ERÝÞKÝNLERDE KÜNT KARIN TRAVMALARINDA DALAK VE KARACÝÐER YARALANMALARININ NONOPERATÝF TEDAVÝSÝ

Eriþkinlerde künt karaciðer ve dalak yaralanmalarýnýn nonoperatif tedavisi bu yaklaþýmýn çocuklarda inkar edilemez yararlarýndan kaynaklanmýþtýr. Olgular hemodinamik yönden stabil olmalý, kan transfüzyon ihtiyacý minimal olmalý ve yaygýn peritoneal hassasiyet olmamalýdýr. Ýleri görüntüleme tekniklerinin (radionüklid sintigrafi, ultrasonografi, kompüterize tomografi) artmasý ve son yýllarda peritoneal lavajýn kullanýlmasý travma niteliðinin belirlenmesine katkýda bulunmuþtur. Gevher Nesibe Hastanesine baþvuran künt karaciðer travmalý 140 ve künt dalak travmalý 144 olgu retrospektif olarak incelendi. 1985 Ocak ve 1994 Aralýk itibariyle ciddi künt karýn ve multisistem travmalý 702 olgu deðerlendirildi. Penetran ve iatrojenik karaciðer ve dalak yaralanmalarý çalýþma dýþý býrakýldý. Hastalar yaþ, cins, travma türü, teþhis yöntemleri ve tercih edilen tedavi yöntemleri açýsýndan sýnýflandýrýldý. 69 olgu nonoperatif olarak tedavi edildi. 42 olguya eksploratris laparatomi, 12 olguya dalak koruyucu cerrahi giriþim, 30 olguya karaciðere basit cerrahi giriþim ve drenaj, 60 olguya karaciðere radikal cerrahi giriþim ve 113 olguya splenektomi uygulandý. Yaygýn periton hassasiyeti olan hiç bir olguya nonoperatif tedavi yapýlmadý. Kan transfüzyon gereksinimi bu grupta ortalama 2.4 Ü idi. Nonoperatif tedavi edilen 69 olgudan 14'ünde (%20.2) komplikasyon geliþti. Yine 69 olgudan 11'i (%15.9) ikincil ciddi komplikasyonlardan kaybedildi. Sonuç olarak karaciðer ve dalak yaralanmalý seçilmiþ eriþkin olgular nonoperatif olarak güvenle tedavi edilebilir.

NONOPERATIVE MANAGEMENT OF LIVER AND SPLENIC INJURIES FOLLOWING BLUNT ABDOMINAL TRAUMA IN ADULTS

The use of selective nonoperative management of blunt splenic and liver trauma in adults is based on the undeniable benefits on this approach in children. Proper patient selection requires hemodynamic stability, lack of generalized peritoneal irritation, and minimal blood transfusion needs. The increased use of sophisticated imaging techniques (radionuclide scintigraphy, ultrasonography, computerized tomography) and peritoneal lavage in the last decade, has contributed to improved characterization of the extent of injury. But the decision for laparotomy is based on clinical grounds. 144 patients with blunt splenic injury and 140 patients with blunt liver injury admitted to Gevher Nesibe Hospital were included in this retrospective study. 702 consecutive adults with serious blunt abdominal or multisystem trauma were evaluated between January 1985 and December 1994. Penetrating and iatrogenic splenic and liver injuries were not included. Patients were seperated into categories based on age, sex, mechanism of injury, diagnostic modality and treatment option employed. Out of the total series, 69 patients were not operated, 42 patients had exploratory laparotomy, and in 12 patients splenic repair, in 30 patients liver repair and drainage, in 60 patients liver resection and 113 patients splenectomy were performed. None of the nonoperatively treated patients had generalized irritation. Blood transfusion requirements were significantly less in the nonoperative groups (average 2.4 U). Fourteen of these 69 patients (20.2%) developed complications. Eleven of these 69 patients (15.9%) died and these were secondary to severe complications. Consequently, liver and splenic injuries in adults can be safely managed nonoperatively in selective patients.