asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2023-005asurgery-342Research ArticleГНОЙНЫЕ И ТРОФИЧЕСКИЕ ПОРАЖЕНИЯPURULENT AND TROPHIC LESIONSСовременные подходы к лечению трофических язв венозной этиологии: фотодинамическая терапияModern approaches to the treatment of trophic ulcers of venous etiology: photodynamic therapyhttps://orcid.org/0000-0002-2108-2362ХитарьянА. Г.KhitaryanA. G.

Хитарьян Александр Георгиевич, д.м.н., профессор, заведующий кафедрой хирургических болезней №3, 344011, Ростов-на-Дону, ул. Варфоломеева, д. 92а;

заведующий хирургическим отделением, 344022, Ростов-на-Дону, пер. Нахичеванский, д. 29

Alexander G. Khitaryan, Dr. Sci. (Med.), Professor, Head of Department of Surgical Diseases No. 3, 92а, Varfolomeev St., Rostov-on-Don, 344011;

Head of the Department of Surgery, 29, Nakhchivan St, Rostov-on-Don, 344022

khitaryan@gmail.comhttps://orcid.org/0000-0003-0651-9076ЛеденевА. А.LedenevA. A.

Леденев Антон Александрович, врач-хирург хирургического отделения,

344011, Ростов-на-Дону, ул. Варфоломеева, д. 92а

Anton A. Ledenev, Surgeon of the Department of Surgery,

92а, Varfolomeev St., Rostov-on-Don, 344011

ledenev-anton@mail.ruhttps://orcid.org/0000-0003-3782-2860ОреховА. А.OrekhovA. A.

Орехов Алексей Анатольевич, к.м.н., доцент кафедры хирургических болезней №3, 344011, Ростов-на-Дону, ул. Варфоломеева, д. 92а;

врач-хирург хирургического отделения, 344022, Ростов-на-Дону, пер. Нахичеванский, д. 29

Alexey A. Orekhov, Cand. Sci. (Med.), Associate Professor Department of Surgical Diseases No. 3, 92а, Varfolomeev St., Rostov-on-Don, 344011;

Surgeon of the Department of Surgery, 29, Nakhchivan St, Rostov-on-Don, 344022

orekhov_aa@rostgmu.ruhttps://orcid.org/0000-0002-0078-260XВелиевК. С.VelievK. S.

Велиев Камиль Саввинович, врач-хирург хирургического отделения,

344011, Ростов-на-Дону, ул. Варфоломеева, д. 92а

Kamil S. Veliev, Surgeon of the Department of Surgery,

92а, Varfolomeev St., Rostov-on-Don, 344011

koma.81@yandex.ruЛяпинаВ. А.LyapinaV. A.

Ляпина Вера Александровна, студентка,

344022, Ростов-на-Дону, пер. Нахичеванский, д. 29

Vera A. Lyapina, Student,

29, Nakhchivan St, Rostov-on-Don, 344022

veralyapina02@gmail.comhttps://orcid.org/0000-0003-2766-1485КузнецоваВ. В.KuznetsovaV. V.

Кузнецова Валентина Владимировна, студентка,

344022, Ростов-на-Дону, пер. Нахичеванский, д. 29

Valentina V. Kuznetsova, Student,

29, Nakhchivan St, Rostov-on-Don, 344022

Kuznetsovav2@mail.ruhttps://orcid.org/0009-0006-8342-2146БондаренкоВ. Н.BondarenkoV. N.

Бондаренко Виктория Николаевна, аспирант кафедры хирургических болезней № 3,

344022, Ростов-на-Дону, пер. Нахичеванский, д. 29

Victoria N.Bondarenko, Postgraduate Student Department of Surgical Diseases No. 3,

