Організаційні питання покращення лікування гнійно-септичних ускладнень у поранених з бойовою травмою живота з використанням сучасних методів

Abstract

SummaryCombat trauma of the abdomen is ranged from 6.6 to 9% in the structure of combatinjuries according to the literature. The specificity of abdomen gunshot wounds resultsin development of functional disorders and complications (51-81%) and, as aconsequence, a high mortality rate (12-31%).Purpose: Improving the results of surgical treatment of purulent-septiccomplications in wounded with combat trauma of the abdomen.Materials and methods. On the basis of the Military Medical Clinical Center of theSouthern Region, up-to-date treatment methods were used for the wounded who wereadmitted with purulent-septic complications of abdominal combat trauma for the period2014-2019, considering the location, clinical manifestations and severity of the injury,namely puncture and drainage interventions under ultrasonography control, installationof vacuum wound therapy systems.During the study period, there were purulent-inflammatory complications of theabdominal cavity, retroperitoneal space, soft tissues in 86 wounded with abdominalcombat trauma (17.3% of the total number of wounded with abdominal trauma).At the first stage of treatment, puncture and drainage interventions were performedunder ultrasonic navigation and gradual remediation for diagnostic and therapeuticpurposes. Vacuum therapy was used in 25 patients with extensive wounds and purulentseptic complications of the soft tissues of the anterior abdominal wall.Thus, the use of interventional sonography, as the primary diagnostic and treatmentmethod for the treatment of purulent-inflammatory complications of abdominal combattrauma, has improved the quality of diagnosis and reduced traumatic interventions,which resulted in reduced number of postoperative complications and terms of inpatienttreatment.Results. 21 (24.4%) cases of puncture and drainage interventions were ineffectiveand required resorting to traditional methods of treatment - opening and drainage ofpurulent-inflammatory foci. Vacuum therapy is an effective method of treatment ofpurulent-septic complications of gunshot wounds of the soft tissues of the abdomen,which, in combination with puncture-drainage interventions, can reduce by 2.5 times thenumber of repeated operations (mainly multi-stage surgical treatments), therebyreducing 1.7 times the length of stay of patients at the hospital.Conclusions. The use of the up-to-date techniques may help to reduce the number ofinvasive treatments, accelerate recovery, reduce terms of hospital stay, reduceintoxication, and increase the rate of return of servicemen.