DIAPHRAGMATIC INJURIES

In this paper we aimed to present our experiences on the cases of diaphragmatic ruptures which were seen generally with associated injuries. Hospital records of 75 patients were analyzed retrospectively in order to evaluate preoperative and intraoperative findings, and the results of their management. Eighty-seven percent of patients were male with a mean age of 32 years. Sixty-three percent of diaphragmatic injuries were secondary to penetrating trauma. The rate of preoperative diagnosis was found as 28 %, and of delayed diagnosis and treatment as 9 %. Lacerations were localized in the left hemidiaphragm in 50 (67 %) patients. The left hemidiaphragm harbored 82 % of blunt and 57 % of penetrating injuries (p=0.031). Associated injuries were determined in 84 % of our cases. Seventy-nine percent of the cases have grade 2 and 3 diaphragmatic lacerations. All ruptures, but one, have been repaired successfully with primary suture. The overall perioperative mortality was 9 %, and all of them were related to associated injuries. The mortality was 14 % after blunt, and 6 % after penetrating trauma (p=0.23). Preoperative diagnosis of traumatic diaphragmatic injuries is usually difficult. However the results of surgical repair of diaphragmatic lacerations is satisfactory. The death generally occurs secondary to associated injuries. To take into account diaphragmatic injuries after blunt or penetrating trauma of the thorax and the abdomen, and careful surgical exploration is essential for proper and successful management.

DÝYAFRAGMA YARALANMALARI

Bu yazýmýzda, preoperatif tanýsý zor olan ve genellikle yandaþ yaralanmalarla birlikte görülen diyafragma yaralanmalý olgulardaki deneyimlerimizin aktarýlmasý amaçlanmýþtýr. Yetmiþ beþ olgunun hastane kayýtlarý, ameliyat öncesi ve ameliyat bulgularýyla, tedavi sonuçlarý deðerlendirilmek amacýyla retrospektif olarak incelenmiþtir. Olgularýn % 87si erkek ve ortalama yaþ 32'dir. Diyafragma yaralanmalarýnýn % 63'ü penetran travmalara baðlýdýr. Preoperatif taný oraný % 28, taný ve tedavi gecikmesi oraný % 9 bulunmuþtur. Laserasyon 50 (% 67) olguda diyafragmanýn sol yansýnda yerleþiktir. Künt yaralanmalarýn % 82'si, penetranlarýn % 57si Diyafragmanýn sol yarýsýndadýr (p=0.031). Olgularýn % 84'ünde yandaþ yaralanmalar saptanmýþtýr. Olgularýn %79'unda 2 ve 3. Derece diyafragma hasarý vardýr. Biri hariç tüm laserasyonlar primer dikiþ ile baþarýlý olarak onarýlmýþtýr. Erken dönemde mortalite % 9'dur ve hepsi yandaþ sistem ve organ yaralanmalarýna baðlýdýr. Mortalite künt travmalarda % 14, penetranlarda % 6'dýr (p=0.23). Travmatik diyafragma yaralanmalarýnýn preoperatif tanýsý güç olmaktadýr. Ancak diyafragma hasarlarýnýn cerrahi onarým sonuçlarý baþarýlýdýr. Ölüm genellikle yandaþ yaralanmalara baðlý geliþmektedir. Künt ve penetran göðüs ve karýn travmalarýnda diyafragma yaralanmasýnýn düþünülmesi ve dikkatli cerrahi eksplorasyon tedavinin baþarýsý için esastýr.