asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2022-005asurgery-346Research ArticleФЛЕБОЛОГИЯPHLEBOLOGYЯтрогенные повреждения сосудисто-нервного пучка и лимфатических коллекторов бедренного треугольника при флебэктомииIatrogenic damage to the vascular-nerve bundle and lymphatic collectors of the femoral triangle during phlebectomyhttps://orcid.org/0000-0003-4488-9123БолдинБ. В.BoldinB. V.

Болдин Борис Валентинович, д.м.н., профессор, заведующий кафедрой факультетской хирургии №2,

117997, Москва, ул. Островитянова, д. 1

Boris V. Boldin, Dr. Sci. (Med.), Professor, Head of the Department of Faculty Surgery No. 2,

1, Ostrovityanov St., Moscow, 117997

facultysurgery@gmail.comhttps://orcid.org/0000-0002-3940-0787БогачевВ. Ю.BogachevV. Yu.

Богачев Вадим Юрьевич, д.м.н., профессор кафедры факультетской хирургии №2, 117997, Москва, ул. Островитянова, д. 1;

хирург-флеболог, 117447, Москва, ул. Дмитрия Ульянова, д. 31

Vadim Yu. Bogachev, Dr. Sci. (Med.), Professor of the Department of Faculty Surgery No. 2, 1, Ostrovityanov St., Moscow, 117997;

Phlebologist-Surgeon, 31, Dmitry Ulyanov St., Moscow, 117447

vadim.bogachev63@gmail.cohttps://orcid.org/0000-0002-6976-7678ГолосницкийП. Ю.GolosnitskiyP. Yu.

Голосницкий Павел Юрьевич, к.м.н., доцент кафедры факультетской хирургии №2, 117997, Москва, ул. Островитянова, д. 1;

руководитель Центра сосудистой хирургии, хирург-флеболог, 119071, Москва, Ленинский проспект, д. 27

Pavel Yu. Golosnitskiy, Cand. Sci. (Med.), Associate Professor of the Department of Faculty Surgery No. 2, 1, Ostrovityanov St., Moscow, 117997;

Head of the Center for Vascular Surgery, Surgeon-Phlebologist, 27, Leninsky Ave., Moscow,119071

hirurg1978@mail.ruhttps://orcid.org/0000-0002-6262-4770ТуркинП. Ю.TurkinP. Yu.

Туркин Павел Юрьевич, к.м.н., доцент кафедры факультетской хирургии №2, 117997, Москва, ул. Островитянова, д. 1;

хирург-флеболог, 119071, Москва, Ленинский проспект, д. 27

Pavel Yu. Turkin, Cand. Sci. (Med.), Associate Professor of the Department of Faculty Surgery No. 2, 1, Ostrovityanov St., Moscow, 117997;

Surgeon-Phlebologist, 27, Leninsky Ave., Moscow, 119071

pavelturkin@gmail.comhttps://orcid.org/0000-0002-3574-6190ВаричГ. А.VarichG. A.

Варич Георгий Александрович, к.м.н., доцент кафедры факультетской хирургии №2,  117997, Москва, ул. Островитянова, д. 1;

хирург, заместитель главного врача по хирургии, 141407, Московская обл., Химки, Куркинское шоссе, д. 11

George A. Varich, Cand. Sci. (Med.), Associate Professor of the Department of Faculty Surgery No. 2, 1, Ostrovityanov St., Moscow, 117997;

Surgeon, Deputy Chief Physician for Surgery, 11, Kurkinskoe Shosse, Khimki, Moscow Region, 141407

geravarich@mail.ruhttps://orcid.org/0000-0003-4298-950XДизенгофИ. М.DizengofI. M.

