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Nonoperative and miniinvasive management of blunt traumatic injuries to the parenchymal abdominal organs


Author: Gurghiş Radu
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Year:2012
Scientific adviser: Gheorghe Rojnoveanu
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution: State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific council: DH 50-14.00.22-27.03.08
State University of Medicine and Pharmacy "Nicolae Testemitanu"

Status

The thesis was presented on the 14 November, 2012
Approved by NCAA on the 20 December, 2012

Abstract

Adobe PDF document0.75 Mb / in romanian

Keywords

polytrauma, blunt abdominal trauma, spleen, liver, nonoperative management.

Summary

Key words: polytrauma, blunt abdominal trauma, spleen, liver, nonoperative management.

The research domain:14.00.27 – surgery.

Study aim. The treatment optimisation of blunt parenchymal abdominal organs trauma by analysing and assessing the mandatory selection criteria required to nonoperative management as a safe treatment modality both in patients with isolated abdominal trauma and polytrauma ones.

The research objectives. Analysis and concretization of mandatory selection criteria for trauma patients required to nonoperative management option in blunt hepatic and splenic trauma; argument of the possibility and opportunity of nonoperative treatment in these injuries at the polytrauma patients, especially in those with compromised neurological integrity.

The novelty and the scientific originality. For the first time in Republic of Moldova has been implemented and used nonoperative treatment tactic in blunt parenchymal organs trauma, by proving the possibility and efficiency of NOM application at the polytrauma patients. It has been demonstrated that consciousness impairment isn’t an absolute criterion of avoidance of NOM when applying NOM to the trauma patients with compromised neurological integrity. It has been used laparoscopy as a modality of argument of the success when apllying NOM at the unconsciousness polytrauma patients with a rather reserved prognosis, which has conduct to increase of rate of nonoperative solution of splenic and hepatic injuries with 18,1%.

The scientific solved problem. For the first time it was proved the possibility and efficiency of NOM application for blunt abdominal organs lesions at the polytrauma patients, with statistical signification, especially at those with an ISS > 25.

The theoretical significance. It has been systematized the mandatory criteria for the selection required to NOM of blunt splenic and hepatic trauma and it has been pointed out the advantages of nonoperative management and the determinant factors of failure.

The applicative value of the work. A rational diagnostic-treatment algorithm has been elaborated for the solution of blunt splenic and hepatic trauma by contemporary opportunity of nonoperative management.

The implementation of the scientific results. As a result of the present study was implemented in Chisinau Emergency Hospital, as well as in the training curricula at the surgical department nr.1 “Nicolae Anestiadi” for the SMPU „Nicolae Testemitanu”.