SURGICAL TREATMENT METHODS IN BLUNT LIVER INJURIES

Between 1986 an 1996, 129 patients with liver injuries secondary to the blunt abdominal trauma were operated. The cases were evaluated according to those criteria: etiology of the trauma, diagnostic methods, associated organ injury, morbidity and mortality rates, results and effectiveness of the surgical procedures that had been applied for major injuries. In minor injuries electrocoagülation or 'U' sutures were applied. Debridement +selective ligation + omental tamponade (DSO), deep matross sutures (DMS), resectional debridement (RD), perihepatic packing (PP) were the choices of the surgical procedures for major liver injuries. Etiologies of the trauma were traffic accident in 79 patients, falls in 37 and beating in 13 patients. There were 67 major and 62 minor injuries. In 84 cases there were an associated abdominal organ injury. When the morbidity due to liver injury itself was evaluated it was seen that morbidity rate in DMS applied group statistically higher than the group underwent DSO and RD (p<0.001). Overall mortality was 20.2%. Six of the 26 deaths (23.1%) had minor injuries and 20 of them (78.9: ) had major injuries. Conclusion: Mortality rate increases with the gravity of injury. DSO and RD combined with suspending the hepatoduodenal ligament are the procedures that can be applied without lengthening the operative time or increasing the need of transfusions.

KÜNT KARACÝÐER YARALANMALARINDA CERRAHÝ TEDAVÝ YÖNTEMLERÝ

1986 ile 1996 yýllarý arasýnda künt abdominal travma sonucu karaciðer yaralanmasý geliþen 129 olguya cerrahi tedavi yapýldý. Olgular travma etkenleri, taný yöntemleri, yandaþ yaralanmalar, morbidite ve mortalite açýsýndan incelendi ve majör yaralanmalarda uygulanan cerrahi tedavi yöntemlerinin etkinliði ve sonuçlarý karþýlaþtýrýldý. Minör yaralanmalarda elektrokoter veya 'U' sütürler kullanýldý. Majör yaralanmalarda Debridman + selektif ligasyon + omental tamponad (DSO), Derin matress sütür (DMS), Rezeksiyonel Debridman (RD) veya Perihepatik Packing (PP) yöntemleri uygulandý. Travma etkeni olgularýn 79'unda trafik kazalarý, 37'sinde yüksekten düþme ve 13 'ünde darp idi. 67 olguda majör, 62 olguda ise minör karaciðer yaralanmasý saptandý. 84 olguda yandaþ abdominal organ yaralanmalarý vardý. Karaciðer yaralanmasýna baðlý komplikasyonlar dikkate alýndýðýnda; DMS uygulanan olgulardaki morbidite oranýnýn, DSO ve RD uygulanan olgulara göre istatiksel olarak anlamlý oranda daha yüksek olduðu belirlendi (p<0.001). Genel mortalite oraný %20.2 olarak bulundu. Kaybedilen 26 olgudan 6 (%23.1)'sý minör yaralanma, 20 (%76.9)'si majör yaralanma grubunda idi. Sonuçlarýmýz, majör yaralanmalarda yaralanma derecesi ile birlikte mortalitenin de arttýðýný, portal triadýn geçici oklüzyonu ile birlikte uygulanan DSO ve RD yöntemlerinin, operasyon süresini uzatmadan, transfüzyon sayýsýnda artýþa neden olmadan, DMS yöntemlerine göre daha az morbidite ve mortalite ile uygulanabileceðini göstermektedir.