[Injury of inferior vena cava].

Results of treatment of 102 patients with injuries of inferior vena cava (IVC) were analyzed. The causes of injury were penetrating stab-incised wounds of abdomen (67.5% patients), close trauma (28.2%), gunshot wounds (4.3%). Zone of confluence of iliac veins was injured in 7% patients, infrarenal and renal segments -- in 51.9%, suprarenal -- in 21.5%, supra- and retrohepatic -- in 19.6% patients. Injury of one wall of vein was revealed in 63.7% patients, both walls -- in 14.7%, complete disruption of vessel -- in 7.9%, avulsion or fissure of hepatic veins -- in 13.7%. In 96.2% patients trauma of IVC were associated with injuries of liver (37.2% cases), small intestine (26.4%), stomach (15.6%), pancreas (12.7%), duodenum (10.7%), large intestine (6.8%), and other organs (10.7%). The side suture (83.7%), circular one (5%), ligation of vein (6.2%), grafting (3.8%), and ligation of left hepatic vein (1.3%) were performed. Reconstructive surgery was carried out by general surgeon in 30% patients, and by vascular surgeon -- in 70%. Lethality was 53.9% (55 patients). Lethality after injuries of supra- and retrohepatic segments of IVC was 100%, suprarenal and renal segments -- 60.6%, infrarenal segment -- 30.6%.

[Causes and features of involvement of the intestine and its vessels in acute disturbance of mesenterial circulation].

A course of acute disturbance of mesenterial circulation (ADMC) in 346 patients (89% of them were over 50 years, mean age 68.4+/-3.6 years) was analyzed. Occlusive forms of ADMC occurred in 88% cases (91% of them were due to affection of intestinal arterial bed). Atherosclerosis of the aorta or/and it unpaired visceral branches was the main cause of ADMC in 96% patients. In 87.6% cases the causes of acute mesenterial ischemia were occlusive disease of intestinal vessels due to thrombosis and embolism of unpaired visceral branches of the abdominal aorta, thrombosis in porto-mesenterial bed. Circulatory disorders on the microcirculation level (non-occlusive ischemia) were among the causes in 7.5% cases.

Acute disorders of mesenteric circulations: the etiology, risk factors and incidence of lesions.

Acute disorder of mesenteric circulation (ADMC) is an emergency pathology of the abdominal organs. It occurs in 0.2% of general surgery patients. A total of 346 patients with verified (before, during operation and/or on autopsy) diagnosis of ADMC were analyzed retrospectively. There were 217 (62.7%) women and 129 (37.3%) men. The mean age of the patients was 68.4+/-3.6 years. In 50.7% of patients, ADMC was induced by thrombosis of the unpaired visceral branches of the abdominal aorta, in 29.1% -- by embolism of the superior mesenteric artery (SMA), in 7.8% -- by thrombosis of the portomesenteric bed, in 7.5% -- by non-occlusion mesenteric ischemia (NOMI), and in 4.9% by diseases of the parietal vessels of the bowel. The most prevalent risk factors of ADMC were: atherosclerosis of the aorta and its branches, previous reconstructions for occlusion-stenotic arterial lesions, episodes of arterial embolism in the anamnesis, congenital and acquired hemostatic disorders, oral contraception, thromboses of the deep veins and/or pulmonary embolism in the anamnesis, operations on the abdominal organs, different types of acute end chronic heart failure. In SMA thrombosis, occlusion most frequently affects the orifice (93.5%) and initial segment of the great vessel, In embolism it occurs before or at the level of the middle colic artery (in 57.9%). Disseminated bowel necroses are more frequently encountered in occlusions of the arterial bed (87.7% in thromboses and 83.3% emdolism) than in the venous system (8.3%).

[Prophylaxis of venous thromboembolic complications in patients operated on abdominal organs]. / Profilaktika venoznykh troboémbolicheskikh oslozhnenii u bol'nykh, operirovannykh na organakh briushnoi polosti.

Comparative analysis of results of venous thromboembolic complications prophylaxis (deep vein thrombosis--DVT1, pulmonary artery thromboembolism--PAT) in patients operated on abdominal organs during two periods--from 1980 to 1983 (when traditional methods were used--leg bandage, rarely--0.25-0.5 g aspirin 1-2 times a day 5-8 days after surgery) and from 1984 to 1998 (when in the operated patients with moderate, high and very high risk of DVT and PAT combination of physical methods of blood flow acceleration in leg deep veins with drugs was used--minidoses or individually selected doses of non-fractionated heparin, low-molecular heparin, dextrans) was carried out. Compared with first period the rate of manifested DVT decreased from 1 to 0.3%, fatal PAT (percentage of those who died from all operated)--from 0.3% in 1982-1983 to 0.026% in 1998, i.e. more than 10 times. In some years (1992-1993) there were no lethal outcomes of PAT.

