НАШ ОПЫТ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ПОВРЕЖДЕНИЙ ЖЕЛУДКА ПРИ СОЧЕТАННОЙ ТРАВМЕ НАШ ДОСВІД ХІРУРГІЧНОГО ЛІКУ-ВАННЯ ПОШКОДЖЕНЬ ШЛУНКА ПРИ ПОЄДНАНІЙ ТРАВМІ Резюме. У статті представлені результати діа-гностики та лікування 57 хворих з ізольовани-ми (12) та поєднаними пошкодженнями шлун-ку. Доопераційна діагностика пошкоджень шлунку при травмі була можливою у 25,6% випадків. Пошкодження передньої стінки шлу-нку виявлено у 42 пацієнтів, задньої-у 4 хво-рих при торакоабдомінальних пораненнях, обох стінок органу-у 11 хворих. У більшості хворих було виконано ушивання ран шлунка (75%). На другому місці за частотою була лік-відація гематом при забою органа. Також були виконані дренуючі операції, антрумектомія або резекція ½ шлунку, в одному випадку була накладена тимчасова декомпресійна гастрос-тома за допомогою катетера Фолея після уши-вання розриву в кардіальному відділі шлунку. Ендоскопічне ушивання ран шлунка ручним ендошвом чи за допомогою степлера було можливим у двох хворих. Ускладнення у післяопераційному періоді виникли у 9 (15,8%) хворих із розривами всіх шарів стінки шлунку. Необхідність релапаротомії виникла у 5 паціє-нтів. Померло 3 із 5 повторно оперованих хворих із поєднаними пошкодженнями. Ключові слова: травма, пошкодження шлун-ку, діагностика, лікування.
The results of diagnostic and treatment were analyzed in 111 victims with abdominal multitrauma at the period from 2010 to 2013. Abdominal traumas were diagnosed on the basis of instrumental investigations and laparascopic data. Combined injuries were often observed in 3-5 areas. The abdominal hemorrhages were in 66 patients as a result of injury of the parenchymatous organs. Diagnostic value of clinical symptoms wasn’t more than 45,9% in abdominal catatrauma, though in case of plan radiography it was from 41,2% to 66,4% and in case of ultrasound study - 91,6%. The laparotomy was performed for 28 patients. The laparoscopy was applied in 66 cases. However, there were revealed the cases of continuing bleeding in 31 patients and because of these complications, the operations were converted to laparotomy in 27 cases. Different variants of laparoscopic coagulation were performed on 4 patients. The rate of lethality consisted of 27%. The authors proposed an algorithm of treatment of the patients with closed abdominal injury on the basis of score assessment of hemoperitoneum (according to USS), which allowed significant rise of treatment efficacy, decrease the rate of postoperative complications and lethality.
Introduction. This article is devoted to one of the urgent problems of modern emergency abdominal surgery – the result of surgical treatment of ulcer bleed in patients with ischemic heart disease.Undoubtedly intensive hemostatic conservative therapy and endoscopic hemostasis methods are the main treatment methods for this group of patients. However, in a certain number of patients with NGDK with various variants of IHD, such treatment is ineffective and there is a need to perform surgical hemostasis in an emergency and urgently.Surgical methods of hemostasis of NGDK patients with different variants of IHD are shown only in cases of inefficiency of conservative and endoscopic treatment methods. Among surgical interventions, radical surgeries are more preferable, which, if performed against the background of intensive resuscitation support, allow to achieve reliable hemostasis and thus avoid postoperative recurrent bleeding. Palliative surgery should be used when radical surgery is not possible due to the severity of the patient’s condition or lack of technical skill of surgeons. Finally, it is clear that in order to improve treatment results in patients in this category, correction of changes caused by the accompanying IHD is necessary.Materials and methods: In our research material, 89 out of 997 patients had such a need, which was 8.9%. It mainly corresponds to the modern literature data.Results: An analysis of the results of these patients’ palliative and radical surgical interventions clearly showed that the last ones were more preferable.The basis for this judgment was the high percentage of mortality after palliative care compared to radical care with approximately the same number of postoperative complications.In addition, it is noteworthy that postoperative complications typical of palliative care in the form of recurrent ulcerative bleeding are often fatal, because half of these patients in our observations have not experienced repeated radical interventions.Conclusion: At the same time, the necessary condition for performing radical operations is, firstly, appropriate technical skill of the surgeon, and secondly, providing the latter with intensive resuscitation support. In case of impossibility of performance of these conditions the method of a choice should serve palliative care.
The developed computer program for choosing the tactics of treating patients with gastro duodenal ulcerous bleeding (GDUB) combined with various forms of coronary heart disease to the fullest extent meets demands not only practical emergency medicine, but modern evidence-based medicine. The presented case of clinical observation serves the clear illustration of this issue, which convincingly indicates that use of the developed computer program to choose the tactics of treating patients with GDUB combined with various forms of coronary heart disease allows us not only to accurately establish the clinical diagnosis, but also to choose the most appropriate treatment tactic.
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