PENETRAN BOYUN YARALANMALARINDA FÝZÝK MUAYENENÝN ÖNEMÝ VE TEDAVÝ ALGORÝTMÝ

Günümüzde penetran boyun travmalarýnýn tedavisinde çok farklý yaklaþýmlar tartýþýlmaktadýr. Bu tartýþma rutin eksplorasyona ilave olarak endoskopi ve anjiografinin mutlak uygulanmasýný isteyenlerden fizik muayene temelinde konservatif kalýnmasýný savunanlara kadar geniþ bir yelpaze oluþturmaktadýr.Bu çalýþmada penetran boyun travmasý nedeni ile baþvuran 32 hastanýn deðerlendirmesini yaparak tedavi yaklaþýmýmýzý disipline etmeðe çalýþtýk. Bu klinik çalýþmada Ocak 1987 - Aralýk 1998 tarihleri arasýndaki dönemde Taksim Eðitim ve Araþtýrma Hastanesi Acil Cerrahi kliniklerine baþvuran 32 hasta çalýþma kapsamýna alýnarak retrospektif olarak incelendi. Hastalar için fizik muayene ve klinik bulgular temelinde tedavi yöntemi belirlendi. Opere edilenler ve konservatif kalýnanlar olmak üzere iki grupta deðerlendirildiler. Uygulanan eksplorasyon, endoskopi ve Doppler USG sonuçlarý kaydedildi. Hastalarýn %59'u (19 olgu), klinik bulgular ve fizik muayene sonrasý operasyona alýndý. Bir hasta (% 3) semielektif olarak opere edildi. % 38(12 olgu) hastada konservatif kalýndý. Operatif mortalite % 3 (1 olgu) oldu. Konservatif kalýnan hastalarda mortalite geliþmedi. % 18 (4 olgu) hastada negatif eksplorasyon kaydedildi. Takip edilen hastalarda % 43 (13 olgu) morbidite ve mortalite görülmedi. Elde ettiðimiz bulgular ve literatür çerçevesinde fizik muayenenin, penetran boyun travmalarýnda tanýda ve tedavinin belirlenmesinde önemli bir unsur olduðu ve diðer taný yöntemlerinden fizik muayene temelinde yararlanýlmasý gerektiði inanandayýz.

THE IMPORTANCE OF THE PHYSICAL EXAMINATION AND A NEW TREATMENT ALGORHYTM OF PENETRATING NECK INJURY

The Importance of The Physical Examination and A New Treatment Algorhytm in Cases of Penetrating Neck Injury Many differing views ranging between obligatory use of angiographie following routine exploration and being conservative on the basis of physical examination only, are currently popular in the treatment of penetrating neck injuries. With the aim of disciplinising our approach in cases of penetrating neck injuries in the light of the current literature we conducted a retrospective analyse of 32 patients with penetrating neck injuries who attended our surgical emergency unit. 59 % (19 cases) were operated on clinical findings elucidated by physical examination only. %38 (12 cases) were managed conservatively. Of the conservative group one patient (%3) was operated later semielectively. After admittance to the emergency surgical unit two patients were lost, one in the pre the other in the peroperative period. There were no deaths in the group of patients treated conservatively. We had four cases (%18) with negative neck exploration. During follow-up period no mortality or morbidity were recorded in %43 (13 cases) patients. Conclusively on the grounds of both, our findings and that of the recent literature we think that the physical examination remains to be the cornerstone in the diagnosis and management of penetrating neck injuries. The necessity for further diagnostic modalities should be decided upon the findings of physical examination only.