Surgical tactics for victims of gunshot wounds of the diaphragm specialized stage of medical care in conditions of a modern armed conflict
Abstract
Introduction. The diaphragm gunshot wounds are serious combat injuries. The main functions of the
diaphragm are to change the intra-abdominal pressure and the outflow of lymph and blood from the abdominal
cavity due to the constant contraction and relaxation. Therefore, when it is injured at the same time with
a powerful painful impulse, cardiopulmonary disorders quickly arise.
Purpose: To improve the results of surgical treatment of patients with gunshot wounds through the introduction
of new video endoscopic technologies at the stage of specialized surgical care.
Materials and methods. The article analyzes the features of specialized surgical care in 64 patients with
gunshot wounds who were treated at the surgical clinic of the Military Medical Clinical Center of the Northern
Region (III level of medical care). New minimally invasive methods are proposed to improve the outcomes of
surgical treatment of victims with diaphragm gunshot wounds at level III of health care delivery.
Results. Thus, the use of video thoracoscopic technique in the surgical treatment of the diaphragm wound
and its suturing in the proposed method allowed to improve the results of treatment by increasing the average value of diaphragmatic excursion in deep breath in the main group to 3.73 ± 0.31 cm, whereas in the comparison group 2.21 ± 0.38 cm. The severity of the pain syndrome on the of Visual Аnalogue Scale 5 days after surgical treatment was 5.2 ± 2.3 points in the injured main group, 6.7 ± 2.1 points in the comparison group. The ratio of vital lung capacity to the required vital lung capacity in the main group was 75.3 ± 2.2%, in the comparison group 64.1 ± 1.7%.
Conclusions. The use of video thoracoscopy increases the efficiency of the diagnosis of gunshot wounds of
the diaphragm. The use of laser imaging and fluorescence diagnosis of diaphragm wounds ensure the adequacy
of the removal of paravulary necrotic tissues. The suturing of the wounds in accordance with the anatomical and
functional structure of the diaphragm with the use of plaques improves the immediate postoperative results of
surgical treatment.
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References
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