Отсроченные эстетические результаты реконструктивных операций с эндопротезированием, выполненных по поводу рака молочной железы. Обзор литературы

Хомиди У.Х., Власова М.Ю., Сарибекян Э.К., Зикиряходжаев А.Д., Хакимова Ш.Г., Хакимова Г.Г., Кодзоева Д.Б. Отсроченные эстетические результаты реконструктивных операций с эндопротезированием, выполненных по поводу рака молочной железы. Обзор литературы. Современная Онкология. 2025;27(1):26–31. DOI: 10.26442/18151434.2025.1.202905

© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.

________________________________________________

Khomidi UKh, Vlasova MYu, Saribekyan EK, Zikiryakhodzhaev AD, Khakimova ShG, Khakimova GG, Kodzoeva DB. Long-term aesthetic outcomes of reconstructive surgeries with endoprosthetics for breast cancer: A review. Journal of Modern Oncology. 2025;27(1):26–31. DOI: 10.26442/18151434.2025.1.202905

Читать PDF

Аннотация

Рак молочной железы (РМЖ) продолжает оставаться наиболее часто встречающимся онкологическим заболеванием среди женского населения как в Российской Федерации, так и в мире. Хирургическое вмешательство является важным этапом в комплексном лечении больных РМЖ. Наибольший интерес для онкологов-маммологов, пластических хирургов представляют различные варианты реконструктивно-пластических операций. В настоящее время для практикующих врачей существует большой выбор различных синтетических, биологических материалов для реконструкции, а также множество вариантов для использования лоскутных методик. Несмотря на многочисленность зарубежных и российских публикаций, в данном направлении актуальным продолжает оставаться вопрос оценки отсроченных результатов реконструкции молочной железы. В нашей статье мы проанализировали исследования, посвященные анализу отсроченных эстетических результатов реконструктивных операций с применением эндопротезов у больных РМЖ. Методика эндопротезирования по сравнению с реконструкцией собственными тканями более проста в техническом плане, менее травматична, срок восстановления больных короче. Однако, несмотря на применение высококачественных имплантов и усовершенствование техник реконструктивных операций, остается определенный риск возникновения осложнений (15–35%). В раннем периоде наиболее часто речь идет о протрузии и инфицировании эндопротеза, некрозе ареолы, краев раны, ротации импланта. Из поздних осложнений наибольший интерес представляет капсулярная контрактура III–IV степени по J. Baker. В исследованиях подчеркивается важность индивидуального подхода и тщательного планирования комплексного лечения для достижения оптимальных результатов и повышения качества жизни.

Ключевые слова: рак молочной железы, реконструкция молочной железы, отсроченные эстетические результаты, качество жизни, осложнения при реконструкции молочной железы

________________________________________________

Breast cancer (BC) is still the most common cancer among the female population both in the Russian Federation and in the world. Surgical intervention is an important step in the complex treatment of patients with BC. Several variants of reconstructive plastic surgeries are of the greatest interest to oncologists-mammologists and plastic surgeons. Currently, practitioners have plenty of choices of synthetic and biological materials for reconstruction and many options for flap techniques. Despite the abundance of foreign and Russian publications, the issue of assessing the delayed results of breast reconstruction is still relevant. In our paper, we analyzed studies on long-term aesthetic outcomes of reconstructive surgeries with endoprostheses in patients with BC. The technique of endoprosthetics, compared to reconstruction using the patient's tissues, is simpler in technical terms, less traumatic, and the recovery time for patients is shorter. However, despite the use of high-quality implants and the improvement of reconstructive surgery techniques, there remains a certain risk of complications (15–35%). In the early postoperative period, the most common complications are protrusion and infection of the endoprosthesis, necrosis of the areola and wound edges, and implant rotation. Of the late complications, the most relevant is grade III–IV capsular contracture according to J. Baker. The studies emphasize the importance of an individual approach and careful planning of comprehensive treatment to achieve optimal outcomes and improve the quality of life of patients with BC.

Keywords: breast cancer, breast reconstruction, long-term aesthetic outcomes, quality of life, complications of breast reconstruction

Полный текст

Материалы доступны только для специалистов сферы здравоохранения.
Чтобы посмотреть материал полностью Авторизуйтесь или зарегистрируйтесь.

