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1.
Khirurgiia (Mosk) ; (12): 68-77, 2022.
Article in Russian | MEDLINE | ID: mdl-36469471

ABSTRACT

OBJECTIVE: To study the incidence and structure of combat gunshot surgical trauma received during the 2nd Karabakh War and to analyze the results of treatment of these victims. MATERIAL AND METHODS: We analyzed surgical treatment of 60 victims with combat gunshot surgical trauma received during the 2nd Karabakh war. In 25 (41.7%) victims, injury occurred as a result of mine-explosive trauma. These victims were divided into 3 groups depending on mechanism of mine-explosive injury. The 1st group included 7 (28%) patients who received mine-explosive injury due to indirect (propelling) effect of blast wave. The 2nd group included 14 (56%) victims in whom mine-explosive injury was caused by non-contact (distant) impact of mine fragments. The 3rd group consisted of 4 (16%) patients whose mine-explosive injuries were caused by direct impact of explosion factors on various anatomical areas. Patients were also ranked into 3 groups depending on the nature and severity of mine-explosive injury: wounded with isolated injuries (n=16, 64%), wounded with concomitant injuries (n=2.8%), wounded with combined and multiple injuries (n=7, 28%). RESULTS: Most patients underwent organ-sparing procedures. Resections were performed only in 4 cases (splenectomy - 3, nephrectomy - 1). Postoperative complications developed in 23 (38.3%) wounded (suppuration of postoperative wounds - 13, post-traumatic pleuritis - 5, clotted hemothorax - 2, subphrenic abscess - 1, phlegmon of perineum and perianal region - 2). Mortality rate was 1.7%. CONCLUSION: Timely sorting and evacuation of victims, early qualified surgical care and correct postoperative management with monitoring of vital functions can improve the results of treatment of victims with mine-explosive trauma. Autologous skin grafting for extensive defects and closure of colostomy with restoration of colon continuity were essential in rehabilitation of these patients.


Subject(s)
Blast Injuries , Explosive Agents , Multiple Trauma , Wounds, Gunshot , Humans , Blast Injuries/diagnosis , Blast Injuries/surgery , Wounds, Gunshot/diagnosis , Wounds, Gunshot/surgery , Multiple Trauma/diagnosis , Multiple Trauma/surgery
2.
Khirurgiia (Mosk) ; (12): 63-71, 2021.
Article in Russian | MEDLINE | ID: mdl-34941211

ABSTRACT

OBJECTIVE: To analyze postoperative outcomes in patients with colon perforation and traumatic ruptures at the multifield hospital. MATERIAL AND METHODS/: The study included 93 patients aged 24-85 years with colon perforation and traumatic ruptures. All patients were divided into 3 groups depending on the cause of colon perforation: group 1 - 43 (46.2%) patients with colon cancer, group 2 - 27 (29%) patients with ulcerative colitis, group 3 - 22 (23.6%) patients with traumatic ruptures following blunt abdominal trauma. Cause of colon perforation was unclear in 1 (1.1%) case. Diagnostic algorithm included routine clinical and laboratory methods and modern minimally invasive endoscopic surgical technologies (ultrasound, CT, MRI, colonoscopy, laparoscopy). RESULTS/: Ninety (96.8%) out of 93 patients with colon perforation underwent surgery. Postoperative mortality was 41.5%, 46.1% and 31.8% in all groups, respectively. Overall postoperative mortality was 40%. CONCLUSION: Bowel resection with colostomy is preferred for colon perforation regardless the cause of injury because this procedure ensures the best immediate results. Palliative suturing of perforations with colostomy or delivering the affected colon segment on anterior abdominal wall are accompanied by high mortality and should be used for strict indications in severely ill patients.


Subject(s)
Colonic Diseases , Intestinal Perforation , Colon/diagnostic imaging , Colon/surgery , Colonic Diseases/diagnosis , Colonic Diseases/etiology , Colonic Diseases/surgery , Colostomy , Hospitals , Humans , Intestinal Perforation/diagnosis , Intestinal Perforation/etiology , Intestinal Perforation/surgery
3.
Vestn Khir Im I I Grek ; 175(2): 80-6, 2016.
Article in English, Russian | MEDLINE | ID: mdl-30427154

