Ulus Travma Acil Cerrahi Derg. 2022; 28(10): 1428-1436 | DOI: 10.14744/tjtes.2022.95476

Künt dalak travma: Nonoperatif baþarýsýzlýk oranýný etkileyen prediktör ve risk faktörlerin analizi

Abdullah Yýldýz¹, Adnan Özpek¹, Ahmet Topçu², Metin Yücel¹, Fikret Ezberci^1
1Saðlýk Bilimleri Üniversitesi Ümraniye Eðitim Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Ýstanbul
²Tokat Devlet Hastanesi, Genel Cerrahi Kliniði, Tokat

AMAÇ: Non-operative management (NOM), künt dalak travmasý olan hemodinamik olarak stabil hastalarda standart bir tedavi haline gelmiþtir. Çalýþmalarda, NOM için çok sayýda prediktör ve risk faktörü tanýmlanmaktadýr. Ancak, bu faktörlerin NOM baþarýsýzlýðýndaki rolleri tartýþýlmaya devam etmektedir. Bu çalýþma, NOM uygulanan hastalardan elde edilen verilerin geriye dönük analiziyle, bu faktörlerin NOM baþarýsýzlýðýndaki rolünü sunmayý amaçladý.
GEREÇ VE YÖNTEM: Mart 2009–Haziran 2021 tarihleri arasýnda künt karýn travmasý ile getirilen ve künt dalak travmasý tanýsý alan 189 hastanýn ilk deðerlendirmesi yapýldý. Hemodinamik instabilite nedeniyle acil ameliyata (immediate splenektomi) alýnan 13 ve hayatýný kaybeden 18 hasta çalýþmaya alýnmadý. Geri kalan 158 hastaya (stabil veya stabilleþen) NOM planlandý. NOM planlanan hastalar baþarýlý (s-NOM; n=139) veya baþarýsýz (f-NOM; n=19) olarak gruplandýrýlarak, sonuçlar geriye dönük olarak analiz edildi.
BULGULAR: NOM için planlanan 158 hastanýn 115’i erkekti. Ortalama yaþ; s-NOM 32.2±14.5 ve f-NOM’da 36.1±16.1) idi. Ortalama hastanede kalýþ süresi 8 (4–21) gün, takip süresi ise 12 (6–18) aydý. Planlanan NOM grubunda 60 (%43.2) hastaya USG ve 137 (%98.6) hastaya BT yapýldý. NOM planlanan hastalarda (n=158) grade I-V sýrasýyla 20 (%12.6), 54 (34.1) 56 (%35.4), 26 (%16.4) ve 2 (%1.3) idi. Grade I-V baþarý oranlarý sýrasýyla 20 (%100), 52 (%96.3), 52 (%92.8), 15 (%57.7), 0 (%0.0) idi. s-NOM grubundaki 41 hastaya 102 ünite eritrosit transfüzyonu (ortalama 2.46 ünite) uygulanýrken, f-NOM grubundaki 19 hastaya 81 ünite (ortalama 4.26 ünite) uygulandý (p<0.001). ISS skoru >15 hastalar %57.5 (ortalama skor, 22.8) ve f-NOM grubunda %78.9 (ortalama skor, 34.8) idi (p<0.001). Bu çalýþmada genel NOM baþarýsý %88.0, toplam komplikasyon %10.1 ve mortalite %1.2 idi.
TARTIÞMA: Bu çalýþmada grade I-III künt dalak travmalý hastalara NOM protokolü uygulanarak baþarýyla tedavi edildi. Ancak, grade IV dalak yaralanmalarýnýn sadece %57.7’si NOM ile baþarýlý bir þekilde yönetildi. Standart bir plan dahilinde prediktör ve risk faktörleri belirlenmesi ve bu plan dahilinde takip ve tedavilerinin yapýlmasý NOM baþarýsýný artýracaðýný öngörüyoruz.

Anahtar Kelimeler: Dalak yaralanmasý, künt dalak trauma, non-operatif yönetim, splenektomi; splenic trauma.

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Blunt splenic trauma: Analysis of predictors and risk factors affecting the non-operative management failure rate

Abdullah Yýldýz¹, Adnan Özpek¹, Ahmet Topçu², Metin Yücel¹, Fikret Ezberci^1
1Department of General Surgery, Health Sciences University Ümraniye Training and Research Hospital, Ýstanbul-Türkiye
²Department of General Surgery, Tokat State Hospital, Tokat-Türkiye

BACKGROUND: Non-operative management (NOM) has become a standard treatment in hemodynamically stable patients with blunt splenic trauma. Studies have identified numerous predictors and risk factors for NOM. However, these factors’ role in NOM failure continues to be debated. This study aimed to reveal the role of these factors in NOM failure through retrospective analysis of data from patients who underwent non-operative treatment.
METHODS: After the initial evaluation of 189 patients brought to the emergency department between March 2009 and June 2021 and diagnosed with blunt splenic trauma, 13 patients underwent emergency surgery due to hemodynamic instability (immediate splenectomy), and 18 patients who died were excluded from the study. NOM was planned for the remaining 158 patients (stable or stabilized). Patients scheduled for NOM were grouped as either successful NOM (s-NOM; n=139) or failure NOM (f-NOM; n=19) and analyzed the results, retrospectively.
RESULTS: Of the 158 patients scheduled for the NOM, 115 were male. The mean age in s-NOM and f-NOM was 32.2±14.5 versus 36.1±16.1. The mean hospital stay was 8 (4–21) days. The mean follow-up period was 12 (6–18) months. Used USG for 60 (43.2%) patients and CT for 137 (98.6%) in the NOM. The number of Grades I-V in the NOM planned patients (n=158) was 20 (12.6%), 54 (34.1%) 56 (35.4%), 26 (16.4%), and 2 (1.3%), respectively. The success rates according to the Grades I-V were 20 (100%), 52 (96.3%), 52 (92.8%), 15 (57.7%), and 0 (0.0%), respectively. There were 102 units of red cell transfusions administered (mean, 2.46 units) to 41 patients in the s-NOM group, while 81 units (mean, 4.26 units) were administered to 19 patients in the f-NOM group (p=0.001). ISS score >15 was 57.5% (mean score, 22.8) and those in the f-NOM group were 78.9% (mean score, 34.8), respectively (p<0.001). Overall NOM success was 88.0%, total complications were 10.1%, and mortality was 1.2% in this study.
CONCLUSION: Grades I-III blunt splenic trauma patients were successfully treated using the NOM protocol in this study. However, more than half of Grade IV (57.7%) splenic injuries were successfully treated using NOM. Identifying predictors and risk factors based on a standardized plan will likely increase this success.

Keywords: Blunt splenic trauma, non-operative management, splenectomy, splenic injury.

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