medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-428medsovet-8687Research ArticleХИРУРГИЧЕСКАЯ ОТОРИНОЛАРИНГОЛОГИЯSURGICAL OTORHINOLARYNGOLOGYВозможности интраоперационного гемостаза при эндоскопической хоанопластике у детейPossibilities of intraoperative hemostasis in endoscopic choanoplasty in childrenhttps://orcid.org/0000-0002-3116-6447АсмановА. И.AsmanovA. I.

Асманов Алан Исмаилович - к.м.н., руководитель отдела острой и хронической патологии уха, горла и носа, НИ клинический институт педиатрии и детской хирургии имени академика Ю.Е. Вельтищева РНИМУ имени Н.И. Пирогова; ассистент кафедры оториноларингологии педиатрического факультета, РНИМУ имени Н.И. Пирогова.

125412, Москва, ул. Талдомская, д. 2; 117997, Москва, ул. Островитянова, д. 1

Alan I. Asmanov - Cand. Sci. (Med.), Head of the Department of Acute and Chronic Pathology of the Ear, Throat and Nose, Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery of the Pirogov RNRMU; Assistant of the Department of Otorhinolaryngology, Faculty of Pediatrics, Pirogov RNRMU.

2, Taldomskaya St., Moscow, 125412; 1, Ostrovityanov St., Moscow, 117997

alan-asmanov@yandex.ruhttps://orcid.org/0000-0003-3673-9272ПивневаН. Д.PivnevaN. D.

Пивнева Наталья Дмитриевна, к.м.н., старший научный сотрудник отдела острой и хронической патологии уха, горла и носа, Научно-исследовательский клинический институт педиатрии и детской хирургии имени академика Ю.Е. Вельтищева РНИМУ имени Н.И. Пирогова; врач-оториноларинголог, РНИМУ имени Н.И. Пирогова.

125412, Москва, ул. Талдомская, д. 2; 117997, Москва, ул. Островитянова, д. 1

Natalya D. Pivneva - Cand. Sci. (Med.), Senior Researcher of the Department of Acute and Chronic Pathology of the Ear, Throat and Nose, Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery of the Pirogov RNRMU; Otorhinolaryngologist, Pirogov RNRMU.

2, Taldomskaya St., Moscow, 125412; 1, Ostrovityanov St., Moscow, 117997

pivnevand@yandex.ruhttps://orcid.org/0009-0000-1293-5346ДегтяреваД. В.DegtyarevaD. V.

Дегтярева Дарья Витальевна - к.м.н., врач-оториноларинголог.

121151, Москва, Кутузовский проспект, д. 20

Daria V. Degtyareva - Cand. Sci. (Med.), Otolaryngologist, Polyclinic No. 4.

20, Kutuzovsky Ave., Moscow, 121151

doctor-queen@yandex.ruhttps://orcid.org/0000-0001-5115-0234ЛукинА. М.LukinA. M.

Лукин Андрей Михайлович - врач-эндокринолог.

141983, Московская область, Дубна, ул. Программистов, д. 4, стр. 6, пом. 3

Andrey M. Lukin – Endocrinologist.

4, Bldg. 6, Room 3, Programmistov St., Dubna, Moscow Region, 141983

look7in@yandex.ruНаучно-исследовательский клинический институт педиатрии и детской хирургии имени академика Ю.Е. Вельтищева Российского национального исследовательского медицинского университета имени Н.И. Пирогова; Российский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияVeltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery of the Pirogov Russian National Research Medical University; Pirogov Russian National Research Medical UniversityRussian FederationПоликлиника №4 Управления делами Президента Российской ФедерацииРоссияPolyclinic No. 4 of the Administrative Department of the President of the Russian FederationRussian FederationИнститут прикладных медицинских исследованийРоссияInstitute of Applied Medical ResearchRussian Federation202413112024018112117Copyright © Асманов А.И., Пивнева Н.Д., Дегтярева Д.В., Лукин А.М., 20242024Асманов А.И., Пивнева Н.Д., Дегтярева Д.В., Лукин А.М.Asmanov A.I., Pivneva N.D., Degtyareva D.V., Lukin A.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8687Введение

Введение. В последнее время отмечен значительный прорыв в хирургии врожденной атрезии хоан у детей: новые доступы, различные модификации хирургических техник хоанопластики позволили снизить процент частоты встречаемости осложнений наряду с достижением хороших клинических результатов по восстановлению носового дыхания. Исход оперативного вмешательства во многом зависит от адекватного гемостаза. Таким образом, повышение его эффективности остается актуальным.

