The article provides a definition of a bilateral gunshot wound to the chest, the features of diagnosis and treatment according to the level of medical care. The isolation of this pathology into a separate nosological unit is justified due to the peculiarities of the lesions of the respiratory system and mediastinum, severe injury, high mortality, long duration of treatment and the existing complications of the same type.

Summary. The aim of the study was to improve the quality of diagnosis of chest injuries and to optimize surgical tactics through the use of spiral computed tomography. Material and research methods. The work is based on prospective analysis of the results of spiral computed tomography of patients with chest injuries for the period from 2014 to 2020. Results and its discussion. The results of SCT make it possible to objectify the choice of surgical tactics and the most rational type of access. The use of SCT has become expedient for chest injuries both before surgery in patients with stable hemodynamics and in the postoperative period to identify early complications. Conclusions. Based on the study, it was concluded that the use of SCT in patients with chest wounds makes it possible to choose rational treatment tactics, optimal access for surgery and drainage area, as well as apply minimally invasive treatment methods. Conducting CT studies in dynamics allows us to assess the effectiveness of conservative and surgical treatment and promptly make adjustments to the treatment.

Damage to the major vessels in a retroperitoneal trauma belongs to the category of the most difficult, including damage to the inferior vena cava. The aim of the work is to demonstrate the features of clinical manifestations and tactical solutions of a gunshot fragment blind wound of the inferior vena cava with the migration of a foreign body along the blood stream. Materials and methods. A case of a gunshot fragment wound of the inferior vena cava with migration of the foreign body along the blood stream was studied. An injured person underwent sCT with and without contrast, FAST protocol, general blood test, biochemical blood test, CBV was determined using the formula of Moore, hourly diuresis was measured. Results. The patient was operated on for vital signs, the condition of the injured person was stabilized. During the revision of the abdominal cavity and paranephric tissue, no foreign body was identified. In the immediate postoperative period, the injured person underwent chest and abdominal CT, according to the data of that, a metal fragment was identified, which migrated along the inferior vena cava to the point of connection with the right atrium. The injured man was operated on at another specialized facility, where the foreign body was removed using a surgical magnetic tool. Conclusions. Fire damage to the inferior vena cava is classically accompanied by a severe general condition, massive blood loss, which requires urgent surgical interventions. Multi-component preoperative preparation, a clearly established diagnostic plan, a multidisciplinary approach based on the example of our clinical case allow saving life even in the most complex cases.

Summary. The arms — to analyze the evolution of the development of modern surgical instruments in gunshot wounds chest. Materials and methods. 80 cases of using a modern magnetic surgical instrument for penetrating gunshot wounds of the chest were analyzed. Intraoperatively used: a magnetic multifunctional tool for the diagnosis and removal of metallic ferromagnetic foreign bodies, a flexible device for removing ferromagnetic foreign bodies, a magnetic tool for endovideoscopic diagnosis and removal of metallic ferromagnetic foreign bodies from the abdominal and pleural cavities, a magnetic nozzle for video endoscopic surgical interventions. When removing metal foreign bodies, the following methods were used: a method for preliminary determination of the material and properties of a foreign body, a method for video endoscopic laser visualization of the internal organs of the abdominal and pleural cavities. Results. Foreign bodies of the pleural cavity were diagnosed in 80 (100 %) wounded according to СT. Ferromagnetic metal foreign bodies of a gunshot origin of the pleural cavity were removed both during thoracotomy or minithoracotomy, and during thoracoscopic surgical interventions using the method of video endoscopic laser visualization of the internal organs of the abdominal and pleural cavities. The most convenient tool was the endoscopic magnetic tool for removing foreign bodies from the pleural or abdominal cavities. A magnetic nozzle for video endoscopic surgical interventions allows navigation both in the pleural cavity and along the wound channel. Conclusions. 1. The development of a surgical magnetic instrument was phased and began with the improvement of a surgical magnetic instrument to remove ferromagnetic foreign bodies of soft tissues. 2. The improvement of the tool took place as the restrictions on the use of the existing tool were established, which was a prerequisite for the development of a new tool. 3. It is advisable to create a special set of surgical magnetic instruments for video endoscopic surgery.

The article analyzes the results of pathomorphological changes of the lungs in the period from 1 day to 1.5 years after receiving a gunshot wound after a gunshot wound to the lungs. The features of the pathomorphosis of modern gunshot wounds of the lungs were determined in the dynamics to identify the optimal surgical tactics. It is found that impaired hemodynamics under the influence of firearms leads to the development of intoxication as a result of necrotic changes in the areola and to thrombosis with obstruction and vascular stenosis, and entails a cascade of local disorders of lung structure and function and as a consequence of pulmonary heart failure. The obtained morphological results of healing of gunshot wounds in the dynamics necessitate the search for new and optimization of existing methods of treatment of persons with gunshot wounds of the lungs in order to primarily optimize the preserved tissues. Keywords: morphological examinations, lungs, gunshot wound.