Список литературы

1. Каприн А.Д., Старинский В.В., Шахзадова А.О. Состояние онкологической помощи населению России в 2022 г. M., 2022 [Kaprin AD, Starinskii VV, Shakhzadova AO. Sostoyaniie onkologicheskoi pomoshchi naseleniiu Rossii v 2022 g. Moscow, 2022 (in Russian)].
2. Иванов Ю.В., Шаробаро В.И., Панченков Д.Н., и др. Современные возможности реконструктивно-пластической хирургии рака молочной железы. Вестник экспериментальной и клинической хирургии. 2018;11(2) [Ivanov YV, Sharobaro VI, Panchenkov DN, et al. Modern Possibilities of Reconstructive Plastic Surgery of Breast Cancer. Bulletin of Experimental & Clinical Surgery. 2018;11(2) (in Russian)].
3. Хакимова Ш.Г., Зикиряходжаев А.Д. Выбор метода реконструкции у больных раком молочной железы. Онкология. Журнал им. П.А. Герцена. 2021;10(4):53-8 [Khakimova ShG, Zikiryakhodzhaev AD. Choice for a reconstruction method in breast cancer patients. PA.Herzen Journal of Oncology. 2021;10(4):53-8 (in Russian)].
4. Власова М.Ю., Зикиряходжаев А.Д., Решетов И.В., и др. Осложнения после одномоментной препекторальной реконструкции имплантатами с полиуретановым покрытием при раке молочной железы. Опухоли женской репродуктивной системы. 2020;16(4):12-20 [Vlasova MYu, Zikiryakhodzhaev AD, Reshetov IV, et al. Complications after simultaneous prepectoral breast reconstruction using polyurethane-coated implants in patients with breast cancer. Tumors of Female Reproductive System. 2020;16(4):12-20 (in Russian)].
5. Jimenez RB, Packowski K, Horick N, et al. The Timing of Acute and Late Complications Following Mastectomy and Implant-Based Reconstruction. Ann Surg. 2023;278(1):e203-8.
6. Зикиряходжаев А.Д., Рассказова Е.А., Хакимова Ш.Г. Онкологическая безопасность радикальных подкожных/кожесохранных мастэктомий с одномоментной реконструкцией при раке. Вопросы онкологии. 2019;65(6):832-7 [Zikiriakhodzhaiev AD, Rasskazova EA, Khakimova SHG. Onkologicheskaia bezopasnost radikalnykh podkozhnykh/kozhesokhrannykh mastektomii s odnomomentnoi rekonstruktsiiei pri rake. Voprosy onkologii. 2019;65(6):832-7 (in Russian)].
7. Rowland JH, Hewitt M, Ganz PA. Psychological impact of treatments for breast cancer. In: Rowland JH. Surgery of the breast: principles and art/editor. Scott L. Spear. 2nd ed. 2006; p. 383.
8. Dieterich M, Reimer T, Dieterich H, et al. A short-term follow-up of implant based breast reconstruction using a titanium-coated polypropylene mesh (TiLoop® Bra). Eur J Surg Oncol (EJSO). 2012;38(12):1225-30.
9. Eriksson M, Anveden L, Celebioglu F, et al. Radiotherapy in implant-based immediate breast reconstruction: risk factors, surgical outcomes, and patient-reported outcome measures in a large Swedish multicenter cohort. Breast Cancer Res Treat. 2013;142(3):591-601. DOI:10.1007/s10549-013-2770-0