Цель

Цель. Оценить эффективность применения интраоперационного гемостаза при проведении хоанопластики у пациентов с врожденной атрезией хоан (ВАХ).

Материалы и методы

Материалы и методы. В исследование вошло 63 ребенка с диагнозом «ВАХ», пролеченных на базе Института Вельтищева (г. Москва). Пациенты были разделены на 2 группы: основную и контрольную. В основной группе гемостаз осуществлялся путем использования биполярного коагулятора (мощность 18 Вт), периодического орошения операционного поля 1-2 мл 1%-ного раствора неполной серебряной соли полиакриловой кислоты (общий объем 10-20 мл), в сочетании с внутривенным введением транексамовой кислоты в разовой дозе 15 мг/кг массы тела со скоростью введения 1 мл/мин. В контрольной группе применялись только коагуляция и транексамовая кислота.

Результаты и обсуждение

Результаты и обсуждение. В основной группе применение неполной серебряной соли полиакриловой кислоты позволило снизить средний объем кровопотери в 1,3 раза по сравнению с контрольной группой.

Заключение

Заключение. Проведенное исследование показало, что применение неполной серебряной соли полиакриловой кислоты в гемостазе при проведении хоанопластики у детей с ВАХ эффективно.

Introduction

Introduction. Recently, a significant breakthrough has been noted in the surgery of congenital choanal atresia in children: new approaches, various modifications of surgical techniques of choanoplasty have reduced the percentage of complications along with achieving good clinical results in restoring nasal breathing. The outcome of surgery largely depends on adequate hemostasis. Thus, increasing its effectiveness remains relevant.

Aim

Aim. Evaluation of the effectiveness of intraoperative hemostasis during choanoplasty in patients with congenital choanal atresia (CCA).

Materials and methods

Materials and methods. The study included 63 children diagnosed with CCA treated at the Veltischev Institute (Moscow). The patients were divided into 2 groups: the main group and the control group. In the main group, hemostasis was carried out by using a bipolar coagulator (power 18 W), periodic irrigation of the surgical field with 1-2 ml of 1% solution of incomplete silver salt of polyacrylic acid (total volume 10-20 ml), in combination with intravenous administration of tranexamic acid in a single dose of 15 mg/kg body weight at a rate of 1 ml/min. In the control group, only coagulation and tranexamic acid were used.

Results and discussion

Results and discussion. In the main group, the use of incomplete silver salt of polyacrylic acid reduced the average volume of blood loss by 1.3 times compared with the control group.

Conclusion

Conclusion. The study showed that the use of incomplete silver salt of polyacrylic acid in hemostasis during choanoplasty in children with CCA is effective.

