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FEATURES OF DIAGNOSTIC RESEARCH METHODS IN SURGICAL
TACTICS FOR TREATMENT OF SPLEEN INJURIES
Khakimov M.Sh.
Zhumanazarov A.U.
Ismailova U.A.
Aripov Sh.Sh.
https://doi.org/10.5281/zenodo.15186652
Relevance.
The incidence of spleen injury is 22.3-30% in abdominal organ
trauma and ranks second among parenchymatous organ ruptures.
The aim
of the study is to determine the most effective methods for
diagnosing spleen damage. Modern instrumental research methods allow us to
detect even minimal damage to parenchymatous organs, and at present,
ultrasound and MSCT are considered the most specific for diagnosing various
spleen injuries.
Materials and methods
. The results of diagnosis and treatment of 55
patients with closed spleen injury during 2021-2022 in the emergency surgery
department of the multidisciplinary clinic of the Tashkent Medical Academy are
presented for analysis. Of these, 32 (58%) patients were men and the remaining
23 (42%) were women aged 21 to 68 years. Among the victims over 60 years
old, there were 5 (9%) people.
According to the classification of spleen injuries developed by the American
Association of Surgeons-Traumatologists (AAST), splenic injuries have 5
degrees. As a result of a number of examinations, 8 (14.5%) patients were
diagnosed with grade I , 26 (47%) – grade II , 11 (20%) III degree and 10 (18%)
– IV degree. The victims were admitted to the emergency or intensive care unit,
only 6 (10.9%) of them were transferred from other departments, and each of
them underwent standard examinations (ultrasound of the abdominal cavity,
general blood and urine tests, plain radiography of the abdominal cavity) to
clarify the nature of the injury. All of them had clinical signs of anemia of varying
degrees, and only 28 (50.9%) patients indicated pain in the left hypochondrium.
Given the impossibility of accurately determining the degree of spleen damage,
14 (25.5%) patients had to undergo diagnostic laparoscopy. However, in other
cases, MSCT and one of the modern and affordable methods – ultrasound – were
used for diagnosis.
Results.
Considering the I - II degree of damage, 32 (58%) patients were
treated conservatively. Despite efforts to direct the operations to preserve the
integrity of the spleen, based on the degree of damage and the viability of the
organ, 13 (23.6%) patients had to undergo splenectomy . In addition, in 6
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(10.9%) cases, general complications were observed as a result of treatment,
and in 7 (12.7%) - surgical complications, such as suture divergence, wound
infection, etc. Only in one case was it necessary to perform a repeat operation. Of
the total, 3 (5.5%) cases were fatal.
Conclusions:
Thus, Experience shows that the leading methods for
diagnosing spleen damage in victims with splenic trauma are ultrasound and
MSCT. Important prognostic factors for spleen trauma are an increase in the size
of the organ and hematomas, especially if they are located in the central parts of
the organ. Dynamic ultrasound for focal changes in the spleen allows for
conservative management of patients. In turn, MSCT allows for a more precise
character of traumatic changes in the spleen, the localization of focal lesions, and
the structure and volume of inclusions in the parenchyma.
