Videoendoscopic Transpopillar and Endovascular Interventions in the Stage Treatment of Combat Liver Injuries
EAES Academy. Haida Y. 07/05/22; 363059; P103
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Abstract
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Introduction:
the frequency of combat injuries to the abdomen in modern military combats ranges from 6.6% to 9%, of which liver injuries are about 21%; In the structure of modern combat injuries of the abdomen increases the proportion of liver injuries, which is accompanied by the development of severe bleeding, traumatic illness and high mortality (20.2-70.5%);
Aim: to improve the results of diagnosis and surgical treatment of wounded with gunshot wounds to the liver by combat trauma to the abdomen, through the use of minimally invasive technologies.
Materials and methods: Clinical and statistical analysis of the results of treatment of 101 wounded with gunshot wounds to the liver, delivered from the area of Operation Joint Forces (Anti-Terrorist Operation), which were treated at II, II and IV levels of care during 2014-2019. All wounded were male, aged 18 to 54 years (average - 32.6 + 1.7 years). Groups of wounded were divided in chronological order and depending on the methods of diagnosis and treatment used. The first group (comparison group) consisted of 47 wounded with gunshot wounds to the liver, received in the period 2014-2015, who were treated according to traditional tactics. The second group (main group) consisted of 54 wounded in the period 2016-2019, who used a comprehensive method of diagnosis and surgical treatment using minimally invasive techniques.
Research results: Complications of the clinical course predominated in the comparison group - 31 (66.0%) cases against 28 (51.9%) cases in the main group (p> 0.05). At thoracoabdominal injuries among complications Respiratory distress syndrome predominated - 7 (14.9%) cases in the group comparison and 4 (7.4%) cases among the complications of the main group; pneumonia - 8 (17.0%) and 6 (11.1%); exudative pleurisy - 12 (25.5%) and 7 (13.0%), respectively. Development of RDS in the early post-traumatic period due to traumatic shock, lung injuries and concomitant diseases. In 4 (8.5%) cases in the postoperative period acute pancreatitis was observed in the wounded of the comparison group and in 4 (7.4%) cases in the wounded of the main group. Multiple organ failure was observed in 2 (4.3%) injured comparison groups, and in 1 (1.9%) wounded of the main group, accompanied by acute cardiac vascular, respiratory and renal failure. Of the 54 wounded in the main group, 4 (7.4%) died, including 1 - 2nd day - 2 (3.7%), on the 3rd - 7th day - 1 (1.9%), on the 16th day and later - 1 (1.9%). Of the 47 injured in the comparison group, 8 (17.0%) died, including on the 1st - 2nd day - 4 (8.5%), on the 3rd - 7th day - 2 (4.3%), on the 8th - 15th day - 1 (2.1%), on the 16th day and later - 1 (2.1%).
Conclusions:
Improved differentiated surgical tactics with the combined use of modern minimally invasive methods of surgical treatment of gunshot wounds of the liver avoided laparotomies in 15 (27.8%) cases of the main group (p <0.001); reduced the number of postoperative complications from 78.7% in the comparison group to 59.3% in the main group (p <0.05), relaparotomy in the wounded from 66 to 20.4% (p <0.001), as well as the duration of treatment wounded from 42.4 + 2.7 to 32.2 + 1.4 bed-days (p <0.001).
the frequency of combat injuries to the abdomen in modern military combats ranges from 6.6% to 9%, of which liver injuries are about 21%; In the structure of modern combat injuries of the abdomen increases the proportion of liver injuries, which is accompanied by the development of severe bleeding, traumatic illness and high mortality (20.2-70.5%);
Aim: to improve the results of diagnosis and surgical treatment of wounded with gunshot wounds to the liver by combat trauma to the abdomen, through the use of minimally invasive technologies.
Materials and methods: Clinical and statistical analysis of the results of treatment of 101 wounded with gunshot wounds to the liver, delivered from the area of Operation Joint Forces (Anti-Terrorist Operation), which were treated at II, II and IV levels of care during 2014-2019. All wounded were male, aged 18 to 54 years (average - 32.6 + 1.7 years). Groups of wounded were divided in chronological order and depending on the methods of diagnosis and treatment used. The first group (comparison group) consisted of 47 wounded with gunshot wounds to the liver, received in the period 2014-2015, who were treated according to traditional tactics. The second group (main group) consisted of 54 wounded in the period 2016-2019, who used a comprehensive method of diagnosis and surgical treatment using minimally invasive techniques.