врожденная атрезия хоанкровотечениепедиатрияоториноларингологияхоанотомияэндоскопияхирургияносовое дыханиеназальная обструкциякоагуляциятранексамовая кислотасеребряная соль полиакриловой кислотыcongenital choanal atresiableedingpediatricsotorhinolaryngologychoanotomyendoscopysurgerynasal breathingnasal obstructioncoagulationtranexamic acidsilver salt of polyacrylic acidReferencesMoreddu E, Rizzi M, Adil E, Balakrishnan K, Chan K, Cheng A et al. International Pediatric Otolaryngology Group (IPOG) consensus recom-mendations: diagnosis, pre-operative, operative and post-operative pediatric choanal atresia care. Int J Pediatr Otorhinolaryngol. 2019;123:151-155. http://doi.org/10.1016/j.ijporl.2019.05.010.Moreddu E, Rizzi M, Adil E, Balakrishnan K, Chan K, Cheng A et al. International Pediatric Otolaryngology Group (IPOG) consensus recom-mendations: diagnosis, pre-operative, operative and post-operative pediatric choanal atresia care. Int J Pediatr Otorhinolaryngol. 2019;123:151-155. http://doi.org/10.1016/j.ijporl.2019.05.010.Котова ЕН, Богомильский МР. Синдром CHARGE у детей с врожденной атрезией хоан. Вестник оториноларингологии. 2022;87(3):7-12. http://doi.org/doi:10.17116/otorino2022870317.Kotova EN, Bogomilsky MR. CHARGE syndrome in children with congenital choanal atresia. Vestnik OtoRinoLaringologii. 2022;87(3):7-12. (In Russ.) http://doi.org/doi:10.17116/otorino2022870317.Alsubaie HM, Almosa WH, Al-Qahtani AS, Margalani O. Choanal Atresia Repair With Stents and Flaps: A Systematic Review Article. Allergy Rhinol. 2021;12:21526567211058052. https://doi.org/10.1177/21526567211058052Alsubaie HM, Almosa WH, Al-Qahtani AS, Margalani O. Choanal Atresia Repair With Stents and Flaps: A Systematic Review Article. Allergy Rhinol. 2021;12:21526567211058052. https://doi.org/10.1177/21526567211058052Yasser AN, Hossam F. Swinging door flap technique for endoscopic transeptal repair of bilateral choanal atresia. Eur Arch Otorhinolaryngol. 2008;265(11):1341-1347. http://doi.org/10.1007/s00405-008-0654-4.Yasser AN, Hossam F. Swinging door flap technique for endoscopic transeptal repair of bilateral choanal atresia. Eur Arch Otorhinolaryngol. 2008;265(11):1341-1347. http://doi.org/10.1007/s00405-008-0654-4.Thomas AT, Waite J, Williams CA, Kirk J, Oliver C, Richards C. Phenotypic characteristics and variability in CHARGE syndrome: a PRISMA compliant systematic review and meta-analysis. J Neurodev Disord. 2022;14(1):49. http://doi.org/10.1186/s11689-022-09459-5.Thomas AT, Waite J, Williams CA, Kirk J, Oliver C, Richards C. Phenotypic characteristics and variability in CHARGE syndrome: a PRISMA compliant systematic review and meta-analysis. J Neurodev Disord. 2022;14(1):49. http://doi.org/10.1186/s11689-022-09459-5.Benjamin RH, Marengo LK, Scheuerle AE, Agopian AJ, Mitchell LE. Prevalence and descriptive epidemiology of choanal atresia and stenosis in Texas, 1999-2018. Am J Med Genet A. 2024;194(6):e63549. http://doi.org/10.1002/ajmg.a.63549.Benjamin RH, Marengo LK, Scheuerle AE, Agopian AJ, Mitchell LE. Prevalence and descriptive epidemiology of choanal atresia and stenosis in Texas, 1999-2018. Am J Med Genet A. 2024;194(6):e63549. http://doi.org/10.1002/ajmg.a.63549.Tomoum MO, Askar MH, Mandour MF, Amer MA, Saafan ME. Stentless mirrored L-shaped septonasal flap versus stented flapless technique for endoscopic endonasal repair of bilateral congenital choanal atresia: a prospective randomised controlled study. J Laryngol Otol. 2018;132(4):329-335. http://doi.org/10.1017/S0022215117002614.Tomoum MO, Askar MH, Mandour MF, Amer MA, Saafan ME. Stentless mirrored L-shaped septonasal flap versus stented flapless technique for endoscopic endonasal repair of bilateral congenital choanal atresia: a prospective randomised controlled study. J Laryngol Otol. 2018;132(4):329-335. http://doi.org/10.1017/S0022215117002614.Carpenter RJ, Neel HB. Correction of congenital choanal atresia in children and adults. Laryngoscope. 