10. Давыдов М.И., Аксель Е.М. Статистика злокачественных новообразований в России и странах СНГ в 2007 г. Вестник РОНЦ им. Н.Н. Блохина РАМН. 2009;20(3):8-12 [Davydov MI, Aksel EM. Statistika zlokachestvennykh novoobrazovanii v Rossii i stranakh SNG v 2007 g. Vestnik RONTS im. NN Blokhina RAMN. 2009;20(3):8-12 (in Russian)].
11. Cordeiro PG, McCarthy CM, Colleen M. A single surgeon's 12-year experience with tissue expander/implant breast reconstruction: part I. A prospective analysis of early complications. Plast Reconstr Surg. 2006;118(4):825-31.
12. Handel N, Cordray T, Gutierrez М, et al. A Long-Term Study of Outcomes, Complications, and Patient Satisfaction with Breast Implants. Plast Reconstr Surg. 2006;117(3):757-67.
13. Friedrich M, Krämer S, Friedrich D. Difficulties of Breast Reconstruction – Problems That No One Likes to Face. Anticancer Res. 2021;41(11):5365-75. DOI:10.21873/anticanres.15349
14. Doherty С, Pearce S, Baxter N, et al. Trends in immediate breast reconstruction and radiation after mastectomy: A population study. Breast J. 2020;26(3):446-43.
15. Hart SE, Brown DL, Kim HM, et al. Association of Clinical Complications of Chemotherapy and Patient-Reported Outcomes After Immediate Breast Reconstruction. JAMA Surg. 2021;156(9):847-55. DOI:10.1001/jamasurg.2021.2239
16. Hung YC, McCarthy JT, Park BC, et al. Comparison of Complication Rates Between Subpectoral vs Prepectoral Techniques in Prosthetic Breast Reconstruction. Aesthet Surg J. 2023;43(11):1285-92. DOI:10.1093/asj/sjad145
17. Liu J, Hou J, Li Z, et al. Efficacy of Acellular Dermal Matrix in Capsular Contracture of Implant-Based Breast Reconstruction: A Single-Arm Meta-analysis. Aesthetic Plast Surg. 2020;44(3):735-42. DOI:10.1007/s00266-019-01603-2
18. Hughes K, Brown C, Perez V, et al. The effect of radiotherapy on implant-based breast reconstruction in the setting of skin-sparing mastectomy: clinical series and review of complications. Anticancer Research. 2012;32(2):553-7.
19. Peled AW, Sears M, Wang F, et al. Complications after total skin-sparing mastectomy and expander-implant reconstruction: Effects of radiation therapy on the stages of reconstruction. Ann Plast Surg. 2018;80(1):10-3. DOI:10.1097/SAP.00000000000011862
20. Naoum GE, Salama L, Niemierko A, et al. Single stage direct-to-implant breast reconstruction has lower complication rates than tissue expander and implant and comparable rates to autologous reconstruction in patients receiving postmastectomy radiation. Int J Radiat Oncol Biol Phys. 2020;106(3):514-24. DOI:10.1016/j.ijrobp.2019.11.008
21. Luvsannyam E, Patel D, Hassan Z, et al. Overview of risk factors and prevention of capsular contracture following implant-based breast reconstruction and cosmetic surgery: a systematic review. Cureus. 2020;12(9):e10341. DOI:10.7759/cureus.10341
22. Araco A, Caruso R, Araco F, et al. Capsular contractures: a systematic review. Plast Reconstr Surg. 2009;124(6):1808-19. DOI:10.1097/PRS.0b013e3181bf7f26
23. Hvilsom GB, Hölmich LR, Steding-Jessen M, et al. Delayed breast implant reconstruction: a 10-year prospective study. J Plast Reconstr Aesthet Surg. 2011;64(11):1466-74.
