Authors
Chuprina A.P.1, 2, Kazakov A.D.3, Kuznetsov I.M.2, Kucherenko A.D.2, Panov V.V.3, Kokoev V.G.3
1 Main Military Medical Directorate of the Russian Defense Ministry, Moscow
2 Military Medical Academy named after S.M. Kirov, Saint-Petersburg
3 1602 Military Clinical Hospital, Rostov-on-Don
Abstract
Backgraund: treatment of thoracoabdominal wounds at the advanced stages of qualified care is not only associated with a high probability of diagnostic and tactical errors, but also accompanied by high mortality, significant risks of developing postoperative complications.
Aims: to analyze diagnostic and therapeutic capabilities, as well as the results of treatment of thoracoabdominal wounds at the stage of qualified surgical care in a modern armed conflict.
Materials and methods: a comparative retrospective analysis of medical records of 200 military personnel who received gunshot thoracoabdominal wounds in the period from 2022 to 2023 was conducted. All wounds were of a combined gunshot nature. The formation of the research database and analysis was carried out using the Microsoft Office Excel 2013 application program.
Results: the frequency of undetected penetrating wounds of the chest and / or abdomen at the stage of qualified surgical care was 16% of the total number of wounded. In doubtful cases 6% of the wounded were sent for сomputed tomography of the chest and abdomen, according to the results of which 3.5% were operated on, 2.5% underwent dynamic observation at the next stages. The frequency of thoracotomy in thoracoabdominal wounds at the stage of qualified surgical care in this study was 4.5%, laparotomy was performed in 84.5% of the wounded. The tactics of dynamic observation in patients with penetrating abdominal wounds were implemented in 4.5% of the wounded.
Conclusions: the leading methods of early diagnostics of thoracoabdominal wounds at the stages of qualified surgical care are radiography, as well as ultrasound examination of the chest and abdomen. An important factor in the multi-stage surgical treatment of these patients is the reduction of surgical invasion. Improvement of conservative therapy methods will reduce the number of “unjustified” thoraco-/ and laparotomies at the stages of medical evacuation. Further study of these issues will reduce the incidence of postoperative complications, mortality, reduce the duration of treatment and financial costs, and speed up the return of military personnel to duty.
Keywords: thoracoabdominal wound, penetrating gunshot wound, gunshot wound of the chest, gunshot wound of the abdomen, penetrating wound of the diaphragm, nonoperative management.
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