CHILDREN'S SURGERY — the section of surgery studying at children inborn and post-natal defects, acquired diseases and damages which treatment demands an operative measure or other methods of correction in surgical institutions.
D.'s problems x. — studying of a pathogeny of diseases, development of the principles and methods of their diagnosis and surgical treatment based on physiological and anatomo-topographical features of the growing organism of the child during various periods of his life, pediatric propaedeutics and the all-surgical principles. X., as well as the surgery of adults, includes a number of sections (abdominal, thoracic, cardiovascular surgery, traumatology, orthopedics, urology, neurosurgery, etc.); independent chapter it is the surgery of newborns. X. it is closely connected with genetics, embryology, normal and patol, physiology, pharmacology, biochemistry, pediatrics, the general surgery, anesthesiology, obstetrics, a radiology, etc.
Methods of a research in D. x. (rentgenol., tool, biochemical, elektrofiziol., patomorfol, etc.) have the distinctiveness caused by age, a condition of the patient and the nature of pathology. Unlike adults, diagnosis of diseases of a surgical profile at children, especially in the period of a neonatality, chest age and in the first years of life, presents serious difficulties because of limited opportunities of active participation of the patient during the studying of the anamnesis and an objective research, and also the small extent of anatomical structures. Dominance of the general symptoms of a disease over local increases need of use of the objective methods of a research containing the most informative indicators and which are followed by the minimum injury. The principles of surgical treatment of children (carrying out the vast majority of operations and painful manipulations under anesthetic, adequate compensation of blood loss, prevention of dehydration and overhydratation, the gentle treatment of fabrics are continuously improved during the performance of operative measures, etc.). It is also necessary to consider a number of factors — a possibility of damage of the growing and developing structures, high reparative abilities of fabrics and a bystry exhaustion of compensatory mechanisms, the lowered resilience to an infection, growth and a differentiation of bodies and systems.
In 19 century surgical help to children would be given in for adults or in children's therapeutic departments. In the first Russian leaders on surgery (I. F. Bush, 1807), operational surgery (X. X. Salomon, 1840), pediatrics (S.F. Hotovitsky, 1847) there are heads devoted to the description of a number of surgical diseases at children and ways of their treatment. Despite active participation of the general surgeons in rendering the surgical help to children, the leading domestic pediatricians — N. A. Tolsky, N. F. Filatov, K. A. Raukhfus — would support need of opening of surgical departments for nurseries.
In Paris the first children's surgical department was organized in the middle of 19 century in pediatric hospital. In England in the 60th 19 century there are «Lectures on children's surgery» of A. W. Johnson approved London medical about-vom, the monograph «Surgical Treatment of Diseases of Babies and Children» written by Holmes (T. Holmes), which were one of the first manuals according to D. x. in Europe. In 1909 the first in the USA is published the «Textbook by children's surgical diseases» written to S. W. Kelley.
In our country the first department of children's surgery would be open in St. Petersburg in 1869 in the nursery at the initiative of the famous pediatrician K. A. Raukhfus. In Moscow in 1876 department of children's surgery in Vladimir would open (nowadays B-tsa of I. V. Rusakov); in 1897 — in Sofia-tse (nowadays B-tsa of N. F. Filatov) and in 1903 — in Morozovskaya-tse (nowadays Children's a wedge,-tsa No. 1). In total before Great October socialist revolution in Russia in 10 cities there were 15 nurseries of surgical departments. In 1910 — 1919 there is the first domestic guide to children's surgery of D.E. Gorokhov «Children's surgery, the Elected heads» in 4 volumes.
After Great October socialist revolution the new stage in D.'s development begins x. Open specialized travmatol., orthopedic, burn departments for children. In 1922 in Petrograd in Sovetsk clinical in-those for improvement of doctors the department D. is organized x., the cut till 1927 managed F. K. Weber, and later — N. W. Schwartz. In Scientific and practical in-those protection of motherhood and an infancy the clinic of children's orthopedics and surgery opens, the cut from 1925 to 1934 directed R. R. Vreden who made a big contribution to development and studying of many questions of surgery of a musculoskeletal system at children.
