OPERATSIYADAN KEYINGI BRONX-O‘PKA ASORATLARINI OLDINI OLISH TAMOYILLARIDA KO‘KRAK VA QORINNING QO‘SHMA JAROHATLARINI XIRURGIK TAKTIKASI

Abstract

Combined injuries of the organs of the chest and of the abdominal cavity belong to the most severe forms of traumatic damage and are characterized by a high mortality rate and a considerably greater number of postoperative complications. Among the unfavourable outcomes, a leading place is occupied by bronchopulmonary complications, including atelectasis, pneumonia, acute respiratory distress syndrome and hospital pneumonia associated with ALV (artificial lung ventilation). A large proportion of fatal outcomes arises not because of the anatomical severity of the injuries but because of tactical errors, diagnostic delays and insufficient prevention of respiratory complications. This review analyses contemporary views on the pathophysiological mechanisms of the formation of bronchopulmonary complications in combined thoracoabdominal injuries and considers the evolution of surgical tactics and the choice of access from the standpoint of preventing respiratory disorders. Particular attention is paid to the role of injuries of the diaphragm, to the introduction of minimally invasive technologies, and also to the problem of ALV-associated hospital pneumonia as the principal factor in the aggravation of the postoperative period. Modern approaches to the prevention of bronchopulmonary complications based on the integration of surgical and intensive-care strategies and on early risk stratification are presented.