Відеолапароскопія при закритій травмі живота з пошкодженням печінки та селезінки

Abstract

Open and closed abdominal trauma is the structure of traumatic injuries makes up from 1.5% to 36.5% of all injuries, accompanied in 26.7-40.8% of cases by liver and spleen damage. Damage to parenchymal organs of the abdominal cavity most often leads to the development of intra-abdominal bleeding, which is the basis of unsatisfactory results of treatment and death of patients. Among the diagnostic methods, video laparoscopy is becoming more and more important in finding the extent of damage to the internal organs of the abdominal cavity. In emergency cases as a minimally invasive but sufficiently informative research method, which in 20-60% of cases allows to supplement, clarify or change the diagnosis. The sensitivity of diagnostic laparoscopy in the case of damage to the organs of the abdominal cavity is 99-100%. Purpose - to study the role and place of video laparoscopy in the diagnosis and treatment of closed abdominal trauma with damage to the liver and spleen. Materials and methods. The results of using video laparoscopy in the diagnosis and treatment of closed abdominal trauma with isolated liver and spleen damage in 131 patients were retrospectively analyzed. The diagnostic search program included clinical, laboratory-biochemical, radiographic studies, ultrasound examination of the abdominal organs according to the FAST protocol, computed tomography, laparocentesis using a search catheter, diagnostic peritoneal lavage, laparoscopy, which were performed in a comprehensive examination according to indications. The obtained data are presented in the form of absolute (number of cases) and relative (%) values. The validity of laparoscopy was considered statistically significant at p˂0.05. Results. Video laparoscopy of the abdominal cavity in the case of a closed injury with isolated damage to parenchymal organs allows to diagnose the nature of the damage in the shortest possible time and to determine the treatment tactics. This method in the diagnosis of hemoperitoneum and injuries of the liver and spleen is informative (100%), sensitivity - 92.8%, specificity - 94.6%, at p<0.05. All laparoscopic operations for injuries of the liver and spleen were ended with a thorough revision, sanitation and drainage of the abdominal cavity. We did not observe complications related to endo-video surgery in this group of patients. There were no fatal consequences. This indicates that the use of minimally invasive laparoscopic methods of treatment in this group of patients helps to reduce the severity of surgical trauma and the frequency of various postoperative complications. Conclusions. Laparoscopy is a highly informative method of diagnosing intra-abdominal damage to the liver and spleen in case of closed abdominal trauma with the possibility of carrying out medical measures. It allows you to prevent and significantly reduce the frequency of postoperative complications, improve the results of treatment, and shorten the hospitalization period of the patients. In compliance of the above criteria, laparoscopy is a safe and adequate replacement for laparotomy as both a diagnostic and treatment intervention. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.