DIRECT RESULTS OF TREATMENT OF GUNSHOT WOUNDS OF THE SPLEEN 

Maslyakov Vladimir Vladimirovich, Doctor of medical sciences, professor, vice-rector for research and public relations, head of sub-department of clinical medicine, Saratov Medical Institute “REAVIZ” (1a Degtyarnaya square, Saratov, Russia), maslyakov@inbox.ru
Barsukov Vitaliy Gennad'evich, Candidate of medical sciences, assistant, sub-department of surgery, Saratov Medical Institute “REAVIZ” (1a Degtyarnaya square, Saratov, Russia), maslyakov@inbox.ru
Kulikov Sergey Aleksandrovich, Student, Saratov State Medical University named after V.I. Razumovsky (112 Bolshaya Kazachya street, Saratov, Russia), maslyakov@inbox.ru  

617.55-001.45-089.168/.168.1 «313» (045) 

Background. The goal of the article is to study the course of the nearest postoperative period of patients with gunshot wounds of stomach, accompanied by spleen damage. Among the most various wounds occuring during military conflicts, the gunshot trauma is one of the leaders both by frequency and by severity. However, despite the achieved progress, the problem, especially in conditions of local wars and armed conflicts, continues to remain very urgent and insufficiently studied. It is necessary to emphasize that the vast majority of publications on this problem belong to military surgeons. It is known that the system of stage-based treatment in field surgery provides for partition of the uniform medical process on separate events held in several places and at different times. Moreover, the volume of medical actions in this system to a great extent depends on the combat and medical situation. At the same time in larga cities people with gunshot wounds may be rapidly delivered to surgical hospitals for specialized surgical aid rendering with continuous supervision in the postoperative period. Therefore, the works by many authors concerning the results of gunshot wounds treatment are incomparable not only due to different conditions of medical care rendering, but also in view of basic distinctions of the systems. It should be noted that the problem of studying the remote results of treatment of such patients remains low-studied.
Materials and methods. The present research is based on the analysis of treatment of 56 casualties among the civilian population undergoing treatment of gunshot wounds of stomach with spleen injuries.
Results. At arrival of patients to a hospital the slight damages were registered in 8 cases (14,2 %), moderately severe – 26 (46,2 %), severe – 15 (26,7 %) and extremely severe – 7 (12,5 %). Crush injury of the organ was prevailing – 34 (60,7 %), in 4 cases (7,1 %) the organ was separated from a vascular pedicle, in 18 cases (32,1 %) capsule damages in the field of poles were revealed. 42 casualties (75%) arrived in shock condition of various severity. Severity of injuries, presence of shock defined further surgical tactics, so in 47 cases (83,9 %) splenectomy was executed, only in 9 cases (16 %) splenectomy was supplemented by autoliyentransplantation. Severity of damages naturally resulted in severity of the further postoperative period, thus in the nearest postoperative period complications developed in 50 (89,2 %) patients. It should be noted that the majority of complications – 98 % developed in the group of patients with multiple damages of abdominal cavity, in case of isolated damages complications were detected in single instances. During the further postoperative period 28 (35,7 %) patients died.
Conclusions. As a result of the conducted research it is established that complications in the further postoperative period in patients with gunshot wounds of stomach, accompanied by spleens injuries, develop in 89,2 % of cases. Their structure includes pneumonia – 23,2 %; pancreatitis – 16 % and postoperative wound suppuration – 14,2 %. Mortality in this group totaled 35,7 %. The main cause of cause was hemorrhagic shock – 12,5 %. The prospective field of research results application is cavity surgery. 

gunshot wounds of stomach, spleen injury, further postoperative period. 

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