[Endovideosurgery of gunshot wounds]. / Endovideokhirurgiia ognestrel'nykh ranenii.

The paper deals with the opportunities of using endovideosurgery in local armed conflicts. There were worked out methods and technique of endovideosurgical operations in case of gunshot wounds of a chest, a belly and lower limbs. Due to a low level of traumatism and high efficiency the method promotes the decrease of the number of complications, early activation of the insured servicemen during the post-operation period, the reduction in time of treatment and rehabilitation and can be recommended at the initial stage of medical evacuation.

[Treatment of gunshot wounds of the veins in the first echelon of specialized surgical care]. / Lechenie ognestrel'nykh ranenii ven v pervom éshelone spetsializirovannoi khirurgicheskoi pomoshchi.

Results of first specialized aid to 26 wounded with injuries of the major veins are analyzed. Rate and nature of injuries of various major veins are regarded. Complete rupture of the vessel and its destruction with dehiscence of different length were seen in more than half of the cases (57.7%). In this case repair of venous vessel patency required various plastic methods. In lateral or incomplete transverse rupture it was possible to put lateral or circular vascular suture. Ligature of injured venous vessel was performed in half of the cases. Based on anatomic features of venous circulation in the extremities, immediate and long-term results of the treatment, 2 groups of injuries were identified: 1st - ligature of the veins did not lead to disorders of venous circulation and function of the extremity in the nearest and long-term period after surgery; 2nd - ligature of the vessel was dangerous due to serious disorders of venous circulation in the nearest period after surgery and might lead to disorders of extremity function and disability. In gunshot wounds of the major veins good results may be achieved in early reconstructive surgeries with individual approach allowing for general condition of the wounded and nature of vessel injury.

Operative videothoracoscopy in the surgical treatment of penetrating firearms wounds of the chest.

We prospectively analyzed our experience with operative videothoracoscopy (OVT) performed in a field military hospital in cases of penetrating firearms wounds of the thorax (PFAWT) sustained in Chechnya. From February to April 1996, we treated 206 wounded patients, of whom 37 (18.0%) had sustained chest injuries. PFAWT were present in 23 soldiers, accounting for 62.2% of all chest injuries. Twelve injuries were confined to the thorax, eight patients had associated injuries, and three soldiers had thoracoabdominal injuries. Nineteen patients had pleural drainage performed during medical evacuation. The thoracic injuries were right-sided (17), involved bullets or shell splinters (23); were through and through (16), represented solitary wounds (19), and were associated with internal organ injuries (21). Fifteen patients had indications for OVT when they were delivered from the battle-field 1.5 to 22 hours after injury. All patients manifested signs of hemorrhagic shock and hemodynamic instability. Indications for OVT were ongoing intrapleural bleeding (6), clotted hemothorax (6), or marked air leakage (3) preventing lung inflation with the OP-02 apparatus (field modification). OVT revealed 12 lung wounds, nine of which were multiple wounds, pleural bleeding in 6 patients, clotted hemothorax in 11 patients, and foreign bodies in 5 patients. Two patients underwent thoracotomy, one for suspicion of heart injury and the second because we could not adequately visualize and control bleeding revealed at OVT to be from the intercostal artery in the left costovertebral angle. Eight of 23 patients had no indication for operative videothoracoscopy and were managed with continued pleural aspiration and drug therapy. Wedge resection of the lung using an Endo-GIA-30 stapler was necessary in two patients because of parenchymal destruction and bleeding. Evacuation of clotted blood by fragmentation and aspiration was satisfactory in all cases. Satisfactory manual suturing of selected lung injuries was obtained largely with intracorporeal knot tying. The duration of the procedures ranged from 40 to 90 minutes. No morbidity nor mortality was encountered in patients undergoing OVT. Postoperative pain was minimized by using OVT placement of catheters in the chest wall soft tissue with local administration of 2% Trimecain. Patients were able to stand in 10 to 12 hours and to walk by the end of the first postoperative day. All patients who underwent OVT were evacuated without drains by the third or fourth postoperative day, all tolerating sitting and standing positions. We conclude that early OVT in the military field hospital for continued bleeding, clotted hemothorax, and continued major air leakage has several advantages in military patients with PFAWT: early definition and management of organ injury; identification and control of bleeding in most instances; earlier and more accurate assessment for thoracotomy; vigorous lavage and removal of projectiles such as bone fragments and evacuation of clotted hemothorax; early debridement with suture closure of the thoracic wall canal; and minimal postoperative pain with dramatically reduced suppurative sequelae and bronchopleural fistulae.

[The operative videothoracosopy in rendering emergency surgical care in penetrating gunshot chest wounds]. / Operativnaia videotorakoskopiia v okazanii neotlozhnoi khirurgicheskoi pomoshchi pri ognestrel'nykh pronikaiushchikh raneniiakh grudi.

The modern doctrine of military surgery is based on the concept of maximal and, if possible, simultaneous surgical aid to the wounded in the shortest period of time after the injury. It could be achieved by approximation of specialized surgical section to the zone of fighting and improvement of medical evaluation. These are conditions for applicability of modern methods of treatment and for perfecting of surgical strategies to the wounded, such as videothoracoscopy. To report the experience of the usage of videothoracoscopy in the treatment of the wounded with penetrating gunshot wounds of chest (PFAWT) in military hospital. 23 patients with PFWAT was administer surgical therapy: 19 patients had pleural draining at previous stages of medical evacuation, 4 patients were delivered directly from the battle Geld 1.5 hours after the injury. 11 patients with pleural drains and 4 patients, delivered from battle Geld, had indications for videothoracoscopy. These indications included ongoing intrapleural bleeding, clotted hemothorax and prolonged leakage of the air through the drain. Suturing of the lung wounds was performed by Endo-GIA-30 stapler. If it was impossible, manual suture EndoStitch USSC was used. In 2 cases was performed wedge-like resection by EndoGIA-30. The bleeding from the thoracic wall wounds was controlled by electrocautery. The clotted hemothorax was removed by fragmentation with EndoBabcock, washing out and aspiration through large diameter tubes. The duration of the procedure ranged from 40 to 90 minutes. None had suppurative complications. All patients was survived. The mean duration of inpatient period was 20 days, rehabilitation period-14 days.

[Surgical tactics in gastroduodenal hemorrhages caused by peptic ulcer]. / O khirurgicheskoi taktike pri gastroduodenal'nykh krovotecheniiakh iazvennoi étiologii.

Among patients operated upon during the recent 10 years for gastroduodenal bleedings of ulcerous etiology emergency operations were performed at the height of bleeding on 12.6% of patients, urgent operations in the early interval on 42.3% of the patients. In the group of patients operated upon at the height of bleeding, the immediate postoperative lethality was high and made up 15.8%. After operations in the early interval 6.3% of patients died. General lethality among patients operated on for emergency and urgent indications made up 8.5%. After operations fulfilled during the late interval lethality was 2.8%.

[Characteristics of the clinical course of gunshot peritonitis]. / Osobennosti klinicheskogo techeniia ognestre'lnogo peritonita.

The article gives characteristics of specific features of the clinical course of gunshot peritonitis due to specificity of the mechanism of the formation of gunshot wounds. Characteristic features of the clinical course of gunshot peritonitis are: high rate of the development of pathomorphological alterations in the abdominal cavity and severity of clinical manifestations. The multiple organ insufficiency in gunshot peritonitis at first is of primary character followed by the development of secondary organic insufficiency due to the progressing infectious process in the abdominal cavity.