1977;87(8):1304-1311. http://doi.org/10.1288/00005537-197708000-00010.Carpenter RJ, Neel HB. Correction of congenital choanal atresia in children and adults. Laryngoscope. 1977;87(8):1304-1311. http://doi.org/10.1288/00005537-197708000-00010.Biron VL, O’Connell DA, Barber B, Clark JM, Andrews C, Jeffery CC et al. Transoral robotic surgery with radial forearm free flap reconstruction: case control analysis. J Otolaryngol Head Neck Surg. 2017;46(1):20. https://doi.org/10.1186/s40463-017-0196-0.Biron VL, O’Connell DA, Barber B, Clark JM, Andrews C, Jeffery CC et al. Transoral robotic surgery with radial forearm free flap reconstruction: case control analysis. J Otolaryngol Head Neck Surg. 2017;46(1):20. https://doi.org/10.1186/s40463-017-0196-0.Bartel R, Levorato M, Adroher M, Cardelus S, Diaz A, Lacima J et al. Performance of endoscopic repair with endonasal flaps for congenital choanal atresia. A systematic review. Acta Otorrinolaringol Esp (Engl Ed). 2021;72(1):51-56. http://doi.org/10.1016/j.otorri.2020.01.002.Bartel R, Levorato M, Adroher M, Cardelus S, Diaz A, Lacima J et al. Performance of endoscopic repair with endonasal flaps for congenital choanal atresia. A systematic review. Acta Otorrinolaringol Esp (Engl Ed). 2021;72(1):51-56. http://doi.org/10.1016/j.otorri.2020.01.002.Burrow TA, Saal HM, de Alarcon A, Martin LJ, Cotton RT, Hopkin RJ. Characterization of congenital anomalies in individuals with choanal atresia. Arch Otolaryngol Head Neck Surg. 2009;135(6):543-547. http://doi.org/10.1001/archoto.2009.53.Burrow TA, Saal HM, de Alarcon A, Martin LJ, Cotton RT, Hopkin RJ. Characterization of congenital anomalies in individuals with choanal atresia. Arch Otolaryngol Head Neck Surg. 2009;135(6):543-547. http://doi.org/10.1001/archoto.2009.53.Usman N, Sur M. CHARGE Syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024. Available at: https://www.ncbi.nlm.nih.gov/books/NBK559199/.Usman N, Sur M. CHARGE Syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024. Available at: https://www.ncbi.nlm.nih.gov/books/NBK559199/.Romeh HE, Albirmawy OA. A 13-year experience and predictors for success in transnasal endoscopic repair of congenital choanal obliteration. Int J Pediatr Otorhinolaryngol. 2010;74(7):737-742. http://doi.org/10.1016/j.ijporl.2010.03.027.Romeh HE, Albirmawy OA. A 13-year experience and predictors for success in transnasal endoscopic repair of congenital choanal obliteration. Int J Pediatr Otorhinolaryngol. 2010;74(7):737-742. http://doi.org/10.1016/j.ijporl.2010.03.027.Newman JR, Harmon P, Shirley WP, Hill JS, Woolley AL, Wiatrak BJ. Operative management of choanal atresia: a 15-year experience. JAMA Otolaryngol Head Neck Surg. 2013;139(1):71-75. http://doi.org/10.1001/jamaoto.2013.1111.Newman JR, Harmon P, Shirley WP, Hill JS, Woolley AL, Wiatrak BJ. Operative management of choanal atresia: a 15-year experience. JAMA Otolaryngol Head Neck Surg. 2013;139(1):71-75. http://doi.org/10.1001/jamaoto.2013.1111.Van Den Abbeele T, Francois M, Narcy P. Transnasal endoscopic treatment of choanal atresia without prolonged stenting. Arch Otolaryngol Head Neck Surg. 2002;128:936-940. https://doi.org/10.1001/archotol.128.8.936.Van Den Abbeele T, Francois M, Narcy P. Transnasal endoscopic treatment of choanal atresia without prolonged stenting. Arch Otolaryngol Head Neck Surg. 2002;128:936-940. https://doi.org/10.1001/archotol.128.8.936.Wormald PJ, Renen G, Perks J, Jones JA, Langton-Hewer CD. The effect of the total intravenous anesthesia compared with inhalational anesthesia on the surgical field during endoscopic sinus surgery. Am J Rhinol. 