[Clinical-pathologoanatomic analysis of post-operative thromboembolism of pulmonary artery]. / Kliniko-patologoanatomicheskii analiz posleoperatsionnoi tromboémbolii legochnoi arterii.

Autopsy and clinical data were analysed for 803 surgical patients whose death was due to pulmonary artery thromboembolism (PAT). PAT was diagnosed intravitally in 32% of the deceased. 87% of the patients with PAT symptoms died within 2 hours. 3/4 of PATs developed in uneventful postoperative period, 1/4--in complications. The cause of PAT in 99.3% of cases were thromboses in vena cava inferior. In 88.3% of cases these thromboses ran latently. Frequency of postoperative PAT as a cause of death was 1.4% in 1972-1973, 2.1% in 1990-1991, 1.3% in 1997. The fall of the death rate is explained by introduction of drug prophylaxis of PAT.

[Abdominal trauma with injuries of the major vessels]. / Travma zhivota s povrezhdeniem magistral'nykh sosudov.

Treatment results in 87 patients (mean age 30.1 years) with traumatic injuries of major abdominal vessels were analyzed. 73 patients had stab-incised wounds, 9--blunt trauma, 5--gunshot wounds. Hemodynamics of the majority of hospitalized patients (66 from 87) was unstable. Inferior cava vein injury was revealed in 29 patients, aorta injury--in 21, iliac vessels injury--in 22, visceral vessels injury--in 15. One vascular wall was injured in 58 cases, two walls--in 27 cases, complete transection or separation of vessel was revealed in 6 cases. Major vessel injuries were associated with abdominal visceral trauma in 97% cases. Vascular operations (side suture--in 49 patients, circular suture--in 11, vein ligation--in 5, prosthesis--in 3) were performed in 17 (25%) patients by general surgeons, in the rest (75%)--by vascular surgeons. General mortality (including hospitalized but non-operated patients, and patients who died during the operation and in postoperative period) was 46%. It is necessary to teach vascular surgery to general surgeons for high-quality and timely care in patients with abdominal trauma complicated by major vessels injuries.

[Postoperative thromboembolism of pulmonary artery]. / Posleoperatsionnaia tromboémboliia legochnoi arterii.

Pathologo-morphological and clinical records of 803 surgical patients have been analysed, in whom the thromboembolism of pulmonary artery (TEPA) was the only or the main cause of the death. Intravital diagnosis of TEPA was established in 32% of all the deceased. 87% of patients with evident symptoms of the embolism died during the first 2 hours, 52.3% died during 15-30 min. 67% of all TEPA were revealed in postoperative weak 1, 15%--in week 2, and 18%--on later terms (15-45 days). 82.6% of patients who died of TEPA underwent elective operations, and 17.4%--urgent operations. The indications were absolute in 67.3% of cases and relative--in 32.7%. 3/4 of all embolisms developed during the smooth p/o period, and 1/4--on the background of various complications. The rate of TEPA with lethal outcomes made up: 4.3% after the amputation of the lower limb for acute and chronic arterial circulatory disturbances, 2.4%--after transvesical adenomectomy of the prostate, 0.7% and 0.2%--after the operations on the biliary system and the stomach, respectively, and 0.14%--after appendectomy. 410 random purposeful autopsies detected that the sources of the TEPA in 99.3% of cases were thromboses in the system of inferior caval vein which developed silently in 88.3% of cases. In 90.9% of patients thrombus came from the deep veins of the shin, and in 9.1%--from iliac and femoral veins. The rate of postoperative TEPA as a cause of death, according to the autopsies data, has increased from 1.4% in 1972-1973 to 2.1% in 1990-1991. Up to 1997 the rate of this index decreased to 1.3%, the quantity of the autopsies (in operated patients--100%) being equal, and in conditions of increased surgical activity. The positive tendency in the dynamics of lethality of TEPA in conditions of a large industrial city, according to authors' view, is referred chiefly to implementation of drug prophylaxis of postoperative thrombosis of the deep veins of the lower extremities using mini-doses of heparine.

[Treatment of heart wounds]. / Lechenie ranenii serdtsa.

Care results in 48 patients (male--38, female--10) with heart wounds (HW) were analyzed. 40 (83.2%) patients had stab-incised wounds, 7 (14.7%)--stab wounds, 1 (2.1%)--gunshot wounds. 23 (47.8%) patients were hospitalized in consciousness, 17 (35.3%)--in unconsciousness, 8 (16.9%)--in twilight state. The lethality among the latter two groups of the patients was 64%, in the former group--13%. 19 patients from 48 died: in preoperative period--3, during operation--10, in early postoperative period (more than 10 days)--2 patients. The suspected of HW patients must be transported in the nearest surgical hospital. In unstable hemodynamics it is necessary to carry out adequate infusion therapy, in obvious signs of heart tamponade the pericardium puncture must be performed. In agonizing patients, and in case of general anesthesia delay, it is necessary to begin thoracotomy before general anesthesia.