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Analiza complicațiilor evolutive la pacienții cu hemoperitoneu traumatic rezolvat nonoperator

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dc.contributor.author Aneste, Eduard
dc.contributor.author Rojnoveanu, Gheorghe
dc.contributor.author Gurghiş, Radu
dc.date.accessioned 2020-12-09T08:56:54Z
dc.date.available 2020-12-09T08:56:54Z
dc.date.issued 2015
dc.identifier.citation ANESTE, E., ROJNOVEANU, G., GURGHIŞ, R. Analiza complicațiilor evolutive la pacienții cu hemoperitoneu traumatic rezolvat nonoperator = Analysis of evolutive complications after nonoperative management in patients with traumatic hemoperitoneum. In: Arta Medica. 2015, nr. 3(56), p. 128. ISSN 1810-1852. en_US
dc.identifier.issn 1810-1852
dc.identifier.uri http://repository.usmf.md/handle/20.500.12710/13794
dc.description Catedra de chirurgie nr.1 ”N.Anestiadi”, USMF ”Nicolae Testemițanu”, Chișinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015 en_US
dc.description.abstract Scopul studiului a fost analiza structurii complicațiilor la pacienții cu hemoperitoneu traumatic rezolvat prin conduită nonoperatorie. Material și metode: Au fost evaluați 48 traumatizați (pe perioada anilor 2011-2015) cu hemoperitoneu posttraumatic cauzat de: leziuni lienale (LL) izolate – 22 (45,84%), leziuni hepatice (LH) izolate – 10 (20,83%), leziuni renale (LR) izolate – 1 (2,08%), LL + LH – 6 (12,5%), LL + LH + LR – 3 (6,25%), LL + LR – 1 (2,08%), leziunea ligamentului teres hepati – 1 (2,08%) și cauze neelucidate – 4 (8,34%). Leziuni închise – 45 (93,75%), deschise – 3 (6,25%), raportul B:F=2:1. Valori medii: vârsta = 36±13,95 ani, scorul RTS = 6,98±1,05; scorul ISS = 28,15±19,2. Stabilirea diagnosticului: USG – 48 (100%) cazuri, TC – 39 (81,25%), laparoscopie – 8 (16,67%), laparocenteză – 1 (2,08%). Rezultate: Severitatea LL (AAST): gr.I (0), gr.II (12), gr.III (18), gr.IV (2); LH (AAST): gr.I (7), gr.II (3), gr.III (7), gr.IV (1); LR (AAST): gr.I (4), gr.II (1), gr.III (2). Politraumatizați cu scorul ISS>25 – 25 (52,08%), cu GCS<12 puncte – 21 (43,75%). Volumul hemoperitoneului la internare stabilit imagistic – 454,47±352,87ml (0-1300 ml). Intervenții chirurgicale extraabdominale – 20 la 12 (25%) pacienți: evacuarea hematomului subarahnoidian – 3 (15%), debridarea chirurgicală a plăgilor – 3 (15%), toracocenteză – 6 (30%), osteosinteză – 5 (25%), traheostomie – 3 (15%). Complicații – 28 la 22 (45,83%) pacienți: intraabdominale specifice (3) – pareză intestinală la 3 (10,72%), și nespecifice, precum hemoragia digestivă – 1 (3,57%). Complicații extraabdominale: pleuropulmonare – 19 (67,86%), cistită – 1 (3,57%), otită medie – 1 (3,57%), embolie lipidică – 1 (3,57%), poliurie – 1 (3,57%), febră de etiologie neidentificată – 1 (3,57%). Toți pacienții (100%) cu complicații pleuropulmonare au suferit traumatism toracic, iar embolia lipidică s-a asociat traumatismului locomotor grav. Concluzii: Analiza complicaţiilor evidenţiază predominarea morbidităţilor legate de traumatismele extraabdominale asociate, iar reabsorbţia naturală a sângelui din cavitatea peritoneală decurge fără repercusiuni locale sau sistemice, cazurile de pareză intestinală fiind asociate laparoscopiei. en_US
dc.description.abstract The aim of study was analysis of complication structure in patients with traumatic hemoperitoneum during nonoperative management. Material and methods: We analyzed a total of 48 patients (during 2011-2015) with traumatic hemoperitoneum, caused by: isolated splenic trauma (LL) – 22 (45.84%), isolated liver trauma (LH) – 10 (20.83%), isolated renal trauma (LR) – 1 (2.08%), LL + LH – 6 (12.5%), LL + LH + LR – 3 (6.25%), LL + LR – 1 (2.08%), lesion of ligamentum teres hepatis – 1 (2.08%) and unclear reasons – 4 (8.34%). Blunt trauma – 45 (93.75%), stab – 3 (6.25%); M:F ratio was 2:1. Average values: age = 36±13.95 years, RTS score = 6.98±1.05; ISS score = 28.15±19.2. Diagnosis was established by ultrasound – 48 (100%), CT – 39 (81.25%), laparoscopy – 8 (16.67%), laparocentesis – 1 (2.08%). Results: Severity of LL (AAST): gr.I (0), gr.II (12), gr.III (18), gr.IV (2); LH (AAST): gr.I (7), gr.II (3), gr.III (7), gr.IV (1); LR (AAST): gr.I (4), gr.II (1), gr.III (2). ISS score >25 – 25 (52.08%). Patients with GCS score <12 – 21(43.75%). The average hemoperitoneum volume at admission – 454.47±352.87ml (0-1300 ml). Extraabdominal surgical interventions – 20 in 12 (25%) patients: subarachnoid haematoma drainage – 3 (15%), wound management – 3 (15%), thoracocentesis/thoracotomy – 6 (30%), osteosynthesis – 5 (25%), tracheostomy – 3 (15%). Were noted 28 complications in 22 (45.83%) patients: specific intraabdominal complications, as intestinal paresis – 3 (10.72%), and nonspecific, as digestive hemorrhage – 1 (3.57%); extraabdominal complications: pleuropulmonary – 19 (67.86%), catheter-associated urinary tract infection – 1 (3.57%), otitis media – 1 (3.57%), fat embolism – 1 (3.57%), polyuria – 1 (3.57%), unexplained fever – 1 (3.57%). All patients (100%) with pleuropulmonary complications suffered thoracic trauma, the patient with fat embolism – severe locomotory trauma. Conclusions: The analysis of evolutive complications showed prevalence of complications related to associated extraabdominal trauma, when the blood absorptions from peritoneal cavity does not show any local or systemic complications, all 3 cases of intestinal paresis being a consequence of laparoscopic procedure.
dc.publisher Asociaţia chirurgilor “Nicolae Anestiadi” din Republica Moldova en_US
dc.title Analiza complicațiilor evolutive la pacienții cu hemoperitoneu traumatic rezolvat nonoperator en_US
dc.title.alternative Analysis of evolutive complications after nonoperative management in patients with traumatic hemoperitoneum en_US
dc.type Article en_US


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