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Abdominal organ injuries in associated trauma: particularities of etiology and pathogenesis, diagnostic and treatment tactics


Author: Rojnoveanu Gheorghe
Degree:doctor habilitat of medicine
Speciality: 14.00.27 - Surgery
Year:2009
Scientific consultant: Gheorghe Ghidirim
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 22 October, 2008
Approved by NCAA on the 22 January, 2009

Abstract

Adobe PDF document2.48 Mb / in romanian

Thesis

CZU 617.55-001-07-089

Adobe PDF document 16.00 Mb / in romanian
333 pages


Keywords

Polytrauma, abdominal trauma, diagnosis, treatment, experimental liver injury, Pringle manoeuvre, albumin-glutaraldehyde sealant

Summary

The aim of this study is to improve the treatment results of traumatized patients with abdominal organ injuries, basing on optimization of the diagnostic and treatment algorithm. In the present study were included 895 traumatized patients with abdominal organ injuries. The following scoring systems: AIS, ISS, RTS, TRISS, APACHE II were used in order to appreciate the severity of patient’s condition. The author presents the diagnostic particularities in traumatized patients with abdominal organ injuries. The author demonstrates the significance of a specialized team of different professionals in order to deliver optimal medical care for traumatized patients, a team able to perform concomitantly the primary patient’s examination and the reanimation procedures, which determines the volume and the order of diagnostic and treatment procedures depending on the patient’s hemodynamic’s parameters and on the severity of the predominant traumatic injury. It was demonstrated that in abdominal organ injuries it is more important to establish the life-threatening injuries in a hemodynamically unstable patient rather than establishing what organ is affected. The author performed analyzed different abdominal symptoms as well as the significance of different diagnostic procedures depending on the character of traumatic agent and patient’s hemodynamics. Were determined the significant factors that negatively influence abdominal symptoms in case of polytrauma, such as: the injury of 3-4 anatomical systems, neurological condition according to Glasgow score, severe shock, blunt abdominal trauma in car accidents and falls from heigth (all the factors are statistically reliable – p<0,001). Were determined the particularities of polytrauma and basing on these particularities was established an optimal treatment tactics for abdominal organ injuries in patients with associated trauma. The surgical tactics in these patients depends on the dominating injury, including two basic directions: surgical procedures for life-threatening correction of trauma’s consequence and particularly surgical challenge that reflect the particularities of one or another association of anatomic and functional injuries depending on their severity. Were studied the morphological and pathophysiological modifications determined by temporary arrest of the afferent hepatic blood flow in experimental liver injuries and were determined the optimal regimens of occlusion. The author demonstrated the rationality of intermittent occlusion (15 minutes ischemia and 10 minutes reperfusion) by means of optimization of hepatic blood inflow arrest in experimental liver injury. The author studied the hemo- and biliostatic effects of albumin-glutaraldehyde sealant in experimental liver injuries and fundamentally argumentated some surgical maneuvers in case of liver injuries. It was demonstrated that non-surgical and minimal access surgical treatment for liver injuries is effective, being associated with the fewest septic complications. Were established the indications for non-surgical treatment in liver injuries: I-III degree of injury, absence of positive peritoneal signs, patient’s hemodynamic stability and the possibility of USG and CT monitoring. For the first time was demonstrated the rationality of gastric transposition in cases of severe duodenal injury, as an alternative for exclusion of the duodenum by suturing it at the pylorus and gastric bypass in cases when duodenorraphy is unfeasible The author suggested the diagnostic and treatment algorithm for patients with associated trauma and abdominal wall injuries which allowed to reduce the lethality from 24,44% (in 1998-2002) to 16,19% (in 2003-2007) (p<0,01).