KÜNT KARACÝÐER YARALANMALARI 278 OLGUNUN DEÐERLENDÝRÝLMESÝ

Karaciðer büyüklüðü nedeni ile künt karýn travmalarýndan sonra en sýk yaralanan intraperitoneal organdýr. Bu yazýda, 182'si trafik kazasý, 96'sý da yüksekten düþmeden oluþan ve 1985-1993 yýllarý arasýndaki 9 yýllýk dönemde acil birimimize getirilip, ameliyat edilen 278 künt karaciðer travmasý olgusu retrospektif olarak incelenmiþtir. Bu olgularýn %64'ü minör, %36'sý majör yaralanma grubundadýr. Minör yaralanma grubundaki olgularýn tümüne basit hepatorafi yapýlmýþtýr. %11 olan mortalitenin nedeni ek intraabdominal ve ekstraabdominal lezyonlardýr. Majör yaralanma grubundaki olgularýn %48'ine hepatorafi, %27'sine rezeksiyon yapýlmýþ ve %25'i de laparotomi sýrasýnda kaybedilmiþtir. %49' olan mortalitenin nedeni daha çok karaciðerdeki kanamaya baðlý olarak geliþen hipovolemik þok tablosudur. Majör yaralanmalarda derin sütürler ile hepatorafi, lober hepatektomi veya hepatik arter ligasyonu gibi agresif cerrahi giriþimler yerine, bir saate kadar uzatýlabilecek olan pringle manevrasý eþliðinde, "finger fracture" yöntemi ile hepatotomi + selektif vasküler ligasyon ve sýnýrlý rezeksiyonel debridman yöntemi tercih edilmelidir, juxtahepatik venöz yaralanmalarda ise total hepatik vasküler izolasyon ile bu damarlarýn tamiri denenmelidir. Genel olarak mortalite oranýmýz %24.8'dir ve %25'lik ortalama deðere yakýn bir deðerdir.

BLUNT LIVER TRAUMA (ANALYSIS OF 27(9 CASES)

Following blunt abdominal injury, liver is the most injured organ due to its big volume. In this study 278 cases of blunt liver injury were evaluated during a period of 9 years (1985 and 1993). The trauma etiology was traffic accidents in 182 patients and fall from a height in 96 patients. 64% were minor and 36% were defined as major hepatic trauma. Simple hepatoraphy was the precedure for all minor trauma. In this group 11% mortality was attributed to associated intraabdominal and extraabdominal injuries. In the major injury group; 48% had hepatoraphy, 27% partial resection and 25% died peroperatively. 49% mortality of the major trauma group can be explained with hypovolemic shock due to the bleeding of the liver. For major hepatic injuries; by the aid of pringle maneveur hepatotomy with "finger fracture" and selective vascular ligation, and limited resectional debridement is being preferred to aggressive procedues such as hepatoraphy with deep sutures, lobar hepatectomy and hepatic artery ligation. In juxtahepatic venous injuries total hepatic vascular isolation is preffered before vascular repair. The overall mortality rate was 24.8%, which was close to the average 25% literature rate.