| 摘要 |
FIELD: medicine. ^ SUBSTANCE: invention relates to medicine, namely to surgery, vascular surgery and traumatology, and can be applied when by life-saving indications it is necessary to perform hemostasis in case of severe trauma of pelvis complicated by massive internal hemorrhage. For this purpose critical zones of hemorrhage are isolated. Then after aorta mobilisation and application of aortal vascular clamp and venous tourniquets maximally high on proximal parts of both hips, work on main vessels is carried out separately in each cellular space of small pelvis without vast destruction of pelvic hematoma. Surgical technique on main arteries is performed within the limits of own fascial vaginas with transaction, by indications, of sympathetic trunk connective branches and at the beginning of medial shift of general, external and internal iliac arteries to determine intactness of iliac veins without their mobilisation without necessity. Performed is revision of iliac-lumbar venous anastomosis and point of its flowing into posterior wall of general iliac vein on the left or fifth lumbar vein on the right, presacral iliac internally iliac venous complex. Performed is ligation of internal iliac artery with its transaction between ligatures on injury side and shift of distal stump of internal iliac artery by its tension medially downwards, then of general and external iliac artery - laterally, thus vastly exposing and bifurcation of general iliac vein becomes mobile enough and main trunk of internal iliac vein. Operative technique is applied on internal iliac, external and general iliac veins without destruction of hematomas. After that performed is ligation of posterior trunk or main trunk of internal iliac artery from side opposite to injury without transaction of vessel between ligatures in order to preserve spasm of collaterals more distally than ligature. Cuts of parietal peritoneum are sewn tightly, abdominal cavity is drained, prevasical space is drained by indications, through obturator foramen operational wounds are sewn layer-by-layer, after which pelvis fragments are stabilised in apparatus of external fixation, or on skeletal extension. In case of continuing hemorrhage in prevasical cellular space performed is revision of damaged abnormal obturator vessels or iliac-obturator venous anstomosis in order to eliminate formation of defects in the wall of external iliac vein and artery, in order to approach external iliac vessels and obturator space additional extra-abdominal Pirogov access is used, distal parts of external iliac vessels are exposed and abnormally diverging obturator vessels are ligated or defect in the wall of main vessel is sewn, simultaneously mail collateral in ligated to iliac-lumbar artery - deep skirting iliac bone wing artery. ^ EFFECT: method allows to carry out revision of massive hematomas of pelvis qualitatively for further operative hemostasis, realise low-traumatic access, without injuring fascial partitions, isolatedly within the limits of each parietal cellular space of small pelvis. ^ 2 ex, 11 dwg |