ABSTRACT

The article analyzed the structure, incidence rate and results of surgical treatment of paracolostomal complications in 69 patients out of 134 (aged from 23 to 77 years old). The patients were divided into 2 groups according to the variant of terminal colostomy. The single-barrel colostomy was formed by classical (intraperitoneal) method using «proboscis¼ design in 58 patients (43,3%) of the first group. Various complications were developed in the area of colostomy in 42 (72,4%) patients. The single-barrel flat colostomy was applied at the skin level using the method modified by the authors in 76 (56,7%) patients of the second group. The authors designed the method of controlled intra- and postoperative decompression and lavage of the colon by a new model of aspiration-irrigation device in order to unload the colon through colostomy. There were noted complications in the area of colostomy in 27 (35,5%) cases. The developed rational method of terminal colostomy formation, upgrading the ways of intra- and postoperative decompression and lavage of the colon facilitated to decrease of the rate of postcolostomy complications more than two times (from 72,4 to 35,5%). The author's method led to optimization of immediate and long-term results of surgical treatment.


Subject(s)
Colon , Colonic Neoplasms , Colostomy/adverse effects , Adult , Aged , Colon/diagnostic imaging , Colon/pathology , Colonic Neoplasms/complications , Colonic Neoplasms/diagnosis , Colonic Neoplasms/pathology , Colonic Neoplasms/surgery , Colostomy/methods , Decompression, Surgical/adverse effects , Decompression, Surgical/methods , Female , Humans , Ileus/diagnosis , Ileus/etiology , Ileus/therapy , Intestinal Obstruction/diagnosis , Intestinal Obstruction/etiology , Male , Middle Aged , Outcome and Process Assessment, Health Care , Postoperative Complications/diagnosis , Postoperative Complications/therapy
7.
Vestn Khir Im I I Grek ; 174(1): 84-9, 2015.
Article in Russian | MEDLINE | ID: mdl-25962304

ABSTRACT

The investigation based on a retrospective analysis of the treatment results of Fournier's gangrene (FG) in 27 patients aged from 34 till 82 years old. There were 27 patients. Diseases of colorectal zone were the nosological reasons of FG in 15 patients. Diseases of urogenital tract had 10 patients with FG. The development of FG was determined by closed trauma (1 patient) and a gunshot wound of the perineum and the scrotum in one patient. The slowly progressive (limited) forms of the disease were noted in 15 patients, although the rapid progressive (extensive) forms were in 12 patients.All the patients had the clinical manifestations of the disease and at the same time laboratory indices indicated a presence of generalized infection and they were characterized by symptoms of systemic inflammatory response syndrome (SIRS). There were 6 patient, who died out of 27.The lethality consisted of 22.2%. The reasons of the death were an infection-toxic shock (1 case), a progressive endotoxicosis (3 cases) and a pulmonary artery thromboembolism (2 cases). The results obtained testified that early diagnostics and the active strategy with radical surgical d-bridement of necrotic suppurative foci combined with programmed (staged) sanitation necrosectomy, complex system of local wound treatment, the rational antibacterial therapy, a task-specific and syndrome correction of dyscrasia could be the actual ways to improve the treatment results in patients with FG.


Subject(s)
Colonic Diseases/complications , Debridement/methods , Fournier Gangrene , Male Urogenital Diseases/complications , Perineum , Systemic Inflammatory Response Syndrome , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Azerbaijan/epidemiology , Early Diagnosis , Fournier Gangrene/diagnosis , Fournier Gangrene/etiology , Fournier Gangrene/mortality , Fournier Gangrene/physiopathology , Fournier Gangrene/surgery , Humans , Male , Middle Aged , Perineum/pathology , Perineum/surgery , Scrotum/pathology , Scrotum/surgery , Sepsis/etiology , Sepsis/therapy , Systemic Inflammatory Response Syndrome/etiology , Systemic Inflammatory Response Syndrome/therapy , Treatment Outcome
9.
Vestn Khir Im I I Grek ; 174(5): 98-104, 2015.
Article in Russian | MEDLINE | ID: mdl-26983270

ABSTRACT

The article presents a retrospective analysis of the results of surgical treatment of postoperative intraabdominal complications in 42 patients with colon cancer complicated by bowel obstruction and perforation of the tumor. The pyoinflammatory processes such as peritonitis and abscesses of abdominal cavity took a leading place in the structure of postoperative complications according to the authors. Method of "closed" decompression and intraluminal irrigation of the large intestine without wide opening of organ lumen was developed and applied into practice as perioperative prophylaxis of pyoinflammatory processes. These measures allowed reducing the rate of postoperative intraabdominal complications from 19.2 to 7.7%.


