Ulus Travma Acil Cerrahi Derg. 2007; 13(1): 36-42

Delici ve kesici alete baðlý torakoabdominal yaralanmalarýn taný ve tedavisinde torakoskopi

Salih Pekmezci¹, Kamil Kaynak², Kaya Sarýbeyoðlu¹, Kemal Memiþoðlu³, Taner Kurdal², Ece Kol¹, Ýlknur Erenler Kýlýç¹, Bilgi Baca¹, Erhun Eyüboðlu¹, Feridun Þirin^1
1Ýstanbul Üniversitesi Cerrahpaþa Týp Fakültesi, Genel Cerrahi Anabilim, Dalý, Ýstanbul
²Ýstanbul Üniversitesi Cerrahpaþa Týp Fakültesi, Göðüs Cerrahisi Anabilim Dalý, Ýstanbul
³Fatih Sultan Mehmet Eðitim Ve Araþtýrma Hastanesi Genel Cerrahi Kliniði, Ýstanbul

AMAÇ
Okült diyafragma yaralanmalarý tanýda gecikildiði takdirde yüksek mortaliteye neden olurlar. Bu yazýda, torakoabdominal bölgenin delici ve kesici alet yaralanmalarýnda tanýsal ve terapötik torakoskopi uygulanan hasta grubuna ait deneyimler sunuldu.
GEREÇ VE YÖNTEM
Haziran 2001-Aralýk 2005 tarihleri arasýnda kliniðimizde torakoabdominal bölgenin delici ve kesici alet yaralanmasý nedeniyle torakoskopik yaklaþým uygulanan hastalar bu çalýþmaya alýndý. Veriler geriye dönük olarak analiz edildi.
BULGULAR
Abdominal ve torakoabdominal delici, kesici alet yaralanmasý nedeniyle 93 hastaya videoendoskopik giriþim uygulandý. Bunlarýn içinde torakoabdominal bölgenin delici ve kesici alet yaralanmasý nedeniyle seçilmiþ 11 hastaya tanýsal ve terapötik torakoskopi uygulandý. Ameliyatlar genel (n=10) ve lokal (n=1) anestezi altýnda uygulandý. Diyafragma yaralanmasý üç hastada saptandý ve intrakorporeal dikiþlerle onarýldý. Ýki hastada kanama kontrolü elektrokoterle saðlandý. Geriye kalan altý hastada torakoskopi yalnýzca tanýsal bir iþlem olarak gerçekleþti ve sonlandý. Ortalama ameliyat süresi ve hastanede yatýþ süresi sýrasýyla 35 dakika ve 3.5 gün idi. Perioperatif veya erken postoperatif dönemde komplikasyonla ya da mortaliteyle karþýlaþýlmadý.
SONUÇ
Torakoskopi diyafragma yaralanmalarýnýn taný ve tedavisinde etkili ve güvenilir bir yöntemdir.

Anahtar Kelimeler: Delici ve kesici yaralanma, diyafragma; torakoabdominal yaralanma; torakoskopi; býçaklanma.

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Thoracoscopy in the diagnosis and treatment of thoracoabdominal stab injuries

Salih Pekmezci¹, Kamil Kaynak², Kaya Sarýbeyoðlu¹, Kemal Memiþoðlu³, Taner Kurdal², Ece Kol¹, Ýlknur Erenler Kýlýç¹, Bilgi Baca¹, Erhun Eyüboðlu¹, Feridun Þirin^1
1Department Of General Surgery,, Istanbul University Cerrahpaþa Medical Faculty, Istanbul, Turkey
²Department Of Thoracic Surgery, Istanbul University Cerrahpaþa Medical Faculty, Istanbul, Turkey
³Department Of General Surgery, Fatih Sultan Mehmet Training And Research Hospital, Istanbul, Turkey

BACKGROUND
Occult diaphragmatic injuries are associated with significant mortality, if the diagnosis is delayed. We report our experience in diagnostic and therapeutic thoracoscopy in a selected group of patients with stab wounds of thoracoabdominal region.
METHODS
The patients who underwent thoracoscopic management of thoracoabdominal stab injuries between June 2001-December 2005 were included into the study. The data were retrospectively analyzed.
RESULTS
Ninety-three patients with abdominal and thoracoabdominal stab wounds underwent videoendoscopic management. Among them, eleven selected patients with thoracoabdominal stab injuries were managed by thoracoscopy. The procedures were performed under general (n=10) or local anesthesia (n=1). Diaphragmatic injuries were repaired by intracorporeal sutures in three cases and bleeding was controlled in another two cases by electrocautery coagulation. The procedures were simply diagnostic in six patients. The mean operating time and hospital stay were 35 minutes and 3.5 days respectively. There was neither intraoperative or early postoperative complication, nor mortality.
CONCLUSION
Thoracoscopy is a safe and efficient tool in the diagnosis and treatment of diaphragmatic stab injuries.

Keywords: Penetrating thoracoabdominal injury, diaphragm; thoracoabdominal wound; thoracoscopy; stab.

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