24. Vardanian AJ, Clayton JL, Roostaeian J, et al. Comparison of implant-based immediate breast reconstruction with and without acellular dermal matrix. Plast Reconstr Surg. 2011;128(5):403e-10e.
25. Collins JB, Verheyden CN. Incidence of breast hematoma after placement of breast prostheses. Plast Reconstr Surg. 2012;129(3):413e-20e. DOI:10.1097/PRS.0b013e3182402ce0
26. Granzow JW, Levine JL, Chiu ES, et al. Breast Reconstruction with Perforator Flaps. Plast Reconstr Surg. 2007;120(1):1-12.
27. Malekpour M, Malekpour F, Wang HT. Breast reconstruction: Review of current autologous and implant-based techniques and long-term oncologic outcome. World J Clin Cases. 2023;11(10):2201-12. DOI:10.12998/wjcc.v11.i10.2201
28. Fischer JP, Wes AM, Tuggle CT, et al. Risk analysis and stratification of surgical morbidity after immediate breast reconstruction. J Am Coll Surg. 2013;217(5):780-7.
29. Kronowitz SJ, Robb GL. Radiation therapy and breast reconstruction: a critical review of the literature. Plast Reconstr Surg. 2009;124(2):395-408. DOI:10.1097/PRS.0b013e3181aee987
30. Albino FP, Koltz PF, Ling MN, et al. Irradiated autologous breast reconstructions: effects of patient factors and treatment variables. Plast Reconstr Surg. 2010;126(1):12-6.
31. Fosnot J, Jandali S, Low DW, et al. Closer to an understanding of fate: the role of vascular complications in free flap breast reconstruction. Plast Reconstr Surg. 2011;128(4):835-43.
32. Sоrensen LT, Lars T. Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Ann Surg. 2012;255(6):1069-79.
33. Ehrl D, Heidekrueger PI, Haas EM, et al. Does cigarette smoking harm microsurgical free flap reconstruction? J Reconstr Microsurg. 2018;34(07):492-8.
34. Mills E, Eyawo O, Lockhart I, et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-54.e8. DOI:10.1016/j.amjmed.2010.09.013
35. Panayi AC, Agha RA, Sieber BA, et al. Impact of Obesity on Outcomes in Breast Reconstruction: A Systematic Review and Meta-Analysis. J Reconstr Microsurg. 2018;34(5):363-75. DOI:10.1055/s-0038-1627449
36. Hart A, Funderburk CD, Chu CK, et al. The Impact of Diabetes Mellitus on Wound Healing in Breast Reconstruction. Ann Plast Surg. 2017;78(3):260-3. DOI:10.1097/SAP.0000000000000881
37. Santosa KB, Qi J, Kim HM, et al. Effect of patient age on outcomes in breast reconstruction: results from a multicenter prospective study J Am Coll Surg. 2016;223(6):745-54.
38. Сарибекян Э.К., Рассказова Е.А., Хомиди У.Х., Зикиряходжаев А.Д. Возможности реконструктивной хирургии при раке молочной железы у пожилых женщин. Клинический случай. Клинический разбор в общей медицине. 2023;4(12) [Saribekyan EK, Rasskazova EA, Khomidi UKh, Zikiryakhodzhaev AD. Reconstructive surgery options for elderly women with breast cancer. Clinical case. Clinical Review for General Practice. 2023;4(12):58-61 (in Russian)]. DOI:10.47407/kr2023.4.12.00332