Subject(s)
Abdominal Abscess , Colectomy , Colonic Neoplasms , Decompression, Surgical/methods , Intestinal Obstruction , Intestinal Perforation , Peritonitis , Postoperative Complications , Abdominal Abscess/diagnosis , Abdominal Abscess/etiology , Abdominal Abscess/prevention & control , Azerbaijan , Colectomy/adverse effects , Colectomy/methods , Colon/pathology , Colon/surgery , Colonic Neoplasms/complications , Colonic Neoplasms/pathology , Female , Humans , Intestinal Obstruction/diagnosis , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Intestinal Perforation/diagnosis , Intestinal Perforation/etiology , Intestinal Perforation/surgery , Male , Middle Aged , Neoplasm Staging , Outcome and Process Assessment, Health Care , Peritonitis/diagnosis , Peritonitis/etiology , Peritonitis/prevention & control , Postoperative Complications/diagnosis , Postoperative Complications/prevention & control , Reoperation/methods , Therapeutic Irrigation/methods
11.
Khirurgiia (Mosk) ; (4): 34-9, 2014.
Article in Russian | MEDLINE | ID: mdl-24816385

ABSTRACT

The results of treatment of scrotum gangrene (Fournier's disease) in 25 patients aged from 34 to 82 years are presented in the article. The diseases of colorectal zone were nosological reasons of Fournier's disease in 13 patients, the diseases of urogenital tract - in 10 cases. Development of Fournier's disease was associated with closed trauma in 1 patient, and 1 case was associated with gunshot wound of perineum and scrotum. Slowly progressing forms of the disease were detected in 14 patients, fulminant and rapidly progressing variants - in 11 patients. Diabetes mellitus of different severity were identified in 6 patients. Clinical picture and laboratory data evidenced about systemic infection in all patients. Non-clostridial anaerobic microbes were the main exciters of pio-necrotic process (92%). 6 patients died. Mortality was about 24%. Toxic shock was the reason of death in 1 patient, progressing endotoxemia - in 3 cases, pulmonary embolism - in 2 cases. The authors consider that early diagnosis and active tactics of radical treatment of pio-necrotic hearth in combination with programmed (phased) remedial necrectomy are effective methods for improvement of treatment results. Also such ways as complex system of local wound treatment, focused and multicomponent therapy of systemic and metabolic disorders of homeostasis are very important in complex treatment of patients.


Subject(s)
Debridement , Fournier Gangrene , Genitalia, Male , Postoperative Complications/rehabilitation , Systemic Inflammatory Response Syndrome/etiology , Urologic Surgical Procedures, Male , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Combined Modality Therapy , Debridement/adverse effects , Debridement/methods , Early Diagnosis , Fournier Gangrene/diagnosis , Fournier Gangrene/etiology , Fournier Gangrene/mortality , Fournier Gangrene/physiopathology , Fournier Gangrene/surgery , Genitalia, Male/pathology , Genitalia, Male/surgery , Humans , Male , Middle Aged , Necrosis , Peptide Hydrolases/therapeutic use , Plastic Surgery Procedures/methods , Retrospective Studies , Survival Analysis , Systemic Inflammatory Response Syndrome/physiopathology , Systemic Inflammatory Response Syndrome/therapy , Treatment Outcome , Urologic Surgical Procedures, Male/adverse effects , Urologic Surgical Procedures, Male/methods
12.
Vestn Khir Im I I Grek ; 173(4): 66-72, 2014.
Article in Russian | MEDLINE | ID: mdl-25552110

ABSTRACT

The article presents results of diagnostics and surgical treatment of diaphragmatic rupture in 32 victims with an estimation of diagnostic value of different instrumental methods of investigation and the efficacy of surgical approach. The correct interpretation of typical clinical and instrumental signs in consideration with trauma mechanogenesis allowed diagnostics of diaphragmatic rupture before the operation in 17 (53.1%) cases. It was observed that an undiagnosed rupture of the left hemidiaphragm caused a formation of posttraumatic diaphragmatic hernia in 2 (6.2%) patients. The laparotomy was applied in 28 patients as a surgical approach and thoracotomy--in 2patients. The laparotomy and after that thoracotomy were performed on one patient. The thoracotomy and laparotomy were carried out on the second patient in turn. The authors consider the laparotomy as optimal variant of surgical approach in acute period of trauma. The postoperative lethality was 15.6%.