Research results: Complications of the clinical course predominated in the comparison group - 31 (66.0%) cases against 28 (51.9%) cases in the main group (p> 0.05). At thoracoabdominal injuries among complications Respiratory distress syndrome predominated - 7 (14.9%) cases in the group comparison and 4 (7.4%) cases among the complications of the main group; pneumonia - 8 (17.0%) and 6 (11.1%); exudative pleurisy - 12 (25.5%) and 7 (13.0%), respectively. Development of RDS in the early post-traumatic period due to traumatic shock, lung injuries and concomitant diseases. In 4 (8.5%) cases in the postoperative period acute pancreatitis was observed in the wounded of the comparison group and in 4 (7.4%) cases in the wounded of the main group. Multiple organ failure was observed in 2 (4.3%) injured comparison groups, and in 1 (1.9%) wounded of the main group, accompanied by acute cardiac vascular, respiratory and renal failure. Of the 54 wounded in the main group, 4 (7.4%) died, including 1 - 2nd day - 2 (3.7%), on the 3rd - 7th day - 1 (1.9%), on the 16th day and later - 1 (1.9%). Of the 47 injured in the comparison group, 8 (17.0%) died, including on the 1st - 2nd day - 4 (8.5%), on the 3rd - 7th day - 2 (4.3%), on the 8th - 15th day - 1 (2.1%), on the 16th day and later - 1 (2.1%).
Conclusions:
Improved differentiated surgical tactics with the combined use of modern minimally invasive methods of surgical treatment of gunshot wounds of the liver avoided laparotomies in 15 (27.8%) cases of the main group (p <0.001); reduced the number of postoperative complications from 78.7% in the comparison group to 59.3% in the main group (p <0.05), relaparotomy in the wounded from 66 to 20.4% (p <0.001), as well as the duration of treatment wounded from 42.4 + 2.7 to 32.2 + 1.4 bed-days (p <0.001).
Introduction:
the frequency of combat injuries to the abdomen in modern military combats ranges from 6.6% to 9%, of which liver injuries are about 21%; In the structure of modern combat injuries of the abdomen increases the proportion of liver injuries, which is accompanied by the development of severe bleeding, traumatic illness and high mortality (20.2-70.5%);
Aim: to improve the results of diagnosis and surgical treatment of wounded with gunshot wounds to the liver by combat trauma to the abdomen, through the use of minimally invasive technologies.
Materials and methods: Clinical and statistical analysis of the results of treatment of 101 wounded with gunshot wounds to the liver, delivered from the area of Operation Joint Forces (Anti-Terrorist Operation), which were treated at II, II and IV levels of care during 2014-2019. All wounded were male, aged 18 to 54 years (average - 32.6 + 1.7 years). Groups of wounded were divided in chronological order and depending on the methods of diagnosis and treatment used. The first group (comparison group) consisted of 47 wounded with gunshot wounds to the liver, received in the period 2014-2015, who were treated according to traditional tactics. The second group (main group) consisted of 54 wounded in the period 2016-2019, who used a comprehensive method of diagnosis and surgical treatment using minimally invasive techniques.
Research results: Complications of the clinical course predominated in the comparison group - 31 (66.0%) cases against 28 (51.9%) cases in the main group (p> 0.05). At thoracoabdominal injuries among complications Respiratory distress syndrome predominated - 7 (14.9%) cases in the group comparison and 4 (7.4%) cases among the complications of the main group; pneumonia - 8 (17.0%) and 6 (11.1%); exudative pleurisy - 12 (25.5%) and 7 (13.0%), respectively. Development of RDS in the early post-traumatic period due to traumatic shock, lung injuries and concomitant diseases. In 4 (8.5%) cases in the postoperative period acute pancreatitis was observed in the wounded of the comparison group and in 4 (7.4%) cases in the wounded of the main group. Multiple organ failure was observed in 2 (4.3%) injured comparison groups, and in 1 (1.9%) wounded of the main group, accompanied by acute cardiac vascular, respiratory and renal failure. Of the 54 wounded in the main group, 4 (7.4%) died, including 1 - 2nd day - 2 (3.7%), on the 3rd - 7th day - 1 (1.9%), on the 16th day and later - 1 (1.9%). Of the 47 injured in the comparison group, 8 (17.0%) died, including on the 1st - 2nd day - 4 (8.5%), on the 3rd - 7th day - 2 (4.3%), on the 8th - 15th day - 1 (2.1%), on the 16th day and later - 1 (2.1%).
