PREDICTION AND PRECONDITIONS OF COMPLICATED COURSE OF TRAUMATIC INJURY OF THE LIVER

Introduction. Liver injury remains an important and urgent problem of surgery, because there is still a large percentage of cases in the structure of the injury and the development of complications in the postoperative period. Damage of the liver in abdominal trauma is 13,7-25,9 % of cases and mortality can reach 28 %. Complications after liver injury can reach 14,8-42 % [1-4]. Material and methods. The study included 40 victims with dominant liver injury (ISS>16 points), including 29 men (72,5 %) and 11 women (27,5 %). The average age was 37±8 years. All the patients were operated. For the prognosis of post-traumatic postoperative period was used algorithm, which consists of the following factors: the extent and duration of anemia, degree of shock on admission, scoring assessment on a scale APACHE II, MODS, ISS, duration of surgery, the index Algovera, the development of multiple organ failure, existing comorbidities. Results and discussion. Special places in the structure of social problems take a traumatic injury, especially a polytrauma. This is explained by many factors, among which a special place take age and gender features. Also note the steady increase in mortality, which is 26 % depending on the severity of the injury and mainly 80 % are men. A particularly adverse course of traumatic liver injury occupied among the elderly. Also among elderly patients disappear the differences in the proportion of traumatic liver injury between men and women. This is due to the increase in life expectancy in developed countries and more mobility of the elderly population, due to the development of medicine and engineering. Also, according to research Major Trauma Outcome Study, found that mortality due to injury among older people three times higher than in people under the age of 55 years, which is associated with plenty complications of abdominal trauma. Benchmarks of immunological changes were determined in liver trauma victims with mild to moderate severity: phagocyteic index 64,27±2,19 %, the number of phagocytic 3,42±0,17, completeness phagocytosis index 1,13±0,05, 71 CIC 33±3,46 units. Nonspecific immune defense were determined not only to confirm the effectiveness of the proposed algorithm, but also for the analysis of complications depending on the amount and character of damage. So for the damaged of liver the indicators of phagocytosis and CIC had the following character (tab. 1). A special place in determining and monitoring the progress of post-traumatic process were determined by the level of middle mass molecules that characterize the level of endogenous intoxication (tab. 2). As the table shows indicators middle mass molecules differed between the groups of patients (main group II) at the stage of hospitalization differed by 25 % compared to the control group, which corresponded to the severity of the damage and the level of endogenous intoxication. In determining the effectiveness of selected indicators for ballroom proposed algorithm com-


Introduction.
Liver injury remains an important and urgent problem of surgery, because there is still a large percentage of cases in the structure of the injury and the development of complications in the postoperative period.Damage of the liver in abdominal trauma is 13,7-25,9 % of cases and mortality can reach 28 %.Complications after liver injury can reach 14,8-42 % [1][2][3][4].
Material and methods.The study included 40 victims with dominant liver injury (ISS>16 points), including 29 men (72,5 %) and 11 women (27,5 %).The average age was 37±8 years.All the patients were operated.For the prognosis of post-traumatic postoperative period was used algorithm, which consists of the following factors: the extent and duration of anemia, degree of shock on admission, scoring assessment on a scale APACHE II, MODS, ISS, duration of surgery, the index Algovera, the development of multiple organ failure, existing comorbidities.
Results and discussion.Special places in the structure of social problems take a traumatic injury, especially a polytrauma.This is explained by many factors, among which a special place take age and gender features.Also note the steady increase in mortality, which is 26 % depending on the severity of the injury and mainly 80 % are men.A particularly adverse course of traumatic liver injury occupied among the elderly.Also among elderly patients disappear the differences in the proportion of traumatic liver injury between men and women.This is due to the increase in life expectancy in developed countries and more mobility of the elderly population, due to the development of medicine and engineering.Also, according to research Major Trauma Outcome Study, found that mortality due to injury among older people three times higher than in people under the age of 55 years, which is associated with plenty complications of abdominal trauma.
Benchmarks of immunological changes were determined in liver trauma victims with mild to moderate severity: phagocyteic index 64,27±2,19 %, the number of phagocytic 3,42±0,17, completeness phagocytosis index 1,13±0,05, 71 CIC 33±3,46 units.Nonspecific immune defense were determined not only to confirm the effectiveness of the proposed algorithm, but also for the analysis of complications depending on the amount and character of damage.So for the damaged of liver the indicators of phagocytosis and CIC had the following character (tab.1).
A special place in determining and monitoring the progress of post-traumatic process were determined by the level of middle mass molecules that characterize the level of endogenous intoxication (tab.2).
As the table shows indicators middle mass molecules differed between the groups of patients (main group II) at the stage of hospitalization differed by 25 % compared to the control group, which corresponded to the severity of the damage and the level of endogenous intoxication.
In determining the effectiveness of selected indicators for ballroom proposed algorithm com-  pared Ball indicators and data of middle mass molecules, immunoglobulins and complement activity (tab.3).
In complicated traumatic liver injury observed increase in long (more than 72 hours) of middle mass molecules and had multiorgan failure in the postoperative period.Unfavorable factor was the increase in the average molecular weight of more than 210 conventional units over 3 days in patients with liver injury and the development of multiple organ failure was complicated course in 60,5 % of cases.Also with prolonged duration of multiple organ failure syndrome (more then 48 hours) were observed changes in nonspecific level of immune defense: index of phagocytic index decreased by (17,9 %) and was in the control group (51,88±2,42), the second main group (46,51±3,68).
Although generalized not only performance of MODS scale but also clinical data and wound process we discovered interdependent evidence that these processes not only lead to the emergence of each other, but also can provoke the development of infectious complications due to a significant fall in resistance of the organism as a whole (tab.4).
By the complicated course of liver trauma should be noted formation of subdiaphragmatic abscess, subhepatic abscesses, peritonitis and extraperitoneal secondary complications.

Conclusion
Thus, as a result of the analysis was performed between the reduction of nonspecific protection and complication after traumatic injury of the liver.Joining postoperative multi organ failure syndrome increases to 35,72 % incidence of complicated course of liver trauma.The proposed algorithm allows to improve the prediction of postoperative course and to detect preclinical stage of formation of complicated course.