[Differential surgical treatment of victims with damage to the small and large intestines in a closed abdominal injury combined, depending on the prediction of traumatic disease course and morphological changes of the intestinal wall].

Use of differentiated surgical approach to the management of surgical treatment, depending on the degree of violation of systemic hemodynamics, the timing and volume of surgical procedures, depending on the prognosis of traumatic disease course of cardiac index, interventions in the small and large intestine depending on morphological changes of the intestinal wall by cardiac and stroke indexes, put method extra-enteric anastomosis in patients with damage to the small intestine and colon combined with closed abdominal injury permitted to reduce the rate of postoperative complications from 22.2 to 10.1%, mortality at 2.1 times in shock period (from 19.3 to 9.2%) and the overall mortality from 33.3 to 21.1%.

[The staged surgical treatment of the injured persons with severe closed combined abdominal trauma].

In 91 injured persons, suffering severe closed combined abdominal trauma, the staged surgical treatment was conducted, in 41 of them the operation was performed during one narcosis, but with surgical pause after temporary stopping of hemorrhage, in 50 the "damage control surgery" was applied. Unstable critical state of the injured persons, "unfavorable" prognosis of course of an acute period of the traumatic disease served as indications for the staged surgical treatment conduction. While the urgent laparotomy performance the surgical manipulations were conducted in minimal volume, surgical pause was applied with the patient's state reestimation. Operative intervention was restarted when a stable hemodynamics and the homeostasis indices improvement were achieved. Middle value of surgical pause have constituted (94.5 +/- 7.2) min. In 50 injured persons, regardless of the hemorrhage stopping and stabilization of systolic arterial pressure, the hemostasis indices were disordered, they were admitted to department of reanimation and intensive therapy with consequent conduction of programmed relaparotomy (the technology of "damage control surgery"). Application of differentiated staged surgical treatment in the injured persons, suffering severe closed combined abdominal trauma, have permitted to reduce the occurrence rate of decompensated shock--by 6.4%, the syndrome of disseminated intravascular coagulation--up to 1%, polyorgan insufficiency--up to 7.1%, general lethality--by 9.5%.

[Prognosis of the traumatic disease course in injured persons with closed combined abdominal trauma as the main criterion for application of a staged surgical intervention tactics].

The method of estimation of the injury severity and the traumatic disease course prognostication was improved and introduced into practice, trying to optimize the choice of the treatment--diagnostic tactic in injured persons with closed combined abdominal trauma (CCAT). Application of the improved anatomic--functional model permits to estimate severity and to prognosticate the course of the traumatic disease in injured persons with CCAT with trustworthiness (81.7 +/- 4.7)% (P < 0.01). The point criteria of the prognosis gradation of the traumatic disease course were named as "favorable", "doubtful" and "unfavorable". In "unfavorable" prognosis the performance of a staged surgical treatment, according to the "damage control" method, is indicated.

[Mistakes and complications in the diagnosis and medical services for persons with closed thoraco-abdominal injuries during pre-hospitalization stage]. / Pomylky i skladnosti u diahnostytsi i nadanni medychnoï dopomohy poterpilym z zakrytoiu torakoabdominal'noiu travmoiu na gohostital'nomu etapi.

Results of medical care, given to injured persons with closed thoracoabdominal trauma on the prehospital stage were analyzed. Lacks and complications in tactic of treatment and diagnosis were determined. Mistakes of the medical ambulance care physicians were noted in 51.3% of observations.

[Traumatic injuries of the abdominal organs]. / Poshkodzhennia orhaniv cherevnoï porozhnyny pry travmi.

The injuries of abdominal cavity organs are analyzed in 1158 injured persons with isolated and concomitant trauma. It is established that the injury frequency of parenchymatous organs is two times more then of cavitial.