ABSTRACT
UNLABELLED: The aim was to determine blood loss degree in case of spleen trauma in children and to justify safety of victims treatment without surgery. MATERIALS AND METHODS: It was performed retrospective cohort study of 105 autopsies of children who died of combined trauma. 33 of them had spleen injury. Prospective cohort study was performed in 75 children with spleen injury, 69 (92%) from whom were treated without surgery. RESULTS: It was established that thanatogenetic feature of spleen injury in children is moderate blood loss (89.6% of victims), incidence of large and massive blood loss was 6.8% and 3.4% respectively. In unoperated children blood loss did not exceed 15% of blood volume. In group of operated children (n=6; 8%) incidence of large blood loss was 4% (n=3) and did not exceed 28% of blood volume. Prevalence of moderate blood loss in case of spleen trauma due to anatomic and physiological features and mechanisms of spleen injury is theoretically justified.
Subject(s)
Abdominal Injuries , Hemoperitoneum , Hemostasis , Spleen , Abdominal Injuries/complications , Abdominal Injuries/mortality , Abdominal Injuries/pathology , Abdominal Injuries/physiopathology , Adolescent , Autopsy , Child , Cohort Studies , Female , Hemoperitoneum/etiology , Hemoperitoneum/pathology , Humans , Incidence , Male , Outcome Assessment, Health Care , Retrospective Studies , Russia , Spleen/injuries , Spleen/pathology , Spleen/surgery , Trauma Severity Indices , Wounds, Nonpenetrating/complications , Wounds, Nonpenetrating/mortality , Wounds, Nonpenetrating/pathology , Wounds, Nonpenetrating/physiopathologyABSTRACT
It was performed cohort prospective study of treatment results of 69 children with through-capsule spleen injuries for the period from 2002 to 2013. Patients were divided into 2 groups. The first group included 63 patients after non-surgical treatment. The second group included 6 children who underwent surgery. In the first group 95.3% of patients had stable hemodynamics at admission. In the second group only 2 patients had the signs of deferred bleeding. Continuing abdominal bleeding was the indication for surgery in 4 patients although stable hemodynamics. Hemoperitoneum in case of spleen injury is not significant prognostic factor defining the tactics of treatment. The physiological response on bleeding but not the amount of blood in abdominal cavity determines tactics of treatment. Hemodynamic status is single statistically significant criterion for choose of surgical treatment of children with spleen injuries. Unstable hemodynamics increases the risk of surgical treatment in 20 times (p<0.007).
Subject(s)
Abdominal Injuries/surgery , Hemostasis, Surgical/methods , Spleen , Wounds, Nonpenetrating/surgery , Abdominal Injuries/complications , Abdominal Injuries/diagnosis , Abdominal Injuries/physiopathology , Adolescent , Child , Female , Hemodynamics , Hemoperitoneum/diagnosis , Hemoperitoneum/etiology , Hemoperitoneum/physiopathology , Hemoperitoneum/surgery , Humans , Injury Severity Score , Male , Patient Selection , Prospective Studies , Risk Adjustment , Russia , Spleen/diagnostic imaging , Spleen/injuries , Spleen/surgery , Treatment Outcome , Ultrasonography , Wounds, Nonpenetrating/complications , Wounds, Nonpenetrating/diagnosis , Wounds, Nonpenetrating/physiopathologyABSTRACT
The retrospective analysis of polytrauma with lethal outcome in 105 children showed that splenic injury had 31.4% of children. It was twice more often than liver injury, though the hemoperitoneum volume by liver injury exceeds that by spleen trauma (846.1±753.8 ml vs. 311±270.3 ml; p<0.002). The risk of death of intraabdominal bleeding by the spleen rupture is considerably low (OR 0.16; 95% CI 0.019-1.34; p=0.04). Nevertheless, the hemothorax by the spleen injury was much more significant than hemoperitoneum (977±866.9 ml vs. 311±270.3 ml; p<0.0003). The risk of death of intrathoracic bleeding by the spleen rupture is 45 times higher than of intraabdominal. The degree of splenic injury poorly correlates with the traumatic mechanism and the hemoperitoneum volume. The chances of the immediate death is considerably low (OR 0.09; 95% CI 0.0096-0.84; p<0.017). The main reasons of death by polytrauma remain brain injury, hemorrhagic shock after injury of thoracic cavity and traumatic shock.
