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№1' 2019
SURGERYInternational Medical Journal, Vol. 25., Iss. 1, 2019, P. 23−26.
FEATURES OF SURGICAL APPROACH FOR CONCOMITANT ABDOMINAL AND PELVIC LESIONS OF PATIENTS WITH POLYTRAUMA
SI "V. T. Zaytsev Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine", Kharkiv,
Kharkiv National Medical University
Kharkiv Regional Clinical Center for Urology and Nephrology named after V. I. Shapoval, Ukraine
The combination of pelvic and abdominal injuries occurs in 26−50% of patients with a combined damage, and up to 55% of pelvic injuries are accompanied with an abdominal trauma. The results of surgical treatment of the patients with dominant abdominal injuries in combination with those of pelvis, as well as pelvic organs have been analyzed. In one clinical group, traditional surgical approach was used and the tactical errors were analyzed; in another, the surgeries were performed using novel techniques, which were applied to perform organ−saving surgeries with reinfusion of the effused blood. The treatment approach to the injuries of pelvic organs differed significantly in the affected individuals of both groups. Thus, in the first group with the injuries of bladder and urethra, it was possible to delay the surgical interventions for up to 12 hours from the moment of injury. In the patients of the second group, as a distinctive feature of surgical treatment of the injuries of bladder and urethra, along with the urine diversion, an adequate prevesical space drainage was considered. The results of investigations demonstrated that the decrease in mortality of the patients of this category from 42.5 % in the first group down to 25.0 % in the second, i.e., 1.7 times, was to a certain extent associated with the stabilization of severe pelvic fractures, which made it possible to achieve hemostasis, prevent the growth of retroperitoneal hematomas and timely perform surgeries in internal organs of abdominal cavity and retroperitoneal space, including the organs of genitourinary system.
Key words: polytrauma, dominant abdominal damage, concomitant damage to the pelvis and pelvic organs, choice of surgical approach.