The use of low-invasive surgical procedures in the treatment of gunshot wounds of the liver.
DOI:
https://doi.org/10.26641/2307-0404.2018.4(part1).145710Ключевые слова:
combat trauma to the abdomen, liver damage, ultrasound diagnosis, laparoscopyАннотация
The problem of diagnostics and stage surgical treatment of a combat trauma of the abdomen with liver damage is actual in conditions of increasing specific gravity of liver damage, accompanied by its severe functional insufficiency. The aim of the study was to improve the results of surgical treatment of gunshot wounds of the liver using minimally invasive surgical techniques. The analysis of surgical treatment of 23 men aged 19 to 49 years with gunshot liver damage at II-IV levels of medical care was carried out. Shock of I st. was observed in 5 (21.7%), II st. - in 8 (34,8%), III st. - 9 wounded (39.2%), IV st. - 1 wounded (4.3%), admitted in an agonizing condition. At the second level of medical care, 12 wounded underwent laparoscopic operations (52.1%). 11 wounded underwewnt laparotomy (47.9%) with the use of mechanical, physical and chemical methods of bleeding stopping. In 17 wounded (73.9%), concomitant lesions of other organs of the abdominal cavity and retroperitoneal space (stomach, small and large intestine, kidneys, spleen) were observed. Correction of concomitant damages was carried out according to generally accepted methods. At the IV level of medical care, three wounded (12.9%) underwent puncture and drainage of intrahepatic abscesses using ultrasound navigation. Ultrasound examination allowed to determine the degree of liver damage, localization of a foreign body and safe access to its removal. In the structure of gunshot wounds of the abdomen, liver damage makes up 19.2% and the most often is observed in combined shrapnel wounds. In 30.4% of cases of gunshot liver damages, the condition of the wounded is regarded as severe and critical, which requires immediate surgical and resuscitative measures. The use of minimally invasive techniques (video laparoscopy, interventional sonography) in the surgical treatment of gunshot liver injuries can improve results and avoid unreasonable laparotomies.
Библиографические ссылки
Briggs A, Askari R. Damage control resuscitation. Int J Surg. 2016;33(Pt B):218-21.
Stassen NA, Bhullar I, Cheng JD, Crandall M, Friese R, Guillamondegui O, Jawa R, Maung A, Rohs TJ, Sangosanya A, Schuster K, Seamon M, Tchorz KM, Zarzuar BL, Kerwin A. Eastern Association for the Surgery of Trauma. Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S288-93.
Jeyarajah R, Harford WV. Sleisenger & Fordtran’s gastrointestinal and liver disease. In: Feldman M, Freidman LS, Brandt LJ, Sleisenger MH, editors. Abdominal hernias and gastric vovulus. Philadelphia, PA, Saunders Elsevier. 2006;477-82.
Munera F, Morales C, Soto JA, Garcia HI, Suarez T, Garcia V, et al. Gunshot wounds of the abdomen: evaluation of stable patients with triple-contrast helical CT. Radiology. 2004;231:399-405.
Piper GL, Peitzman AB. Current management of hepatic trauma. Surg. Clin. North Am. 2010;90(4):775-85.
Navsaria PH, Nicol AJ, Krige JE, Edu S. Selective nonoperative management of liver gunshot injuries. Ann Surg. 2009;249(4):653-6.
Lin BC, Fang JF, Chen RJ, Wong YC, Hsu YP. Surgical management and outcome of blunt major liver injuries: experience of damage control laparotomy with perihepatic packing in one trauma centre. Injury. 2014;45(1):122-7.
Загрузки
Как цитировать
Выпуск
Раздел
Лицензия
Copyright (c) 2018 Medicni perspektivi (Medical perspectives)
Это произведение доступно по лицензии Creative Commons «Attribution» («Атрибуция») 4.0 Всемирная.
Submitting manuscript to the journal "Medicni perspektivi" the author(s) agree with transferring copyright from the author(s) to publisher (including photos, figures, tables, etc.) editor, reproducing materials of the manuscript in the journal, Internet, translation into other languages, export and import of the issue with the author’s article, spreading without limitation of their period of validity both on the territory of Ukraine and other countries. This and other mutual duties of the author and all co-authors separately and editorial board are secured by written agreement by special form to use the article, the sample of which is presented on the site.
Author signs a written agreement and sends it to Editorial Board simultaneously with submission of the manuscript.