________________________________________________

1. Kaprin AD, Starinskii VV, Shakhzadova AO. Sostoyaniie onkologicheskoi pomoshchi naseleniiu Rossii v 2022 g. Moscow, 2022 (in Russian).
2. Ivanov YV, Sharobaro VI, Panchenkov DN, et al. Modern Possibilities of Reconstructive Plastic Surgery of Breast Cancer. Bulletin of Experimental & Clinical Surgery. 2018;11(2) (in Russian).
3. Khakimova ShG, Zikiryakhodzhaev AD. Choice for a reconstruction method in breast cancer patients. PA.Herzen Journal of Oncology. 2021;10(4):53-8 (in Russian).
4. Vlasova MYu, Zikiryakhodzhaev AD, Reshetov IV, et al. Complications after simultaneous prepectoral breast reconstruction using polyurethane-coated implants in patients with breast cancer. Tumors of Female Reproductive System. 2020;16(4):12-20 (in Russian).
5. Jimenez RB, Packowski K, Horick N, et al. The Timing of Acute and Late Complications Following Mastectomy and Implant-Based Reconstruction. Ann Surg. 2023;278(1):e203-8.
6. Zikiriakhodzhaiev AD, Rasskazova EA, Khakimova SHG. Onkologicheskaia bezopasnost radikalnykh podkozhnykh/kozhesokhrannykh mastektomii s odnomomentnoi rekonstruktsiiei pri rake. Voprosy onkologii. 2019;65(6):832-7 (in Russian).
7. Rowland JH, Hewitt M, Ganz PA. Psychological impact of treatments for breast cancer. In: Rowland JH. Surgery of the breast: principles and art/editor. Scott L. Spear. 2nd ed. 2006; p. 383.
8. Dieterich M, Reimer T, Dieterich H, et al. A short-term follow-up of implant based breast reconstruction using a titanium-coated polypropylene mesh (TiLoop® Bra). Eur J Surg Oncol (EJSO). 2012;38(12):1225-30.
9. Eriksson M, Anveden L, Celebioglu F, et al. Radiotherapy in implant-based immediate breast reconstruction: risk factors, surgical outcomes, and patient-reported outcome measures in a large Swedish multicenter cohort. Breast Cancer Res Treat. 2013;142(3):591-601. DOI:10.1007/s10549-013-2770-0
10. Davydov MI, Aksel EM. Statistika zlokachestvennykh novoobrazovanii v Rossii i stranakh SNG v 2007 g. Vestnik RONTS im. NN Blokhina RAMN. 2009;20(3):8-12 (in Russian).
11. Cordeiro PG, McCarthy CM, Colleen M. A single surgeon's 12-year experience with tissue expander/implant breast reconstruction: part I. A prospective analysis of early complications. Plast Reconstr Surg. 2006;118(4):825-31.
12. Handel N, Cordray T, Gutierrez М, et al. A Long-Term Study of Outcomes, Complications, and Patient Satisfaction with Breast Implants. Plast Reconstr Surg. 2006;117(3):757-67.
13. Friedrich M, Krämer S, Friedrich D. Difficulties of Breast Reconstruction – Problems That No One Likes to Face. Anticancer Res. 2021;41(11):5365-75. DOI:10.21873/anticanres.15349
14. Doherty С, Pearce S, Baxter N, et al. Trends in immediate breast reconstruction and radiation after mastectomy: A population study. Breast J. 2020;26(3):446-43.
15. Hart SE, Brown DL, Kim HM, et al. Association of Clinical Complications of Chemotherapy and Patient-Reported Outcomes After Immediate Breast Reconstruction. JAMA Surg. 2021;156(9):847-55. DOI:10.1001/jamasurg.2021.2239
16. Hung YC, McCarthy JT, Park BC, et al. Comparison of Complication Rates Between Subpectoral vs Prepectoral Techniques in Prosthetic Breast Reconstruction. Aesthet Surg J. 2023;43(11):1285-92. DOI:10.1093/asj/sjad145
17. Liu J, Hou J, Li Z, et al. Efficacy of Acellular Dermal Matrix in Capsular Contracture of Implant-Based Breast Reconstruction: A Single-Arm Meta-analysis. Aesthetic Plast Surg. 2020;44(3):735-42. DOI:10.1007/s00266-019-01603-2
18. Hughes K, Brown C, Perez V, et al. The effect of radiotherapy on implant-based breast reconstruction in the setting of skin-sparing mastectomy: clinical series and review of complications. Anticancer Research. 2012;32(2):553-7.
19. Peled AW, Sears M, Wang F, et al. Complications after total skin-sparing mastectomy and expander-implant reconstruction: Effects of radiation therapy on the stages of reconstruction. Ann Plast Surg. 2018;80(1):10-3. DOI:10.1097/SAP.00000000000011862
20. Naoum GE, Salama L, Niemierko A, et al. Single stage direct-to-implant breast reconstruction has lower complication rates than tissue expander and implant and comparable rates to autologous reconstruction in patients receiving postmastectomy radiation. Int J Radiat Oncol Biol Phys. 2020;106(3):514-24. DOI:10.1016/j.ijrobp.2019.11.008
