METHOD FOR SELECTING A METHOD FOR SURGICAL TREATMENT OF TRAUMATIC LIVER INJURIES Russian patent published in 2023 - IPC A61B17/00 A61B17/04 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery, and can be used to select a method for surgical treatment of traumatic liver injuries. An examination of the victim is carried out, in which his hemodynamic status and the degree of liver damage are determined according to the OIS scale. The volume of blood loss, ml, the nature of the injury, the absence or presence of concomitant liver diseases, such as hepatitis, fatty hepatosis or cirrhosis of the liver, as well as the value of the international normalized ratio (INR), characterizing the intensity of hypocoagulation, are determined. The indicators of the examination results are determined: the indicator of the hemodynamic status of the victim (Ihs), the indicator of the degree of liver damage (Idld), the indicator of the volume of blood loss (Ibl), the indicator of the nature of the injury (Ini), the indicator of concomitant liver diseases (Icld) and the indicator of the intensity of hypocoagulation (Iih). Depending on the results of the survey, each indicator is assigned a certain numerical value. In hemodynamically stable patients, the Ihs value is assigned a numerical value of "1", in hemodynamically unstable patients, for whom antishock therapy was effective, the Ihs value is assigned a numerical value of "2", in hemodynamically unstable victims, for whom antishock therapy was ineffective, the Ihs value is assigned a numerical value. value "3". At I - II degrees of liver damage on the OIS scale, the Idld value is assigned a numerical value of "1", at III degrees of damage - a numerical value of "2", at IV - V degrees of liver damage on the OIS scale, the Idld value is assigned a numerical value of "3". When the volume of blood loss is up to 1000 ml, the value of Ibl is assigned a numerical value of "1", with a volume of blood loss from 1000 to 1500 ml inclusive - a numerical value of "2", with a volume of blood loss of more than 1500 ml, the value of Ibl is assigned a numerical value of "3". In case of an isolated injury, the value of Ini is assigned a numerical value of "1", in case of multiple injury - a numerical value of "2", in case of a combined injury, the value of Ini is assigned a numerical value of "3". If the victim does not have concomitant liver diseases, the Icld value is assigned the numerical value "0", if the victim has hepatitis, the Icld value is assigned the numerical value "1", if the victim has fatty hepatosis, the Icld value is assigned the numerical value "2", if the victim has cirrhosis liver, the value of Icld is assigned the numerical value "3". When the value of INR<1.6, the value of Pig is assigned the numerical value "0", at 1.6≤MNO≤2.0 - the numerical value "1", with the INR>2.0, the value of Pig is assigned the numerical value "2". The coefficient of choice of the method for surgical treatment (Cmc) is calculated by the formula: Cmc=0.9Pgs+0.95Pspp+0.6Pok+0.24Pxt+0.4Pszp+0.65Pig. When the condition 2.69≤Cmc≤3.57 is met, electrocoagulation is chosen as the method for surgical treatment of traumatic liver injuries. When the condition 3.57<Cmc<7.28 is met, suturing of traumatic liver injuries. When the condition 7.28≤Kvm≤10.57 is met, tamponade is chosen as the method for surgical treatment of traumatic liver injuries.

EFFECT: method provides the possibility of reducing the number of postoperative complications and mortality due to the claimed scoring system for choosing a method for surgical treatment.

1 cl, 8 ex