MODERN ASPECTS OF DIAGNOSTICS AND TACTICS OF SURGICAL TREATMENT IN COMPLICATED TRAUMA OF THE CHEST

Background. Closed chest trauma is one of the most dangerous and life-threatening critical conditions. Medicosocial topicality of the problem is associated with its high frequency, large number of complications (45.6% - 75%) and high mortality rate (2% - 6.2%). The choice of the optimal tactics of diagnostics and treatment of patients with chest trauma currently continues to be a topical problem in emergency surgery. Purpose. To detail the pattern of occurrence of complications in chest trauma for increasing the effectiveness of investigation and providing adequate qualified medical help in patients with chest trauma. Material and methods. Medical documentation of 259 patients with various complicated chest injuries over the period from 2007 to 2017 was analyzed. Patients in the dynamics underwent a standard x-ray examination of the chest, ultrasound (US) investigation of the pleural cavities, ultrasound investigation of the chest with examination of ribs and sternum, computed tomography of the chest. The developed algorithm of diagnostics and treatment was applied to all patients with closed chest trauma. Results. There were no discrepancies in diagnostics of localization and the number of damaged ribs and intrapleural complications in patients who underwent simultaneous plain chest radiography and chest ultrasound investigation. Surgical interventions were performed in 231 (89.2%) patients. Urgent surgical operations were carried out in 28 (10.8%) cases. All the patients were discharged in satisfactory condition. Conclusions. Rib fractures are the most frequent damage to the chest that causes complications. An intrapleural complication can occur with any number of damaged ribs and at any time of fracture consolidation. Ultrasound examination of the chest organs should be included in the investigation complex. Computed multislice tomography should be performed as a clarifying study. Active diagnostic and treating surgical tactics enable to obtain good results in treatment of complicated chest trauma.