Tkachenko A. The differential surgery of patients with multiple cranio-abdominal trauma

The dissertation is dedicated to the treatment of injured patients with multiple cranio-abdominal trauma. A study of 281 patients with multiple cranio-abdominal trauma was carried out. In the main group (143 injured) the differential surgery depending on the severity of injury, leading damage, prognosis and monitoring of the traumatic disease was used. In the comparison group (138 injured) the fullness of operating procedures did not depend on the severity of the trauma. Specific of diagnosis in the main group were: the use of the FAST protocol ultrasound and CT of head according to criteria of consciousness level. This helped to reduce the diagnostic errors by 14.5%. Differential surgery in the main group allowed to expand indications for nonoperative management of abdominal injury (12,6%) and laparoscopic surgery (3,5%). In the case of laparotomy with minor trauma the surgery was performed in "full" content (56,6%), with severe and very severe in the "reduced" and "minimal" content using the "damage control" (27,3%). Craniotomy was performed by the method of resection decompression craniotomy in the "reduced" content without plastic of dura. The dynamic monitoring of functional systems with determining the periods of stabilization at the end of the first - the second, seventh - tenth and after sixteenth day helped to prove the timing of urgent and delayed surgical interventions. The use of differential diagnostic and treatment resulted in reductions of cranial complications by 8,3%, abdominal postoperative complications by 6,7% and total mortality by 11,7%.