Conclusions:
Improved differentiated surgical tactics with the combined use of modern minimally invasive methods of surgical treatment of gunshot wounds of the liver avoided laparotomies in 15 (27.8%) cases of the main group (p <0.001); reduced the number of postoperative complications from 78.7% in the comparison group to 59.3% in the main group (p <0.05), relaparotomy in the wounded from 66 to 20.4% (p <0.001), as well as the duration of treatment wounded from 42.4 + 2.7 to 32.2 + 1.4 bed-days (p <0.001).
the frequency of combat injuries to the abdomen in modern military combats ranges from 6.6% to 9%, of which liver injuries are about 21%; In the structure of modern combat injuries of the abdomen increases the proportion of liver injuries, which is accompanied by the development of severe bleeding, traumatic illness and high mortality (20.2-70.5%);
Aim: to improve the results of diagnosis and surgical treatment of wounded with gunshot wounds to the liver by combat trauma to the abdomen, through the use of minimally invasive technologies.
Materials and methods: Clinical and statistical analysis of the results of treatment of 101 wounded with gunshot wounds to the liver, delivered from the area of Operation Joint Forces (Anti-Terrorist Operation), which were treated at II, II and IV levels of care during 2014-2019. All wounded were male, aged 18 to 54 years (average - 32.6 + 1.7 years). Groups of wounded were divided in chronological order and depending on the methods of diagnosis and treatment used. The first group (comparison group) consisted of 47 wounded with gunshot wounds to the liver, received in the period 2014-2015, who were treated according to traditional tactics. The second group (main group) consisted of 54 wounded in the period 2016-2019, who used a comprehensive method of diagnosis and surgical treatment using minimally invasive techniques.
Research results: Complications of the clinical course predominated in the comparison group - 31 (66.0%) cases against 28 (51.9%) cases in the main group (p> 0.05). At thoracoabdominal injuries among complications Respiratory distress syndrome predominated - 7 (14.9%) cases in the group comparison and 4 (7.4%) cases among the complications of the main group; pneumonia - 8 (17.0%) and 6 (11.1%); exudative pleurisy - 12 (25.5%) and 7 (13.0%), respectively. Development of RDS in the early post-traumatic period due to traumatic shock, lung injuries and concomitant diseases. In 4 (8.5%) cases in the postoperative period acute pancreatitis was observed in the wounded of the comparison group and in 4 (7.4%) cases in the wounded of the main group. Multiple organ failure was observed in 2 (4.3%) injured comparison groups, and in 1 (1.9%) wounded of the main group, accompanied by acute cardiac vascular, respiratory and renal failure. Of the 54 wounded in the main group, 4 (7.4%) died, including 1 - 2nd day - 2 (3.7%), on the 3rd - 7th day - 1 (1.9%), on the 16th day and later - 1 (1.9%). Of the 47 injured in the comparison group, 8 (17.0%) died, including on the 1st - 2nd day - 4 (8.5%), on the 3rd - 7th day - 2 (4.3%), on the 8th - 15th day - 1 (2.1%), on the 16th day and later - 1 (2.1%).
Conclusions:
Improved differentiated surgical tactics with the combined use of modern minimally invasive methods of surgical treatment of gunshot wounds of the liver avoided laparotomies in 15 (27.8%) cases of the main group (p <0.001); reduced the number of postoperative complications from 78.7% in the comparison group to 59.3% in the main group (p <0.05), relaparotomy in the wounded from 66 to 20.4% (p <0.001), as well as the duration of treatment wounded from 42.4 + 2.7 to 32.2 + 1.4 bed-days (p <0.001).
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