In Moscow in the 20th the center D. x. there was department of surgery of children's age in the 1st Nursery a wedge,-tse, a cut T.P. Krasnobayev headed. S. D. Ternovsky and A. N. Ryabinkin were his closest assistants. In this department questions of the organization of children's surgical service, treatment of a pylorostenosis, appendicitis, hematogenous osteomyelitis, an empyema of a pleura were developed. In T. P. Krasnobayev's works the problem of treatment of bone and joint tuberculosis at children figures prominently. For the monograph on bone articulate tuberculosis (1950) T.P. Krasnobayev was conferred the State award.
In 1931 in the 2nd MMI the department D. was organized x., the cut from 1931 to 1934 managed K. D. Yesipov, then for 1941 — V. P. Voznesensky. From 1943 to 1960 this department was headed by S. D. Ternovsky who created school of domestic children's surgeons. S. D. Ternovsky and his pupils developed the most urgent problems of surgery of children's age: questions of urgent and purulent surgery, orthopedics, thoracic surgery, surgery of a gullet, anesthesiology. For the first time in the country in this clinic the center of surgery of newborns will be organized. S. D. Ternovsky's pupils — M. V, Volkov, S. Ya. Doletsky, L. A. Vorokhobov, V. M. Derzhavin, E. A. Stepanov, A. G. Pugachev, N. I. Kondrashin and others continued development of problems of this school. Since 1966 Yu. F. Isakov directs department.
In Leningrad department D. x. pediatric in-that, to-ruyu R. R. Vreden organized, since 1959 heads G. A. B of acoruses. The staff of this department deals with issues of surgery of a gullet, malformations of newborns, urology, intestinal impassability, anesthesiology at children.
A big role in training of specialists according to D. x. belongs to departments D. x. in-t of improvement of doctors. In Moscow such department was organized in TsIU in 1956 (V. A. Kruzhkov). Since 1959 S. Ya. Doletsky manages this department. The department successfully works on problems of surgery of newborns, thoracic surgery, urology, traumatology, hepathology.
Current state of D. x. it is characterized by the continuing specialization and development of various sections (surgery of newborns, pulmonary surgery, a heart surgery and large vessels, urology, a proctology and so forth). Big development was gained by researches patofiziol. problems — protection of the child against an operational injury, correction of a homeostasis in to - and the postoperative period, development of a complex of the problems of the pathogenetic, diagnostic and medical plan connected with a surgical infection. The solution of these problems demands complex researches» with participation of biochemists, physiologists, anesthesiologists, immunologists, etc.
In post-war years D. x. gained further development in connection with qualitatively new conditions which immeasurably expanded its opportunities (a modern intratracheal anesthesia with artificial ventilation of the lungs, widespread introduction in a wedge, practice of antibiotics that promoted progress of children's thoracic surgery). In surgery of lungs the wide experience of anatomichny resections is accumulated, and the sparing economical principle gained development.
Indications, technology of surgeries are developed at malformations (inborn cysts, the inborn localized emphysema, sequestration and so forth), acute purulent processes (staphylococcal destruction, a bronchietasia). The big contribution to development of this problem was made by P. A. Kupriyanov, A. P. Kolesov, S. D. Ternovsky, B. I. Geraskin, S. Ya. Doletsky, C. L. Libov, A. G. Pugachev, E. A. Stepanov, M. N. Stepanova, etc. Essentially new methods of treatment, napr, the isolated removal of the affected bronchial tubes are developed (with leaving of a parenchyma and vessels) at a bronchietasia, artificial sealing of bronchial system by temporary occlusion of the affected bronchial tubes at a pyopneumothorax and pheumothorax. It is possible to carry surgery of inborn heart diseases at children to undoubted achievements of the post-war period; the beginning it in our country is put by A. N. Bakulev, E. N. Meshalkin, V. I. Burakovsky. Surgical correction of inborn heart diseases and large vessels at children of early chest age is successfully carried out (V. I. Frantsev, Ya. V. Volkolakov, etc.). It is made progress and in surgery of a gullet.