2005;19:514-520. Available at: https://www.sci-hub.ru/10.1177/194589240501900516.Wormald PJ, Renen G, Perks J, Jones JA, Langton-Hewer CD. The effect of the total intravenous anesthesia compared with inhalational anesthesia on the surgical field during endoscopic sinus surgery. Am J Rhinol. 2005;19:514-520. Available at: https://www.sci-hub.ru/10.1177/194589240501900516.Habibullah A, Mogharbel AM, Alghamdi A, Alhazmi A, Alkhatib T, Zawawi F. Characteristics of Choanal Atresia in Patients With Congenital Anomalies: A Retrospective Study. Cureus. 2022;14(9):e28928. https://doi.org/10.7759/cureus.28928.Habibullah A, Mogharbel AM, Alghamdi A, Alhazmi A, Alkhatib T, Zawawi F. Characteristics of Choanal Atresia in Patients With Congenital Anomalies: A Retrospective Study. Cureus. 2022;14(9):e28928. https://doi.org/10.7759/cureus.28928.Ko MT, Chuang KC, Su CY. Multiple analyses of factors related to intraoperative blood loss and the role of reverse Trendelenburg position in endoscopic sinus surgery. Laryngoscope. 2008;118:1687-1691. https://doi.org/10.1097/MLG.0b013e31817c6b7c.Ko MT, Chuang KC, Su CY. Multiple analyses of factors related to intraoperative blood loss and the role of reverse Trendelenburg position in endoscopic sinus surgery. Laryngoscope. 2008;118:1687-1691. https://doi.org/10.1097/MLG.0b013e31817c6b7c.Gilony D, Scheuerman O, Kornreich L, Hod R, Raveh E. Unilateral Choanal Atresia Presenting With Congenital Respiratory Distress and Recurrent Cyanotic Episodes. Ear Nose Throat J. 2023;102(9):NP429-NP431. https://doi.org/10.1177/01455613211020978.Gilony D, Scheuerman O, Kornreich L, Hod R, Raveh E. Unilateral Choanal Atresia Presenting With Congenital Respiratory Distress and Recurrent Cyanotic Episodes. Ear Nose Throat J. 2023;102(9):NP429-NP431. https://doi.org/10.1177/01455613211020978.Teissier N, Kaguelidou F, Couloigner V, Frangois M, Van Den Abbeele T. Predictive factors for success after transnasal endoscopic treatment of choanal atresia. Arch Otolaryngol Head Neck Surg. 2008;134(1):57-61. https://doi.org/10.1001/archoto.2007.20.Teissier N, Kaguelidou F, Couloigner V, Frangois M, Van Den Abbeele T. Predictive factors for success after transnasal endoscopic treatment of choanal atresia. Arch Otolaryngol Head Neck Surg. 2008;134(1):57-61. https://doi.org/10.1001/archoto.2007.20.Hathorn IF, Habib AR, Manji J, Javer AR. Comparing the reverse Trendelenburg and horizontal position for endoscopic sinus surgery: a randomized controlled trial. Otolaryngol Head Neck Surg. 2013;148(2):308-313. https://doi.org/10.1177/0194599812466529.Hathorn IF, Habib AR, Manji J, Javer AR. Comparing the reverse Trendelenburg and horizontal position for endoscopic sinus surgery: a randomized controlled trial. Otolaryngol Head Neck Surg. 2013;148(2):308-313. https://doi.org/10.1177/0194599812466529.Riepl R, Scheithauer M, Hoffmann TK, Rotter N. Transnasal endoscopic treatment of bilateral choanal atresia in newborns using balloon dilatation: own results and review of literature. Int J Pediatr Otorhinolaryngol. 