TRAVMATÝK DALAK YARALANMALARI

Künt veya penetran abdominal travmasý ve dalak yaralanmasý olan hastalarda halen en sýk kullanýlan cerrahi yöntem splenektomidir. Bu çalýþmada, travmalý ve dalak yaralanmasý olan hastalarda uyguladýðýmýz cerrahi yöntemleri ve sonuçlarýný incelemeyi amaçladýk. Toplam 225 hastanýn 55 (%24)'i kadýn, 170 (%76)'i erkek, yaþ ortalamasý 29 idi. Moore sýnýflamasýna göre; birinci derece 23 (%10), ikinci derece 96 (%43), üçüncü derece 75 (%33), dördüncü derece 24 (%11) ve beþinci derece dalak yaralanmasý 7 (%3) hastada tespit edildi. Splenektomi 203 (%90) hastaya uygulandý. Kalan 22 hastanýn 18'ine (%8) (I. ve II. derece dalak yaralanmasý olan hastalar) splenorafý, 4'üne (%2) (II. derece yaralanma) parsiyel splenektomi yapýldý. Toplam 27 (%12) hastada mortalite geliþti. Ýlave organ yaralanmasý ile mortalite arasýnda belirgin bir korelasyon olduðu tespit edildi (Fisher Ki-Kare Testi; X2=9,538, p<0.002). Sonuç olarak; dalak yaralanmalarýnda, özellikle I ve II derece yaralanmalarda nonoperatif tedavi yöntemlerine olan yönelim hastalarýn yarýsýna yakýnýnda gereksiz splenektomileri önleyebilir. Kombine yaralanmalar mortaliteyi artýran en önemli faktörlerden biridir.

TRAUMATIC SPLENIC INJURIES

Splenectomy is the frequently used surgical method for the treatment of traumatic splenic injuries. In this study, the patients who had traumatic splenic injuries were investigated and the results of surgical treatments were evaluated. There were 225 patients with traumatic splenic injuries, which contains 55 (24%) female and 170 (76%) male. The mean age was 29 (range 16-71) years. Severity of splenic injury was classified according to Moore organ injury scaling and there were 23 (10%) patients in grade 1,96 (43%) in grade II, 75 (33%) in grade HI, 24 (11%) in grade IV and 7 (3%) in grade V. Splenectomy was performed in 203 (90%) patients, splenoraphy in 18 (8%) and partial Splenectomy in 4 (2%) patients. The overall mortality was 12%. A positive correlation was estimated between the combined trauma and the mortality (Fisher's Chi-Square test; X2-9,538, p<0.002). In conclusion, non-operative treatment methods may prevent unnecessary splenectomies, especially in grade I and II blunt or penetrating splenic injuries. Combined injuries are the major factor increasing the mortality.