| Popis: |
Background. Closed injuries of the spleen are considered one of the most common problems encountered in urgent surgery. Ruptures of this parenchymal organ that occur in the case of a closed abdominal injury occur in 16-50 % of cases. The purpose of the study is to determine the differences in the endothelial function of the vascular lining in patients who belong to the older age groups and, based on the data obtained, to determine the optimal type of surgical treatment of spleen rupture in this age group. Materials and methods. The work includes the results of the study of the postoperative period in 120 patients with a ruptured spleen. Of these, 68 patients with spleen injuries aged 60-89 years. In addition to the main group, a comparison group was formed, which consisted of 52 people whose age, according to the above classification, was young and average. In accordance with the purpose of the study, the function was evaluated; the concentration of tissue plasminogen activator of serum plasma, fibrinolysis in patients of the two groups compared was studied. Results. As the analysis shows, in patients of the older age group, after removal of the spleen as a result of its rupture, changes in the atithrombogenic properties of the vascular lining endothelium change in a variety of ways. On the one hand, there is a decrease in the anti-thrombotic effect, and on the other, against this background, there is an increase in the efficiency of dissolving fibrin thrombi, depletion of tissue plasminogen activator reserves is noted, which leads to a decrease in its entry into the bloodstream. These changes occur only in patients of the older age group who underwent splenectomy supplemented by autolyentransplantation. In the group of patients whose age was within the range of young and average, a decrease in vascular endothelial thrombosis, an increase in fibrinolytic activity occurs only in the group after splenectomy, autolyentransplantation prevents such changes. Conclusion. Splenectomy is the optimal method of surgical treatment of spleen injuries in patients of older age groups, which prevents endothelial dysfunction. |
