Background. The high frequency of injuries of the spleen, as well as its important immunocompetent role in the body, dictate the need to develop a standardized approach to the diagnosis and treatment of this category of patients.Aim. Standardization of the treatment and diagnostic approach for combined blunt splenic injury to improve treatment results.Material and methods. The analysis of literary sources of Russian and foreign authors on this issue.Results. The therapeutic and diagnostic algorithm was developed for combined blunt splenic injury based on the severity of the patient, and a detailed description of non-operative and damage control surgical treatment was given.Conclusion. The use of endovascular interventions in the treatment of splenic injuries, as well as their gradual treatment in conditions of severe polytrauma, helps to reduce mortality.
1 ГБОУ ВПО «Северо-Осетинская государственная медицинская академия Минздрава России», г. Владикавказ (и.о. ректора -д.м.н. О.В.Ремизов) 2 ГБОУ ВПО «Волгоградский государственный медицинский университет Минздрава России», г. Волгоград (ректор -академик РАН В.И.Петров) 3 НУЗ «Узловая больница на ст. Владикавказ ОАО «РЖД», г. Владикавказ (директор -Т.К.Карсанова) 4 СПб ГБУЗ «Городская больница № 9», г. Санкт-Петербург (главный врач -Н.Н.Гриненко) В обзоре представлены обоснованные с позиций доказательной медицины принципы дифференцированного подхода к лечению воспалительных осложнений дивертикулярной болезни (ВОДБ). Основой для эффективного решения стратегических задач при ВОДБ является общепринятая дефиниция и классификация клинических форм заболевания. Принципы дифференцированной лечебной тактики при ВОДБ включают: консервативные методы лечения при неосложнённых формах, пункционно-дренирующий метод при абсцессах, резекционный (преимущественно, лапароскопический) подход при распространенном перитоните с расширением возможности выполнения первично-восстановительных (с протективной стомой) неотложных операций, а в случае планового хирургического лечения хронических осложнений -необходимость максимально широкого применения лапароскопических технологий. [Ключевые слова: дивертикулярная болезнь, воспалительные осложнения, лечение, хирургия] The review respresents contemporary trends in treatment of diverticular disease. The basement of optimal decision making for these patients are clear diagnostic criteria, relevant diagnostic methods and comprehensive universal classification. The spectrum of therapies for diverticular disease includes conservative treatment for uncomplicated forms, percutaneous drainage for abscesses, resection for peritonitis. A possibility of primary anastomosis in case of resection for free perforation with or without protective stoma is discussed. Laparoscopic technologies for chronic complications of diverticular disease is a main trend to improve short, late and functional results in elective surgery.
Introduction. The multisystem closed abdominal trauma is accompanied by a high mortality rate, and exceeding the minimum required volume of surgery in an extremely difficult patient’s condition often leads to an unfavorable outcome.Aim of study. Standardization of staged treatment of patients with severe concomitant closed abdominal trauma.Material and methods. This review presents the latest information obtained as a result of studying domestic and foreign literature on the issue of multistage surgical treatment of severe multisystem closed abdominal trauma. The concept of damage control, its stages are described step by step, indications for types of surgical interventions are specified. The literature data on the results of clinical application of the technique from the standpoint of evidence-based medicine are presented.Conclusion. A clear knowledge of the required volume of surgical intervention at each stage of treatment of patients with severe concomitant closed abdominal trauma, the main points of intensive care, the criteria for patient stabilization and indications for relaparotomy improve the treatment results for this category of victims.
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