Дизенгоф Игорь Михайлович, к.м.н., ассистент кафедры факультетской хирургии №2, 117997, Москва, ул. Островитянова, д. 1;

заместитель главного врача по хирургии, 119071, Москва, Ленинский проспект, д. 27

Igor M. Dizengof, Cand. Sci. (Med.), Assistant of the Department of Faculty Surgery No. 2, 1, Ostrovityanov St., Moscow, 117997;

Deputy Chief Physician for Surgery, 27, Leninsky Ave., Moscow, 119071

idizengof@yandex.ruРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова; Первый флебологический центрРоссияPirogov Russian National Research Medical University; First Phlebological CenterRussian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова; Центральная клиническая больница Святителя Алексия Митрополита Московского Московской Патриархии Русской Православной ЦерквиРоссияPirogov Russian National Research Medical University; Central Clinical Hospital of St. Alexis Metropolitan of Moscow of the Moscow Patriarchy of the Russian Orthodox ChurchRussian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова; Химкинская областная больницаРоссияPirogov Russian National Research Medical University; Khimki Regional HospitalRussian Federation2023180520232011636Copyright © Болдин Б.В., Богачев В.Ю., Голосницкий П.Ю., Туркин П.Ю., Варич Г.А., Дизенгоф И.М., 20232023Болдин Б.В., Богачев В.Ю., Голосницкий П.Ю., Туркин П.Ю., Варич Г.А., Дизенгоф И.М.Boldin B.V., Bogachev V.Y., Golosnitskiy P.Y., Turkin P.Y., Varich G.A., Dizengof I.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.a-surgeon.ru/jour/article/view/346

Стремительное развитие инновационных медицинских технологий, расширение показаний к оперативному лечению, значительное увеличение числа выполняемых операций при варикозной болезни вен нижних конечностей, анализ литературы и данных крупных обсервационных исследований последних 20 лет позволяют констатировать неуклонный рост частоты ятрогенных повреждений сосудисто-нервного пучка и лимфатических коллекторов нижней конечности в хирургии варикозной болезни, что и явилось поводом для публикации данного обзора. Это может приводить к тяжелым осложнениям, требующим хирургического вмешательства, вызывает социальные и экономические последствия, связанные с необходимостью длительного амбулаторного и стационарного лечения, расходами на социальное обеспечение и выраженное снижение качества жизни. Сообщения о встречаемости данной патологии в медицинской литературе немногочисленны и, как правило, описывают исключительно редкие клинические случаи. Своевременная диагностика осложнений, тактика хирургического лечения пациентов с ятрогенными повреждениями при хирургическом лечении варикозной болезни и возможные варианты коррекции возникающих осложнений продолжают вызывать дискуссии и остаются одной из обсуждаемых проблем современной ангиохирургии. В статье проведен обзор литературы, посвященной анализу возможных причин ятрогении в хирургии варикозной болезни: повреждение сосудисто-нервного пучка и лимфатических сосудов бедренного треугольника, бедренной вены, большой подкожной вены, бедренной артерии, сочетанные повреждения артерии и вены, лимфатических узлов и коллекторов, подкожного нерва при флебэктомии. Рассмотрены вопросы диагностики и варианты коррекции возникших осложнений. Проблема ошибок и осложнений в хирургии вен должна решаться на основе комплексной подготовки хирургов-флебологов, включая обязательное обучение навыкам сосудистой хирургии, а также оснащения клиник специальным оборудованием и инструментарием. 

The rapid development of innovative medical technologies, the expansion of indications for surgical treatment, a significant increase in the number of operations performed for varicose veins entails a steady increase in the frequency of iatrogenic damage to the vascular-nerve bundle and lymphatic collectors of the lower limb. This can lead to severe complications requiring surgery, social and economic consequences associated with the need forlong-term outpatient and inpatient treatment, social security costs and a marked decrease in quality oflife. Reports on the occurrence of this pathology in the medical literature are few and, as a rule, describe extremely rare clinical cases. Timely diagnosis of complications, tactics of surgical treatment of patients with iatrogenic injuries in the surgical treatment of varicose veins and possible options for correcting emerging complications continue to cause discussion and remain one of the discussed problems of modern angiosurgery. The article provides a review of the literature devoted to the analysis of possible causes of iatrogenesis in varicose vein surgery: damage to the neurovascular bundle and lymphatic vessels of the femoral triangle, femoral vein, great saphenous vein, femoral artery, concomitant damage to the artery and vein, lymph nodes and basins, saphenous nerve during phlebectomy. The issues of diagnosis and options for correcting the complications that have arisen. The problem of mistakes and complications in the vein surgery should be resolved through comprehensive training of phlebologists, including compulsory teaching of vascular surgery skills, as well as supplying special equipment and instruments to the clinics. 

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