Methods of operational correction at inborn malformations are developed and are successfully applied — the atresia of a gullet, an achalasia, inborn stenoses, malformations which are followed by a gastroesophagal reflux (G. A. Bairov, Yu. F. Isakov, E. A. Stepanov, etc.). Questions of creation of an artificial gullet are widely studied, and the greatest distribution was gained by a retrosternal esophagoplasty from a large intestine, questions of diagnosis and operational treatment of tumors and cysts of a mediastinum are developed.
In the field of abdominal surgery a number of researches on treatment of peritonitis is executed, corrections of malformations went. - kish. a path in * the period of a neonatality (at inborn impassability of intestines), malformations of bilious ways, etc.
New techniques of operative measures at inborn and acquired diseases of a liver at children are developed and implemented in a wedge, practice — hron, hepatitis, portal hypertensia, injuries of a liver (V. G. Akopyan).
In children's urology reconstructive and plastic surgeries on ureters, a bladder, an urethra entered practice. The method of a hemodialysis is implemented at acute and hron. renal failure.
Great attention is drawn by problems of surgical correction at defects of sexual development.
Large sections D. x. the traumatology and orthopedics of children's age are. Domestic surgeons in detail studied and developed the principles of reposition of changes at children, indications to their operational treatment. Diagnosis and tactics of treatment of children with a severe cherepnomozgovy injury is improved. New methods of conservative and operational treatment of congenital dislocation of a hip, funneled deformation of a thorax, a wryneck, a clubfoot, malformations of a brush, diagnosis and treatment of bone tumors at children are developed (S. D. Ternovsky, N. G. Damye, M. V. Volkov, A. P. Biyezin, N. I. Kondrashin, M. V. Gromov, etc.).
One of the main in D. x. the problem of a purulent surgical infection is. Scientific research and organizational and practical actions are developed in three main directions: impact on a macroorganism, on a contagium and a suppurative focus.
Improvement of the organization of the surgical help to children, diagnostic methods, use of methods of infusional therapy and correction of a homeostasis, use of modern antibiotics, improvement of the surgical equipment promoted considerable improvement of results of treatment of children with an acute appendicitis and peritonitis, especially at younger age, with acute hematogenous osteomyelitis, acute purulent diseases of lungs and pleurae. New opportunities of protection and treatment of patients for an infection give gnoto-biol. methods (local gnotobiol. isolation, abacterial surgery, the general isolation), for the first time applied in the USSR in clinic of children's surgery of the 2nd MMI.
Big contribution to D.'s development x. foreign scientists brought: in the USA — R. Gross, W. Potts, Svensson (O. Swenson); in Switzerland — the Coffin (M. Grob); in Germany — Obernidermayer (And. Oberniedermayer); in GDR — F. Meissner; in England — J. J. Brown, Nixon (N. Nixon), O'Donnell (V. O’Donnell), Whyte (M. White), W. Dennison; in France — Febvre (M. Fevre), Duhamel (V. Duhamel); in ChSSR — V. Tasovsky; in NRB — D. Arnaudov; in the Party of Russian Taxpayers — I. Kossakowski, etc.
Level of development of modern D. x. is of great importance for practice of medicine and health care. Studying and implementation in medical practice of methods of early correction of malformations, performance of operative measures at children of any age, determination of optimum terms and conditions for operations are problems of paramount importance.
The experience accumulated by D. x., use for the solution of some other medical problems, in particular at treatment of the medical emergencies which are not connected with surgical pathology.
