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Уважаемые коллеги,Я хотел бы повторить свой вопрос о вашем опыте или вашем отношении к перевязке внутренних подвздошных артерий при переломе костей таза и повреждении внутренних органов и мягких тканей в тазовой области. Ниже приведен абстракт наших коллег из Китая в котором описывается опыт 33 перевязок внутренних подвздошных артерий при тяжелых переломах тазовых костей, массивном кровотечении и сочетанном повреждении прилежащих внутрених органов. Авторы рекомендуют эту процедуру вкомплексе с другими оперативными вмешательствами.Пожалуйста... ваш опыт или мнения, или наблюдения... Да.. нет.. почему..Спасибо за ответ, Олег Блинников =================== Zhonghua Wai Ke Za Zhi. 2005 Feb 15;43(4):232-4. [Management of severe pelvic fracture associated with injuries of viscera] [Article in Chinese] Gao JM, Wei GB, He P, Zhao SH, Wang JB. Department of Traumatology, Chongqing Emergency Medical Center, Chongqing 400014, China. gaojinmou2002@sina.com OBJECTIVE: To probe the approach of emergency management for severe pelvic fracture associated with injuries of adjacent viscera and evaluate the therapeutic effect. METHODS: The data of 79 patients with severe pelvic fracture associated with injuries of adjacent viscera were retrospectively studied, and the study covered a period of 14 years. RESULTS: Ligation of internal iliac arteries was performed in 33 cases for ceasing massive bleeding due to pelvic fracture, and angioembolization in 8. Of 42 patients with cystic or/and urethral injury, 35 underwent cystostomy and delayed reconstruction, and 7 received a primary realignment. All of 17 patients with injury ofretroperitoneal rectum underwent diverting colostomy of the proximal end of sigmoid with presacral drainage, but 4 received primary repair without colostomy. In 22 patients with intraperitoneal colorectal injury, 19 were managed with primary repair or anastomosis while 3 received a colostomy. The overall mortality rate was 9% (7/79); The main causes were hemorrhagic shock and associated injury. The complications included urethro-rectal fistula in 4, thrombosis of right common iliac artery in 1, acute respiratory distress syndrome (ARDS) following chest trauma in 1, and paraplegia in 1. Except the patient with paraplegia, all of them were cured. CONCLUSIONS: Prompt diagnosis and proper treatment were the key of the success. Devascularization of internal iliac arteries with external fixation cage of pelvis, cystostomy and proximal sigmoidostomy were effective procedures frequently used in the emergency treatment of the severe pelvic fracture patients.PMID: 15842918 [PubMed - in process] -- Best regards, Oleg < | >
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Re: Severe pelvic fracture associated with injuries of viscera
