Lykhman V. Complex surgical treatment of patients with severe blunt thoracic trauma (clinical and experimental study)

Thesis is dedicated to optimizing of the surgical treatment of patients with severe blunt injuries of the thoracic cavity, which improves the efficiency of specialized care in these patients through the development of etiopathogenic substantiated surgical approach and the expansion of indications for minimally invasive and two-step surgery. In the experiment on a model of blunt thoracic injury for the first time endovascular occlusion of bleeding vessels of the chest wall and extracorporeal oxygenation at different times from the moment of injury was studied, the optimal timing for use of this technique in clinical practice was defined. In clinical practice it was proved that this method improves the functional resistance to the pathological posttraumatic effects and greatly reduces the risk of myocardial and thymus-associated immune deficiency. In a clinical study retrospective and prospective analysis of treatment results of 470 patients with severe blunt injuries of the chest cavity was performed. Dynamic objective assessment of severity of the condition of patients with the prediction of the dynamics of their functional condition was developed. The diagnostic algorithms based on the dominant syndrome and type of damage were substantiated. Implementation of endovascular methods of hemostasis, the use of videothoracoscopic technologies, endoscopic stenting of damaged large bronchi, original methods of esophagoplasties, original device for the drainage of the pleural cavity and mediastinum allowed to determine the tactics of the two-step interventions and to increase the number of minimally invasive interventions to 35,7%, improve efficacy of treatment and reduce the risk of specific complications. The use of local microwave irradiation in combination with traditional antibacterial treatment reduced the incidence of septic complications on 16.8% and increase the effectiveness of their treatment.