Search

Experience of treatment of 782 injured persons with combined thoracic trauma was summarized. Of the total number of injured persons with pulmonary contusion 177 (control group) were treated using conventional methods and 165 (basic group)--an early active operative tactics. Of the total number of injured persons in 150 with heart contusion (basic group) the cardiotropic therapy conduction was started from the hospitalization moment and in 134 (control group)--from the second day and later. Mortality while pulmonary contusion in control group was 43% and in the basic one--31%; in the heart contusion--46 and 12% accordingly.

The paper considers the main issues of a primary emergency radiology in thoracic and abdominal gunshot injury proceeding from some practical experience gained in examining and surgically treating 271 victims with this injury. It defines specific indications to examine either anatomic region and expediency of applying various radiation techniques and procedures. Recommendations are given on the optimum scope of radiology to solve different diagnostic problems. By and large, principles and policy of radiation study are defined in thoracic and abdominal gunshot injuries.

A generalized experience with treatment of more than 1000 patients with wounds of the chest is presented. Bullet wounds prevailed. Methods of treatment of penetrating wounds of the chest are described.

The authors have studied the peculiarities of diagnosis and the results of treatment in cases of penetrating chest gunshot wounds combined with heart contusions. It was found out that heart gunshot contusions had a quite definite clinical picture, which almost was corroborated by ECG examinations. Diagnostic ultrasound is a matter of great importance in such cases. The clinical experience proves that cardiotropic therapy must be started as soon as possible in order to prevent the development of cardiogenic shock. Hyperbaric oxygenation, if started at an early period, has a solid favourable effect.

Exact indications for urgent, early and late thoracotomy are given on the basis of a great clinical experience of the authors. Specific features of the operation, principles of the management of postoperative patients are described. The general postoperative lethality from chest injuries of the patients was 9.5%.

Closed active sanitation of the pleural cavity with the local application of proteolytic enzymes and antibiotics in rational general therapy allowed to cure more than half of the patients with pleural empyema of a traumatic origin. An insufficient effect of drainage results in wide thoracotomy being necessary. The most adequate operation is pleurectomy and decortication contributing to complete expansion of the lung and preservation of its functional capacities.

On the basis of an analysis of great clinical material the author gives recommendations for diagnosis and surgical measures for thoracoabdominal wounds. Realization of the lines of treatment proposed in the article reduces lethality in critical patients to 23,7%.