Subject(s)
Abdominal Injuries , Diaphragm/injuries , Hernia, Diaphragmatic, Traumatic , Laparotomy/methods , Multiple Trauma , Thoracic Injuries , Thoracotomy/methods , Wounds, Nonpenetrating , Abdominal Injuries/diagnosis , Abdominal Injuries/mortality , Abdominal Injuries/physiopathology , Abdominal Injuries/surgery , Adult , Azerbaijan , Diagnosis, Differential , Female , Hernia, Diaphragmatic, Traumatic/complications , Hernia, Diaphragmatic, Traumatic/diagnosis , Hernia, Diaphragmatic, Traumatic/physiopathology , Hernia, Diaphragmatic, Traumatic/surgery , Humans , Male , Middle Aged , Multiple Trauma/diagnosis , Multiple Trauma/mortality , Multiple Trauma/physiopathology , Multiple Trauma/surgery , Retrospective Studies , Rupture/complications , Rupture/diagnosis , Rupture/physiopathology , Rupture/surgery , Survival Analysis , Thoracic Injuries/diagnosis , Thoracic Injuries/mortality , Thoracic Injuries/physiopathology , Thoracic Injuries/surgery , Trauma Severity Indices , Treatment Outcome
13.
Vestn Khir Im I I Grek ; 172(4): 68-71, 2013.
Article in Russian | MEDLINE | ID: mdl-24341249

ABSTRACT

The work is devoted to the hernioplasty method, which provides the strengthening of back wall of the inguinal canal by autogenous tissues, which were the walls of the hernial sac. After dissection of hernial sac, two muscle flaps were formed and fixed to transverse fascia on the whole perimeter of the inguinal canal. The control group consists of 64 patients and main group - 66 (90.4%). The Liechtenstein operation was performed in control group. In contrast, the method, suggested by the authors, was used in the main group. The patients with hernioplasty were carefully and sufficiently examined in order to make an objective comparative analysis of the results. The results of the review allow the authors to confirm, that the suggested hernioplasty method provides stable local homeostasis of tissues and high quality of life.


Subject(s)
Fascia/transplantation , Hernia, Inguinal/surgery , Herniorrhaphy/methods , Inguinal Canal/surgery , Surgical Flaps , Adult , Female , Follow-Up Studies , Humans , Male , Middle Aged , Recurrence , Treatment Outcome , Young Adult
19.
Khirurgiia (Mosk) ; (11): 45-52, 2012.
Article in Russian | MEDLINE | ID: mdl-23258359

ABSTRACT

The experience of treatment of 48 patients with colon cancer, complicated with bowe obstruction, colon perforation, abdominal sepsis and intraabdominal hypertension was analyzed. Men were 18, women - 30. Patients' age ranged 24-85 years. 31 patients (64.6%) had the 3rd stage (T4N2M0) of the disease by the time of the diagnosis. Tumor perforation was registered in 35 patients, the rest 13 had suprastenotic perforation. 39 patients developed SIRS and abdominal sepsis. The method of intraoperative "closed" colon decompression and intraluminar colon irrigation with the original modification of vacuum aspiration-irrigation device was introduced, as well as the modified method of end colostomy. Radical treatment was performed in 36 (78.3%) patients, 10 patients received palliative treatment and 2 patients could not be operated on. The postoperative lethality rate was 45.6%, the overall - 47.9%. The suggested method of colon decompression allowed to decrease the postoperative lethality rate from 47.7 to 45.6%, and the overall lethality rate from 50 to 47.9%.


Subject(s)
Colon , Colonic Neoplasms/complications , Decompression, Surgical , Intra-Abdominal Hypertension , Aged , Colectomy/methods , Colectomy/mortality , Colon/diagnostic imaging , Colon/injuries , Colonic Neoplasms/mortality , Colonic Neoplasms/pathology , Colonic Neoplasms/physiopathology , Colostomy/methods , Decompression, Surgical/instrumentation , Decompression, Surgical/methods , Equipment Design , Female , Humans , Intestinal Obstruction/diagnosis , Intestinal Obstruction/etiology , Intestinal Perforation/diagnosis , Intestinal Perforation/etiology , Intra-Abdominal Hypertension/diagnosis , Intra-Abdominal Hypertension/etiology , Intra-Abdominal Hypertension/physiopathology , Intra-Abdominal Hypertension/surgery , Male , Middle Aged , Neoplasm Staging , Palliative Care/methods , Radiography , Survival Rate , Therapeutic Irrigation/instrumentation , Therapeutic Irrigation/methods , Treatment Outcome
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