Novosti
|
This journal is indexed in Scopus |
---|
Year 2016 Vol. 24 No 1
EXCHANGE OF EXPERIENCE
Ê.À. LINYOV, À.V.TORBA
SURGICAL TREATMENT MANAGEMENT OF ABDOMINAL GUNSHOT INJURIES
SE ''Lugansk Medical University'' ,
Ukraine
Objectives. To develop the surgical treatment algorithm for patients with abdomen gunshot injuries.
Methods. The work is based on case histories analysis of victims (n=100) with abdominal gunshot injuries. The nature of injury has been analyzed (isolated – combined, bullet – shrapnel, penetrating – non-penetrating); the nature of the organ damage, the results of the use of the following diagnostic methods: ultrasonography; plain abdominal radiography; spiral computed tomography; the type of operations performed, so as complications and treatment outcome.
Results. It was established that blast mine injury: (shrapnel wounds) constituted 93% of the victims; bullet wounds were noted only in 7%. Penetrating injuries of the abdomen constituted 79%. 29% had isolated abdomen gunshot injuries, 71% of victims – combined gunshot injuries. The wounding projectile inlet was located in the anterior abdominal wall in 41% only, but in 35% it was located on the back surface of the body. The survey procedures were limited to emergency ultrasound examination, plain abdominal radiography, spiral CT.
Conclusion. The indications for laparotomy in abdomen gunshot injuries are considered to be hemorrhagic shock, peritonitis, the presence of free abdominal fluid on ultrasound and intra-abdominal foreign bodies on X-ray and CT, the penetrating trauma according to the revision of wound channel and rectal hemorrhage. In the study of the incidence of organ injuries the small intestine damage was commonly noted – 27%, colon injury – 23%, liver – 23%, spleen – 19%, diaphragm – 13%, rectum – 10%. The penetrating abdomen gunshot injuries were treated by one-stage final operation in 19%, being guided by the "Damage control" principle – in 81%. The mortality rate was 29% mainly in combined gunshot injury, the number of septic complications – 39%.
- Masliakov VV, Dadaev AIa, Kerimov AZ, Khasikhanov SS. Neposredstvennye i otdalennye rezul'taty lecheniia bol'nykh s ognestrel'nymi raneniiami zhivota [Immediate and long-term results of treatment of patients with gunshot wounds to the abdomen]. Fundam Issledovaniia. 2013;(7):339-43.
- Gromov MS, Kerimov AZ. Khirurgicheskaia taktika pri ognestrel'nykh raneniiakh zhivota v usloviiakh regional'nogo konflikta [Surgical tactics in gunshot wounds of the abdomen in a regional conflict]. Sarat Nauch-Med Zhurn. 2010:6(2):460-62.
- Bykova IIu, Efimenko NA, Gumanenko EK, redaktory. Voenno-polevaia khirurgiia [Military surgery]: nats ruk. Moscow, RF: GEOTAR Media: 2009. 816 p.
- Ermolov AS, Khubutiia MSh, Abakumov M.M. Abdominal'naia travma [Abdominal injury]. Moscow, RF: Vidar; 2012. 495 p.
- Beschastnov VV, Maramokhin VN. Sluchai tiazhelogo ognestrel'nogo pronikaiushchego mnozhestvennogo raneniia zhivota, oslozhnennogo razvitiem mestnogo i generalizovannogo infektsionnogo protsessa [Cases of severe multiple gunshot wounds penetrating the stomach, complicated by the development of local and generalized infection]. Sovrem Tekhnologii v Meditsine. 2011;(1):146-48.
- Magomedov MP, Khamidov MA, Magomedov MA, i dr. Sravnitel'naia kharakteristika rezul'tatov lecheniia patsientov s ognestrel'nymi raneniiami obodochnoi kishki pri razlichnoi lechebnoi taktike [Comparative characteristics of the results of treatment of patients with gunshot wounds of the colon at different medical tactics]. Vestn Sovrem Klin Meditsiny. 2014;7(1):65-89.
- Sutton E, Bochicchio GV, Bochicchio K, Rodriguez ED, Henry S, Joshi M, Scalea TM. Long term impact of damage control surgery: a preliminary prospective study. J Trauma. 2006 Oct;61(4):831-4; discussion 835-36.
- Khriakov AS, Esetov AK, Razumov AN, Shubin IuV. Skvoznoe ognestrel'noe ranenie zhivota s mnozhestvennymi povrezhdeniiami vnutrennikh organov [Perforating gunshot wound to the abdomen with multiple internal injuries]. Khirurgiia Zhurn im NI Pirogova. 2005(10):65-66.
- Doklestic KS, Bumbasirevic V, Detanac D, Detanac D, Karamarkovic AR. Damage control surgery in abdominal gunshot injury. BHSURG. 2012;(2):58-64.
- Revskoi AK, Liufing AA, Voinovskii EA, Klipak VM. Ognestrel'nye raneniia zhivota i taza [Gunshot wounds of the abdomen and pelvis]. Moscow, RF: Meditsina; 2000. 316 p.
- Sagraves SG, Toschlog EA, Rotondo MF. Damage control surgery–the intensivist's role. J Intensive Care Med. 2006 Jan-Feb;21(1):5-16.
91045, Ukraine
Lugansk, kv. 50-letiya Oboronyi Luganska, d. 1,
GU ''Luganskiy gosudarstvennyiy
meditsinskiy universitet'',
kafedra gospitalnoy khirurgii, ortopedii i travmatologii,
tel. office. 380954695178, 38 (0642) 63-02-36, 63-02-16,
e-mail: k_linev@mail.ru
Linyov Konstantin Alekseevich
Linyov K.A. PhD, an associate professor of the hospital surgery, orthopedics and traumatology chair of SE ''Lugansk State Medical University''.
Torba A.V. PhD, an associate professor of the hospital surgery, orthopedics and traumatology chair of SE ''Lugansk State Medical University''.