2014;78(3):459-464. https://doi.org/10.1016/j.ijporl.2013.12.017.Riepl R, Scheithauer M, Hoffmann TK, Rotter N. Transnasal endoscopic treatment of bilateral choanal atresia in newborns using balloon dilatation: own results and review of literature. Int J Pediatr Otorhinolaryngol. 2014;78(3):459-464. https://doi.org/10.1016/j.ijporl.2013.12.017.Brihaye P Delpierre I, De Ville A, Johansson AB, Biarent D, Mansbach AL. Comprehensive management of congenital choanal atresia. Int J Pediatr Otorhinolaryngol. 2017;98:9-18. https://doi.org/10.1016/j.ijporl.2017.04.022.Brihaye P Delpierre I, De Ville A, Johansson AB, Biarent D, Mansbach AL. Comprehensive management of congenital choanal atresia. Int J Pediatr Otorhinolaryngol. 2017;98:9-18. https://doi.org/10.1016/j.ijporl.2017.04.022.Barham HP, Sacks R, Harvey RJ. Hemostatic Materials and Devices. Otolaryngol Clin North Am. 2016;49(3):577-584. https://doi.org/10.1016/j.otc.2016.02.002.Barham HP, Sacks R, Harvey RJ. Hemostatic Materials and Devices. Otolaryngol Clin North Am. 2016;49(3):577-584. https://doi.org/10.1016/j.otc.2016.02.002.Hoylaerts M, Lijnen HR, Collen D. Studies on the mechanism of the antifibrinolytic action of tranexamic acid. Biochim Biophys Acta. 1981;673:75-85. https://doi.org/10.1016/0304-4165(81)90312-3.Hoylaerts M, Lijnen HR, Collen D. Studies on the mechanism of the antifibrinolytic action of tranexamic acid. Biochim Biophys Acta. 1981;673:75-85. https://doi.org/10.1016/0304-4165(81)90312-3.Horrow JC, Van Riper DF, Strong MD, Grunewald KE, Parmet JL. The dose-re-sponse relationship of tranexamic acid. Anesthesiology. 1995;82:383-392. https://doi.org/10.1097/00000542-199502000-00009.Horrow JC, Van Riper DF, Strong MD, Grunewald KE, Parmet JL. The dose-re-sponse relationship of tranexamic acid. Anesthesiology. 1995;82:383-392. https://doi.org/10.1097/00000542-199502000-00009.Boezaart AP, van der Merwe J, Coetzee A. Comparison of sodium nitroprussideand esmolol-induced controlled hypotension for functional endoscopic sinus surgery. Can J Anaesth. 1995;42(5):373-376. https://doi.org/10.1007/BF03015479.Boezaart AP, van der Merwe J, Coetzee A. Comparison of sodium nitroprussideand esmolol-induced controlled hypotension for functional endoscopic sinus surgery. Can J Anaesth. 1995;42(5):373-376. https://doi.org/10.1007/BF03015479.Yap D, Shakir A, Hunt A. Tranexamic acid in sinus and nasal surgery: an up-to-date meta-analysis. J Laryngol Otol. 2022;136(8):692-702. https://doi.org/10.1017/S0022215121003170.Yap D, Shakir A, Hunt A. Tranexamic acid in sinus and nasal surgery: an up-to-date meta-analysis. J Laryngol Otol. 2022;136(8):692-702. https://doi.org/10.1017/S0022215121003170.Ping WD, Zhao QM, Sun HF, Lu HS, Li F. Role of tranexamic acid in nasal surgery: A systemic review and meta-analysis of randomized control trial. Medicine (Baltimore). 2019;98(16):e15202. https://doi.org/10.1097/MD.0000000000015202.Ping WD, Zhao QM, Sun HF, Lu HS, Li F. Role of tranexamic acid in nasal surgery: A systemic review and meta-analysis of randomized control trial. Medicine (Baltimore). 2019;98(16):e15202. https://doi.org/10.1097/MD.0000000000015202.Patel PA, Wyrobek JA, Butwick AJ, Pivalizza EG, Hare GMT, Mazer CD, Goobie SM. Update on Applications and Limitations of Perioperative Tranexamic Acid. Anesth Analg. 2022;135(3):460-473. https://doi.org/10.1213/ANE.0000000000006039.Patel PA, Wyrobek JA, Butwick AJ, Pivalizza EG, Hare GMT, Mazer CD, Goobie SM. Update on Applications and Limitations of Perioperative Tranexamic Acid. Anesth Analg. 2022;135(3):460-473. https://doi.org/10.1213/ANE.0000000000006039.

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