Subject(s)
Multiple Trauma/complications , Shock, Hemorrhagic/etiology , Spleen/injuries , Splenic Rupture/mortality , Adolescent , Cause of Death/trends , Female , Hemoperitoneum/complications , Hemoperitoneum/mortality , Humans , Male , Multiple Trauma/mortality , Retrospective Studies , Shock, Hemorrhagic/mortality , Siberia/epidemiology , Splenic Rupture/complicationsABSTRACT
The aim of the study was to substantiate the conservative treatment of closed spleen injuries in children. Laparoscopic method was used in 42 patients and conservative protocol was observed in 36 cases. Laparoscopy allowed to avoid a major surgical operation in 29 (69%) patients. Splenectomy was performed in 12 (28,6%) patients. Splenectomy was performed once due to continuent bleeding in group of conservatively treated patients. Long-term follow-up results demonstrated absence of clinical signs of adhesive obstruction and spleen pseudoaneurisms, free blood dissolution from the abdominal cavity during 1-6 months after treatment.
Subject(s)
Abdominal Injuries/complications , Hemoperitoneum/surgery , Hemostasis, Endoscopic/methods , Laparoscopy/methods , Spleen/injuries , Wounds, Nonpenetrating/complications , Abdominal Injuries/surgery , Adolescent , Child , Child, Preschool , Follow-Up Studies , Hemoperitoneum/etiology , Humans , Retrospective Studies , Treatment Outcome , Wounds, Nonpenetrating/surgeryABSTRACT
BACKGROUND/PURPOSE: The purpose of this investigation was to evaluate the advantages and the shortcomings of laparoscopic varicocelectomy compared with open traditional treatment of varicoceles. METHODS: A total of 654 patients were operated on for left-sided varicoceles over 5 years from 1995 to 2000. To evaluate the clinical efficiency of the treatment, the patients were divided randomly into 2 groups. Laparoscopic varicocelectomy (LV) was performed on 434 patients, and open varicocelectomy (OV) in 220 patients. Outcome data looked at relapse rate, presence of hydrocele, wound complications, and testicular or scrotal edema. Operating time, postoperative length of stay, and pain control also were compared. In both groups, the operations were performed by Palomo's technique with preservation of lymphatics and mass ligation of the artery and veins in the retroperitoneum above the internal inguinal ring. RESULTS: In LV versus OV, relapse rates were 1.84% versus 1.36 (P < 0.5), hydrocele occurrence was 0.23% versus 1.82% (P < 0.1), wound complication was 0.23% versus 7.73%, and testicular or scrotal edema was 3.9% versus 13.1%. LV hospital stay was an average of 3 days versus 7 days for OV. Operating time was 15 minutes for LV versus 26 minutes in open. Postoperative analgesic use was almost cut in half with LV. CONCLUSION: The clinical efficacy of LV is superior to traditional OV.
Subject(s)
Laparoscopy/methods , Varicocele/surgery , Adolescent , Child , Humans , Male , Treatment OutcomeSubject(s)
Abdomen, Acute/surgery , Abscess/diagnosis , Intestinal Obstruction/diagnosis , Peritonitis/diagnosis , Postoperative Complications/diagnosis , Abscess/etiology , Abscess/surgery , Child , Humans , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Peritonitis/etiology , Peritonitis/surgery , Postoperative Complications/etiology , Reoperation , Time FactorsSubject(s)
Esophageal Atresia/surgery , Esophagoplasty , Female , Humans , Infant, Newborn , Suture TechniquesSubject(s)
Intestines/blood supply , Intussusception/diagnosis , Acute Disease , Adolescent , Blood Pressure , Child , Child, Preschool , Humans , Infant , Intestinal Obstruction/diagnosis , Intestinal Obstruction/surgery , Intestines/physiopathology , Intraoperative Care/methods , Intussusception/surgery , Time Factors , Tissue Survival , TransilluminationABSTRACT
An analysis of treatment of 152 children allowed the authors to make a conclusion that one of the main ways to reduce the postoperative lethality is to improve surgical tactics. In particular, the use of intraoperative visual angiotensometry after M. Z. Sigal facilitates more exact establishing of the borders of resection of the gut in its necrosis.
Subject(s)
Colonic Diseases/surgery , Ileal Diseases/surgery , Intussusception/surgery , Postoperative Complications/mortality , Adolescent , Child , Child, Preschool , Humans , Infant , Intraoperative Care , Male , Peritonitis/mortality , Peritonitis/prevention & control , Postoperative Complications/prevention & controlABSTRACT
Having analyzed results of the treatment of 151 children with intussusception the authors made a conclusion that an irrational choice of the operation volume, wrong assessment of the viability of the intestine during the first operation may be responsible for relaparotomies. The application of transillumination methods of the assessment of the viability of the intestine resulted in rarer repeated operations (9,4% instead of 17,7%).
