RESUMO
The results of the treatment of 378 patients with severe combined (n=270) and isolated (n=108) close abdominal trauma with an injury of the spleen are analyzed. Overall lethality was 11.9% including 7.41% during the first 24 hours. Spleen-preserving surgery was performed in 150 patients, 98% of them had severe injuries of this organ. Splenectomy was performed in 228 patients. Ligation of splenic artery is the indispensable condition of spleen-saving surgery. The level of ligation was validated by the data of own 102 x-ray and 73 anatomic examinations. Optimal level of ligation is located in proximal and middle part of the splenic artery. Spleen-preserving surgeries (especially laparoscopic procedures) significantly reduced lethality, number of postoperative complications and hospital stay.
Assuntos
Traumatismos Abdominais/cirurgia , Tomada de Decisões , Laparoscopia/métodos , Traumatismo Múltiplo/cirurgia , Baço/lesões , Esplenectomia , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/mortalidade , Adolescente , Adulto , Angiografia , Feminino , Seguimentos , Humanos , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/diagnóstico por imagem , Traumatismo Múltiplo/mortalidade , Estudos Retrospectivos , Ruptura , Baço/diagnóstico por imagem , Baço/cirurgia , Artéria Esplênica/diagnóstico por imagem , Artéria Esplênica/cirurgia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
Results of examination and treatment of 646 patients with severe combined trauma and closed abdominal trauma are analyzed. Laparocentesis and laparoscopy were used for diagnosis. Laparocentesis (342 procedures) diagnosed injuries of the abdominal organs in 47% cases and excluded them in 33% cases that made a total of 80% of accurate diagnoses. Laparoscopy (304 procedures) provided accurate diagnosis in 99.34% cases. Laparoscopy did not reveal injuries that required additional surgical procedures in 56% patients, in the rest 44% patients surgical methods of treatment were used including laparotomy (29.2%) and endo-surgical procedures (14.8%). Algorithm of diagnosis and treatment is described.
Assuntos
Traumatismos Abdominais/cirurgia , Traumatismo Múltiplo/cirurgia , Ferimentos não Penetrantes/cirurgia , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/diagnóstico por imagem , Algoritmos , Previsões , Hemoperitônio/diagnóstico , Hemoperitônio/cirurgia , Humanos , Laparoscopia , Laparotomia , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/diagnóstico por imagem , Paracentese , Punções , Radiografia Abdominal , Ultrassonografia , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/diagnóstico por imagemRESUMO
Results of treatment of 378 patients with severe combined and isolated abdominal trauma with spleen injury are analyzed. Severity of patients state and severity of trauma are assessed. General lethality was 11.9% including 7.41% during first day. Spleen-saving surgery was performed in 150 patients, 96% of them had severe injuries of organ. Spleen was removed in 228 patients. Spleen-saving surgeries (especially laparoscopic procedures) permitted to reduce significantly lethality, number of postoperative complications and hospital stay.
Assuntos
Traumatismos Abdominais/complicações , Baço/lesões , Esplenopatias/complicações , Adulto , Feminino , Humanos , Laparoscopia/métodos , Masculino , Índice de Gravidade de DoençaRESUMO
Based on 102 X-ray and 73 anatomic examinations, the scheme of arterial circulation of the pancreas and spleen, features of their collateral circulation are analyzed. Optimal level of spleen artery ligation at proximal part as the main stage of organ-saving surgical treatment in traumatic disruption of the spleen is substantiated.
