Lebid' P. Surgical approach and treatment of patients with parenchymal organs' injuries in abdominal trauma

The work was done by the results of inpatient examination and treatment of 265 patients with blunt abdominal trauma of parenchymal organs (liver, spleen). The evaluation of modern diagnostic methods and the possibility of providing an effective surgical care with laparotomic interventions in 149 patients, as well as miniinvasive in 116, allowed to create the algorithm of diagnostic and treatment for such patients. Among the successfully performed miniinvasive surgical techniques in 44 it was endovideolaparoscopy, in 34 - hypothermic ozone lavage and in 38 - endovascular hemostasis. The possibility of effective using of minimally invasive surgical techniques is proved based on the results of their application in 116 (43.8%) patients. Application of endovideolaparoscopy , as well as developed hypothermic ozone lavage were revealed as promising methods for injuries of the liver and spleen I-II class OIS, moderate (up to I degree), hemorrhagic shock, and functional disorders at 0-9 APACHE II. In traumatic injuries of class III and IV, hemorrhagic shock I-III degree, dysfunctional disorders from 9 to 15 points on the APACHE II endovascular methods of mechanical hemostasis were used at increasing subcapsular and intra-organ hematomas (polyurethane embols and Gianturko or Kittner spirals), and at damages of the capsule open (laparotomic), mostly sparing surgical methods were used with newly experimentally and clinically developed original sutures, or selective endovascular catheter events during «damage control» to provide favorable conditions for the hemostatically-sealing laparotomic interventions. Comparative clinical analysis in groups allowed to ground the differential approaches to the applicable types and volumes of surgical care with minimal complications and deaths.