29, Nakhchivan St, Rostov-on-Don, 344022

toriabondarenko7@gmail.comКлиническая больница «РЖД-Медицина» г. Ростова-на-Дону; Ростовский государственный медицинский университетРоссияRailway Clinical Hospital at the Rostov-Glavnyy Station; Rostov State Medical UniversityRussian FederationКлиническая больница «РЖД-Медицина» г. Ростова-на-ДонуРоссияRailway Clinical Hospital at the Rostov-Glavnyy StationRussian FederationРостовский государственный медицинский университетРоссияRostov State Medical UniversityRussian Federation202302052023201116125Copyright © Хитарьян А.Г., Леденев А.А., Орехов А.А., Велиев К.С., Ляпина В.А., Кузнецова В.В., Бондаренко В.Н., 20232023Хитарьян А.Г., Леденев А.А., Орехов А.А., Велиев К.С., Ляпина В.А., Кузнецова В.В., Бондаренко В.Н.Khitaryan A.G., Ledenev A.A., Orekhov A.A., Veliev K.S., Lyapina V.A., Kuznetsova V.V., Bondarenko V.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.a-surgeon.ru/jour/article/view/342

Хроническая венозная недостаточность, являясь исходом и осложнением большинства заболеваний вен нижних конечностей, представляет собой основополагающую причину формирования трофических язв. В течение последнего десятилетия в решении проблемы лечения венозных трофических язв достигнуты определенные успехи как в теоретическом, так и в практическом плане. Современная концепция курации пациентов с трофическими язвами венозного происхождения предполагает разумное сочетание следующих методов лечения: местного, в т. ч. компрессионного, а также медикаментозного, хирургического, малоинвазивного и дополнительных методов (физиотерапевтических, фотодинамических и др.). Главной целью проводимого лечения является ликвидация язвенного дефекта, после чего предпринимаются меры, направленные на коррекцию первопричины (хроническая венозная недостаточность) и профилактику рецидива. Однако тактика наиболее успешного лечения пациентов с трофическими язвами венозной этиологии все еще не определена и требует дальнейшего совершенствования. В частности, изучения и расширения перспектив для клинического применения также заслуживает метод фотодинамической терапии с применением особых лекарственных средств – фотосенсибилизаторов. Механизм фотодинамического воздействия основан на способности фотосенсибилизаторов накапливаться в микробных и патологических клетках. При местном световом воздействии фотосенсибилизатор переходит в возбужденное состояние и заряжает кислород, находящийся в связи с гемоглобином эритроцитов. Таким образом, в клетках, находящихся под воздействием, запускается фотохимическая реакция, которая обеспечивает образование синглетного кислорода и его свободных радикалов. Активные формы кислорода, в свою очередь, оказывают повреждающий эффект на патогенную флору и некротизированные ткани. Основными преимуществами метода являются относительная простота, отсутствие риска развития антибиотикорезистентности, ускорение репаративно-регенераторных процессов, предупреждение вторичного инфицирования. Таким образом, фотодинамическая терапия позволяет неинвазивно, безопасно и эффективно оптимизировать местное лечение и предоперационную подготовку пациентов с венозными трофическими язвами. 

Chronic venous insufficiency, being the outcome and complication of most diseases of the veins of the lower extremities, is the fundamental cause of the formation of trophic ulcers. Over the past decade, in solving the problem of treating venous trophic ulcers, certain successes have been achieved, both in theoretical and practical terms. The modern concept of curation of patients with trophic ulcers of venous origin involves a reasonable combination of the following methods of treatment: local, including compression, as well as medical, surgical, minimally invasive and additional methods (physiotherapy, photodynamic therapy, etc.). The main goal of the treatment is to eliminate the ulcer, after which measures are taken to correct the underlying cause (chronic venous insufficiency) and prevent relapse. However, the tactics of the most successful treatment of patients with trophic ulcers of venous etiology is still not defined and requires further improvement. In particular, the method of photodynamic therapy, which includes the usage of special drugs - photosensitizers, also deserves to be studied and expanded for clinical use. The mechanism of photodynamic action is based on the ability of photosensitizers to accumulate in microbial and pathological cells. Under local light exposure, the photosensitizer enters an excited state and charges oxygen, which is associated with erythrocyte hemoglobin. Thus, in cells under the influence, a photochemical reaction is triggered, which ensures the formation of singlet oxygen and its free radicals. Reactive oxygen species, in turn, have a damaging effect on pathogenic flora and necrotic tissues. The main advantages of the method are relative simplicity, no risk of developing antibiotic resistance, acceleration of reparative and regenerative processes, and prevention of secondary infection. Thus, photodynamic therapy allows non-invasive, safe and effective optimization of local treatment and preoperative preparation of patients with venous trophic ulcers. 

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