21. Luvsannyam E, Patel D, Hassan Z, et al. Overview of risk factors and prevention of capsular contracture following implant-based breast reconstruction and cosmetic surgery: a systematic review. Cureus. 2020;12(9):e10341. DOI:10.7759/cureus.10341
22. Araco A, Caruso R, Araco F, et al. Capsular contractures: a systematic review. Plast Reconstr Surg. 2009;124(6):1808-19. DOI:10.1097/PRS.0b013e3181bf7f26
23. Hvilsom GB, Hölmich LR, Steding-Jessen M, et al. Delayed breast implant reconstruction: a 10-year prospective study. J Plast Reconstr Aesthet Surg. 2011;64(11):1466-74.
24. Vardanian AJ, Clayton JL, Roostaeian J, et al. Comparison of implant-based immediate breast reconstruction with and without acellular dermal matrix. Plast Reconstr Surg. 2011;128(5):403e-10e.
25. Collins JB, Verheyden CN. Incidence of breast hematoma after placement of breast prostheses. Plast Reconstr Surg. 2012;129(3):413e-20e. DOI:10.1097/PRS.0b013e3182402ce0
26. Granzow JW, Levine JL, Chiu ES, et al. Breast Reconstruction with Perforator Flaps. Plast Reconstr Surg. 2007;120(1):1-12.
27. Malekpour M, Malekpour F, Wang HT. Breast reconstruction: Review of current autologous and implant-based techniques and long-term oncologic outcome. World J Clin Cases. 2023;11(10):2201-12. DOI:10.12998/wjcc.v11.i10.2201
28. Fischer JP, Wes AM, Tuggle CT, et al. Risk analysis and stratification of surgical morbidity after immediate breast reconstruction. J Am Coll Surg. 2013;217(5):780-7.
29. Kronowitz SJ, Robb GL. Radiation therapy and breast reconstruction: a critical review of the literature. Plast Reconstr Surg. 2009;124(2):395-408. DOI:10.1097/PRS.0b013e3181aee987
30. Albino FP, Koltz PF, Ling MN, et al. Irradiated autologous breast reconstructions: effects of patient factors and treatment variables. Plast Reconstr Surg. 2010;126(1):12-6.
31. Fosnot J, Jandali S, Low DW, et al. Closer to an understanding of fate: the role of vascular complications in free flap breast reconstruction. Plast Reconstr Surg. 2011;128(4):835-43.
32. Sоrensen LT, Lars T. Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Ann Surg. 2012;255(6):1069-79.
33. Ehrl D, Heidekrueger PI, Haas EM, et al. Does cigarette smoking harm microsurgical free flap reconstruction? J Reconstr Microsurg. 2018;34(07):492-8.
34. Mills E, Eyawo O, Lockhart I, et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-54.e8. DOI:10.1016/j.amjmed.2010.09.013
35. Panayi AC, Agha RA, Sieber BA, et al. Impact of Obesity on Outcomes in Breast Reconstruction: A Systematic Review and Meta-Analysis. J Reconstr Microsurg. 2018;34(5):363-75. DOI:10.1055/s-0038-1627449
36. Hart A, Funderburk CD, Chu CK, et al. The Impact of Diabetes Mellitus on Wound Healing in Breast Reconstruction. Ann Plast Surg. 2017;78(3):260-3. DOI:10.1097/SAP.0000000000000881
37. Santosa KB, Qi J, Kim HM, et al. Effect of patient age on outcomes in breast reconstruction: results from a multicenter prospective study J Am Coll Surg. 2016;223(6):745-54.
38. Saribekyan EK, Rasskazova EA, Khomidi UKh, Zikiryakhodzhaev AD. Reconstructive surgery options for elderly women with breast cancer. Clinical case. Clinical Review for General Practice. 2023;4(12):58-61 (in Russian). DOI:10.47407/kr2023.4.12.00332

Авторы

У.Х. Хомиди*¹, М.Ю. Власова¹, Э.К. Сарибекян¹, А.Д. Зикиряходжаев^1–3, Ш.Г. Хакимова^3,4, Г.Г. Хакимова⁴, Д.Б. Кодзоева¹

¹Московский научно-исследовательский онкологический институт им. П.А. Герцена – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава России, Москва, Россия;
²ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
³ФГАОУ ВО «Российский университет дружбы народов им. Патриса Лумумбы», Москва, Россия;
⁴Ташкентский педиатрический медицинский институт, Ташкент, Узбекистан
*khomidy@mail.ru

________________________________________________

Umar Kh. Khomidi*¹, Maria Yu. Vlasova¹, Erik K. Saribekyan¹, Aziz D. Zikiryakhodzhaev^1–3, Shakhnoz G. Khakimova^3,4, Gulnoz G. Khakimova⁴, Dali B. Kodzoeva¹

¹Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Centre, Moscow, Russia;
²Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
³Patrice Lumumba People’s Friendship University of Russia, Moscow, Russia;
⁴Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan
*khomidy@mail.ru

Назад к списку

Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.