, факультет фундаментальной медицины (МГУ имени М.В. Ломоносова)РоссияFederal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)Russian Federation20222406202202514Copyright © Агапов М.А., Какоткин В.В., Юдина В.Д., Кадрев А.В., Гарманова Т.Н., 20222022Агапов М.А., Какоткин В.В., Юдина В.Д., Кадрев А.В., Гарманова Т.Н.Agapov M.A., Kakotkin V.V., Yudina V.D., Kadrev A.V., Garmanova T.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.spractice.ru/jour/article/view/303

Цель исследования – оценка эффективности персонализированного алгоритма определения методики хирургического лечения паховых грыж, позволяющего выбрать оптимальную оперативную тактику (ее модификации) в зависимости от антропометрических, клинических, инструментальных данных пациента.

В ходе исследования были проанализированы результаты применения клинического алгоритма в медицинском научно-образовательном центре Московского государственного университета имени М.В. Ломоносова для пациентов с односторонними неущемленными симптомными паховыми грыжами. Проводилось сравнение частот основных послеоперационных неблагоприятных исходов исследовательской группы при использовании алгоритма и пациентов немецкого регистра Herniamed Hernia Register, для которых применяются только стандартные принципы выбора оперативного вмешательства, основные положения рекомендаций международной группы экспертов HerniaSurge Group. В ряде случаев учитывались индивидуальные исключительные факторы пациентов.

Благодаря применению алгоритма удалось достичь частоты хронической боли и боли, требующей повторной операции значительно ниже средних частот немецкого регистра Herniamed (13,8% против 28,7% (p<0.00001) и 0,99% против 3,8% (p=0.0103) соответственно). При этом частота неблагоприятных исходов, таких как рецидивы и ранние послеоперационные осложнения схожи с международными с популяционными данными.

The aim of the study is to evaluate the effectiveness of a personalized algorithm for determining the technique of surgical treatment of inguinal hernias, which allows choosing the optimal operational tactics (its modifications) depending on the anthropometric, clinical, instrumental data of the patient.

In the course of the study, the results of the application of a clinical algorithm in the Medical research and Educational center of Lomonosov Moscow State University for patients with unilateral non-incarcerated symptomatic inguinal hernias were analyzed. The frequencies of the main postoperative adverse outcomes of the research group were compared using the algorithm and patients of the German Herniamed Hernia Register, for whom only standard principles of surgical intervention selection are applied, the main provisions of the recommendations of the international HerniaSurge Group of experts. In some cases individual exceptional factors of patients were taken into account.

The frequency of chronic pain and pain requiring repeated surgery was significantly lower than the average frequencies of the German Herniamed register (13.8% vs 28.7% (p<0.00001) and 0.99% vs 3.8% (p=0.0103) respectively). At the same time, the frequency of adverse outcomes, such as relapses and early postoperative complications, is similar to international population data.

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The authors declare that there are no conflicts of interest present.