[Surgical tactics in combined thoraco-abdominal injuries]

Differential surgical tactics is suggested on basis of experience in the treatment of 141 patients with thoracoabdominal and associated injuries to the chest and abdomen. The emergency of the operation is dictated by continued bleeding and the volume of blood lost into the serous cavity; this can be determined with certain precision by the method described in the article. In most cases with injury to the chest management may be limited to drainage of the pleural cavity. The anatomical structure of the injured abdominal organs and diaphragm is restored through an abdominal approach. Thoracodiaphragmatomy and thoracolaparotomy are indicated only in injuries on the right side with damage of parts of the liver the approach to which is difficult. When both cavities must be opened, the order of the operative stages is determined by the predominance of the clinical picture of the injuries to the organs and the hemorrhage into the thoracic or abdominal cavity. The mortality was 13.5%.