BABKINA E.P., SHEVCHENKO J.A., KOROBKO I.S.

SZ "Lugansk State Medical University"(Lugansk)

DYNAMICS OF THE CHANGES OF ULTRASOUND INDEXES OF LIVER WITH DIFFERENT TERMS OF MECHANICAL TRAUMA.

Introduction. Timely detection of liver damage, especially during the first day after injury, which is set by nature and remoteness of injury, significantly improves the selection of methods of diagnosis and treatment of patients and reduces mortality. To address the question of diagnosis of liver injury used for many laboratory techniques: X-ray, laparoscopy, biochemical, biophysical, ultrasound diagnostics, etc.. Very reasonable and reliable for establishing the limitations of liver damage in mechanical trauma is a method of ultrasound.
The aim of this work is to study the dynamic changes of liver ultrasound parameters at various types of mechanical injury, depending on the period of injury.
Material and methods. Ultrasound diagnosis to detect pathological changes in organs and tissues performed using ultrasound frequency from 0.5 to 1.5 million vehicles fluctuations on Sonoace 8000 (South Korea), Sonosite Titan (USA) convex and microconvexional sensors traditionally, with the patient standing, lying on the right and left side on the back. Examination of the abdomen and retroperitoneal area conducted for admission to medical schools in 46 injured, as well as the dynamics of 1, 2, 3 and 5 days after injury.
Results and discussion. Suspicion of liver injury during the ultrasound we investigated the presence, location and quantity of free fluid in the abdominal cavity, the presence or absence of lesions located close organs and tissues, so that the absence of free fluid in the abdominal cavity minimizes the chance of tearing the liver and its vascular-secretory apparatus. In isolated liver trauma imaging it is practically not affected. In cases of liver damage occur in conjunction with damages hollow organs and pancreas, liver imaging significantly affected by presence of gas and fluid in the abdomen.
In 46 patients (31 male and 15 female) aged 20 to 60 years, we have investigated with liver injury location it was typical, cases of separation from the body ligaments were not. Determined the fate of two convex diaphragmatic and visceral surfaces flat. In the presence of free fluid in 7 injured liver capsule was not seen. When parenchymal lesions in the peripheral parts of the body contours of the liver were unequal, blurred. Echogenicity, homogeneity of structure and sound conductivity liver depended on the initial state of the body and nature of injury.
In the presence of ultrasound signs of liver damage us free fluid was found in almost 37% of cases (17 persons). On examination, the patient in a horizontal position most often free fluid was found in shallow areas of the abdominal cavity, the right side channel and the pelvic cavity. We found that the amount of fluid, which we determined using ultrasonic indices in all cases was less than the detection as a result of surgical operation. In 8 victims (18%) with ultrasound free fluid in the abdominal cavity was not found us, although during surgical intervention was found from 20 to 200 ml of liquid. In terms of liver damage distinguish single and multiple. Isolated hematoma detected in 78% of cases (35 victims), multiple in 20% (10 patients). Max revealed hematoma - 2% (1 patient). Revealed the following features localization hematomas: the right hepatic fate in 31 affected (67%) in the left - in 5 affected (11%), simultaneous destruction left and right fractions was 10 injured persons (22%).
In the first 6 hours hematoma characterized by areas of low echogenicity with diffuse irregular contours (stage traumatic infiltration). After 12-24 hours observed signs of the formation of liquid component in place of hypo-and anechogenic inclusions in the parenchyma. During this period hematoma under the capsule liver characterized by the following ultrasound criteria: location in the peripheral parts of the liver, just below the capsule; single or multi-volume form, rounded or sickle shape, internal content anechogenic or hypoechogenic nature, homogeneous or heterogeneous, outlines fuzzy, unequal ( limit fuzzy, rough). Intra-parenchymal hematoma was observed in the form of rounded structures with homogeneous anechogenic or hypoechogenic structure with the location in the central parts of the liver. In the first 6 hours contours hematomas were indistinct, blurred around them in 35 victims (75%) observed hyperechogenic rim. In color mode doppler mapping vascular pattern projection liver hematoma was missing on the periphery - architectonics it changed. After 12-24 hours after injury intra-parenchymal hematoma taking the correct, more rounded shape beyond them became more clear. From 2 nd to 7 days ultrasound picture of under-and intra-capsule hematoma is relatively stable. Against the background of hypo-or anechogenic entities with effect distal pseudo gain, we have identified areas of uneven or granular internal structure. During this period hematoma increased to its maximum size.
In 31 cases (68%) we observed a steady flow of hematoma liver. By the end of the first Sunday anechogenic structure hematomas took granular structure due to the appearance of local structures medium or high echogenicity. Hyperechogenic area around the hematoma disappeared. Hemolysis of red blood cells in the middle of hematomas characterized by the appearance of being a large number anechogenic inclusions. In 12 cases where bleeding into the cavity of the hematoma continued, structure hematoma changed: increased size of not less than 1.5 times, appeared anechogenic structure on background arisen hyperechogenic blood. Around hematoma rim again observed, in most cases due to haemorrhagic fluid leakage into the surrounding liver tissue. Such hematomas us regarded as unstable.
After 7 or more days after the injury hematoma not increased in size. They were seen as single or multiple anechogenic formed rounded with clear smooth contours, homogeneous or heterogeneous, but stable internal structure.
Conclusions. Thus, as a result of research we discovered the logical dynamics of ultrasonic parameters in liver injured and killed as a result of injuries inflicted, indicating the possibility of developing a set of criteria to evaluate the establishment of old injuries of internal organs retroperitoneal space, particularly the liver. The main features of ultrasonic liver damage should be considered breaks parenchyma with formation of intra-parenchymal or hematomas under capsule, which are characterized by ultrasound criteria is to increase the size of the liver (often due to the increase of the damaged part), heterogeneous structure, blur and discontinuity, the presence of hypo-and anechogenic plots (hematoma) on the background of undamaged parenchyma. Intra-parenchymal hematoma we found in 70% of cases, under capsule 30%.

Література

1.Pichards J.R. Sonographic detection of blunt hepatic trauma: hemoperitoneum and parenchymal patterns of injury / J.R. Piichards, J.P. McGahan, M.J. Pali, P.A. Bohnen // J. Trauma. - 1999. - Vol. 47, № 6. - P. 1092-1097.

2.McKenney K.L. Ultrasound of blunt abdominal trauma / K.L. McKermey // Radiol. Clin. North Am. - 1999. - Vol. 37, № 5. - P. 879-893.

3.McGahan J.P. Use of ultrasonography in the patient with acute abdominal trauma / J.P. McGahan [et al.] // J. Ultrasound. Med. - 1997. - Vol. 16, № 10. - P. 653-662.

4.Сабиров Ш.Р. Органосохраняющие принципы гемостаза при повреждениях паренхиматозных органов (печени, селезенки и почек), анатомо-экспериментальное и клиническое исследование : автореф. на соискание ученой степени д-ра мед. наук: 14.00.27 - хирургия, 10.00.02 - анатомия человека/ Ш.Р. Сабиров. - Москва, 2006. - 36 с.

5. Абакумов М.М. Огнестрельные ранения груди и живота взгляд на историю и особенности оказания хирургической помощи в условиях мегаполиса / М.М. Абакумов // Российский медицинский журнал. - 2005. - № 4. - С. 40-44.