Modern D.'s progress x. are in many respects caused by development of methods of anesthesia in the course of operation and in the postoperative period, the principles and ways of an intensive care, questions of correction and maintenance of the main vital functions. Perspectives of its development are connected with studying of opportunities of use of modern achievements (use of energy of the laser and ultrasound, low temperatures, hyperbaric oxygenation, extracorporal clarification of blood by means of sorbents), development of questions of surgery of a fruit, organ transplantation and further development of the principles of abacterial surgery.
In our country research establishments in which urgent problems D. are purposefully developed are created x.: research in-you pediatrics and children's surgery of M3 of RSFSR, department of children's surgery in scientific research institute of pediatrics of the USSR Academy of Medical Sciences, Moscow regional research clinical in-those of M. F. Vladimir and in research in-ta of pediatrics of a number of federal republics (The Georgian SSR, the Kyrgyz SSR, etc.).
Specialized departments of a children's heart surgery, pulmonology are available in a number of research in-t of the USSR Academy of Medical Sciences and M3 of the USSR.
In 1973 on the basis of department of children's surgery of the 2nd MMI the All-Union center of children's surgery, anesthesiology and resuscitation is created.
X. it is presented in various international and national organizations. The British, Pacific, American associations of children's surgeons into which scientists and specialists of many countries enter are created and function. In the USSR since 1965 the section of children's surgeons All-Union about-va surgeons is organized. In 1952 the section of children's surgeons is formed at Moscow, and in 1958 — at Leningrad scientific about-ve surgeons. In a number of the socialist countries (GDR, NRB, ChSSR) created sections and about-va children's surgeons.
Special magazines according to D. x. are published in France, Italy, Germany, jointly England and the USA. In our country scientific works on D. x. are published in magazines «Hirurgiya», «Vestnik hirurgii», «Klinicheskaya hirurgiya», «Pediatriya», «Voprosy okhrany materinstva i detstva», «Anesteziologiya i reanimatologiya» and in other periodicals.
Questions D. x. are widely discussed at numerous international and regional forums. In the USSR in 1965, 1969, 1974, 1976 held all-Union conferences of children's surgeons. All-Union symposiums on current questions of D. are annually carried out x.
D.'s teaching x. in the USSR it is conducted in medical in-ta on pediatric and to lay down. f-takh. Specialization is carried out in system of a subinternship and internship. Improvement of doctors is carried out at departments and courses of children's surgery in in-ta of improvement of doctors.
In total in the country there are 73 departments and courses of children's surgery in medical in-ta, in-ta of improvement of doctors and high fur boots.
Bibliography: Bairov G. A. Urgent surgery of newborns, L., 1963, bibliogr.; about N, the Urgent surgery of children, L., 1973; Biyezinya. P. Children's surgery, M., 1964, bibliogr.; Voznesensky V. P. Urgent surgery of children's age, M., 1944; Children's thoracic surgery, under the editorship of V. I. Struchkov and A. G. Pugachev, M., 1975, bibliogr.; Dimitrov, etc. Children's surgery, the lane with bolg., Sofia, 1960; Doletsky S. Ya. and Isakov Yu. F. Children's surgery, p.1 — 2, M., 1970; Doletsky S. Ya. and Nikiforova N. P. Development of surgery of children's age in 50 years, Surgery, No. 10, page 88, 1967; Doletsky S. Ya., Gavryushovv. Century and Akopyanv. G. Hirurgiya of newborns, M., 1976, bibliogr.; The multivolume guide to pediatrics, under the editorship of Yu. F. Dombrovskaya, t. 9, M., 1964; Ternovsky S. D. Surgery of children's age, M., 1959; Schwartz N. W. Surgery of children's age, M. — L., 1937; Arnaudov D., Lukanov A. and Velichkova D. Ostjr surgically brown in a detskat vjzrast, 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 paediatric 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 ortopedie urgente, Bucu-re§ti, 1973.
Yu. F. Isakov.