POSSIBILITIES OF VIDEOLAPAROSCOPIC DIAGNOSIS AND TREATMENT OF ISOLATED AND COMBINED LIVER DAMAGE
POSSIBILITIES OF VIDEOLAPAROSCOPIC DIAGNOSIS AND TREATMENT OF ISOLATED AND COMBINED LIVER DAMAGE
Nazarov F.N., Nazarov Kh.N., Pirov Kh.A., Yorov U.U.
Department of Surgery of Kurgan-Tyube office of State educational establishment «Institute of postgraduate education in health sphere of Republic of Tajikistan», Kurgan-Tube
Aim. Assessment of efficiency of application of therapeutic and diagnostic laparoscopy at liver damage.
Materials and methods. The work is based on a results of research of 94 patients with liver damage (core group with using laparoscopy — 22, control group with application traditional access — 72, men — 79, women — 15, isolated liver injury — 51, combination — 43).
Results. Videolaparoscopy was performed in 22 patients. It was used for the differential diagnosis of penetrating and non-penetrating wounds of the abdomen, exception damage to internal organs. Complications were observed in three cases (effluence of bile — 2, bleeding — 1), which ceased on the background of conservative treatment.
All the victims were operated during the first four hours from the moment of receipt, depending on the severity of the condition. Traditional operative interventions were performed in 72 victims.
Seven patients died from of diffuse peritonitis, poly organ and acute heart failure.
The indications for laparoscopic operations were considered isolated liver damage I-II degree of severity to their localization on the front-diaphragmatic surface, hemoperitoneum not more than 500 ml, the absence of breakthrough bleeding and intestinal damage. After diagnostic laparoscopy in 22 patients with liver injury were performed laparoscopic operations.
In 15 observations was generally limited by the coagulation of liver wounds, in seven cases after coagulation wound surface was covered with a strand of greater omentum. On six patients with combined damages of the spleen was performed coagulation.
Among the patients with isolated liver damage were no fatal outcomes. After laparoscopic operations one patient died from complications of severe associated injuries.
Conclusion. Using of videolaparoscopy for diagnosis and treatment of liver injury, a differentiated approach to the choice of method of treatment with application of simultaneous endovideosurgical and traditional operations allows to optimize the treatment of this severe categories of patients.
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