Khomenko I. P., Bilenky V. A., Shypilov S. A., Mikhailusov R. М., Nehoduyko V. V

METHODS AND METHODOLOGIES

Scentific article

The complexity of the differential diagnosis of firearms in the diaphragm is emphasized by many authors. Standard approaches to diagnostic and therapeutic measures are highly traumatic. The desire of surgeons to reduce the traumatic nature of surgical interventions has led to widespread thoracoabdominal surgery of minimally invasive technologies. The purpose of the research: to improve the results of diagnostics of gunshot wounds in the affected patients delivered from the zone of ATO by introducing new videoendoscopic technologies at the stage of provision of specialized surgical care. The object and methods of research. The study was carried out at the surgical clinic of the Military Medical Clinical Center of the Northern Region of the Ministry of Defense of Ukraine. The clinic was delivered to 64 wounded with the simultaneous penetration of the wounded projectile into the chest and abdominal cavity, that is, wounds were damaged by the diaphragm. Research results and their discussion. Diagnostic and therapeutic videothoracoscopy was performed on 64 (100%) wounded. In order to evaluate the diaphragm wounds, namely their number, localization and topography, the presence of foreign bodies of the gunspot, the detection of hematoma, sulfur and associated damage to the organs of the cavity and parenchymal organs of the chest and mediastinum in the clinic, a method for laser imaging of the gunshot wounds of the diaphragm was developed and implemented (sent application for a patent of Ukraine). The proposed method is carried out as follows: during thoracoscopic surgical intervention in the victims with fire-fighting wounds of the diaphragm after performing a visual audit with the help of video endoscopic camera to increase the image to 8-10 times, an overview of difficult-to-reach areas for examination of the chest cavity with the use of an additional source of illumination. Laser irradiation is carried out with the help of the apparatus of laser therapeutic «Lika Therapist M» (the manufacturer of Primer Photonics Plus, Cherkassy), which connects to the proposed endoscopic laser nozzle, which provides uniform diffuse scattering radiation. A review is carried out in red (660 nm), green (525 nm) and blue (405 nm) laser irradiation spectra in its various combinations, with a laser power density of 50 mW, which improves the visibility of wound defects and allows to identify additional non-visual impairments with normal lighting. With the additional use of laser imaging during diagnostic thoracoscopy in the developed way, with the help of the apparatus of laser therapeutic «Lika Therapist M», 8 (13%) patients were diagnosed with additional wound diaphragms that had a tangent (in 6 (9%) patients) and through (in 2 (3%) patients) character. The largest number of diaphragmatic wounds 5 (8%) was detected in a red (660 nm) laser radiation spectrum survey. In our opinion, laser imaging in the red spectrum is most effective. Complications during the application of the developed method of laser imaging of the gunshot wounds of the diaphragm were not observed. The offered videoendoscopic methods of diaphragmatic gunshot wound diagnostics at the specialized level of provision of surgical care allow to effectively visualize defects of the diaphragm, even in hard-to-reach places. Obtaining positive test results is the basis for recommending videothoracoscopic laser imaging of diaphragm wounds for use in surgical practice. Conclusions. In our study, the use of videothoracoscopy allowed to detect a gunshot wound diaphragm, which shows the high sensitivity of the method. The use of the laser imaging technique for the firearms of the diaphragm allowed the additional detection of 8 injured (12.5%) wounds of the tangent (in 6 (9.3%) patients) and transversal (in 2 (3.1%) patients). The use of endoscopic techniques for diagnosing gunshot wounds of the diaphragm is a modern and less traumatic direction of the development of the surgery of damage.

gunshot wounded diaphragm, laser visualization, videothoracoscopy, specialized surgical care

1. Romanov MD, Golubev AG, Piksin IN, Pigachev AB. Hirurgicheskaya taktika pri torakoabdominalnyh ranenih. V: Romanov MD, redaktor. Tez. dokl. Mezhdunarodnyj hirurgicheskij kongress; 2005. Rostov-na-Donu. s. 31. [in Russian].
2. Sotnichenko BA, Makarov VI, Kalinin OB, Salienko CB, Fisun DS. Oshibki diagnostiki i hirurgicheskoj taktiki pri razryvah diafragmy. Vestnik hirurgii. 2008;3:19-23. [in Russian].
3. Florikyan AK. Hirurgiya povrezhdenij grudi (patofiziologiya, klinika, diagnostika, lechenie): izbrannye lekcii. Harkov: Osnova; 1998. 520 s. [in Russian].
4.  Abakumov MM, Ermolova IV, Pogodina AN. Diagnostika i lechenie razryvov diafragmy. Hirurgiya. 2000;7:28-33. [in Russian].
5.  Bykov VP. Ognestrelnye raneniya grudi i zhivota mirnogo vremeni. Hirurgiya. 2003;7:72-4. [in Russian].
6.  Gumanenko EK, redaktor. Voenno-polevaya hirurgiya. 2-e izdanie. Moskva: GEOTAR-Media; 2015. 768 s. [in Russian].
7. Wise D, Davies G, Coats T. Emergency thoracotomy: «how to do it». Emergency Medical Journal. 2005;22:22-4.
8.  Zhestkov KG, Gulyaev AA, Abakumov MM, Voskresenskij OV, Barskij BV. Rol torakoskopii v hirurgii ranenij grudi. Hirurgiya. 2003;12:19-23. [in Russian].
9. Ermolova IV, Abakumov MM, Pogodina AN. Diagnostika i lechenie razryvov diafragmy pri zakrytoj travme. V: Ermolova IV, redaktor. Materialy kongressa moskovskih hirurgov. Moskva; 2005. s. 174. [in Russian].
10. Kukushkin AV. Povrezhdeniya i gryzhi diafragmy. Diagnostika i hirurgicheskoe lechenie [dissertaciya]. SPb: Sev.-zap. gos. med. un-t; 2015. 38 s. [in Russian].
11.  Zaruckij YaL, Shudrak AA. Vkazivki z voyenno-polovoyi hirurgiyi. Kiyiv: SPD Chalchinska NV; 2014. 396 s. [in Ukrainian].
12.  Kolesnikov IS, Rahimov BM, Kutepov EH, Galkin IV, Seredin JIB. Algoritm diagnostiki i hirurgicheskogo lecheniya postradavshih s tyazhyolymi sochetannymi povrezhdeniyami grudi i zhivota. V: Kolesnikov IS, redaktor. Tez. dokl. Neotlozhnye sostoyaniya v praktike mnogoprofilnogo stacionara. Tolyatti; 2008. s. 37-9. [in Russian].

«Bulletin of problems biology and medicine» Issue 1 Part 2 (149), 2019 year, 258-262 pages, index UDK 616-079.1-001.45::616-072.1-26

10.29254/2077-4214-2019-1-2-149-258-262