TRAKEA VE ÖZEFAGUSUN ATEÞLÝ SÝLAH ÝLE EÞZAMANLI YARALANMALARI

Eþ zamanlý trakea ve özefagus yaralanmasý olan olgular trakeoözefageal fistül, özefagus kaçaðý, pnömoni ve mediastinel abse gibi majör komplikasyonlarýn geliþebileceði risk altýnda olan olgulardýr. Ocak 1980 Mayýs 1997 tarihleri arasýnda kliniðimizde 23 trakeobronþial yaralanma olgusu tedavi edilmiþtir. Bu olgularýn 7'sinde (%30.4) eþ zamanlý trakea ve servikal özefagus yaralanmasý vardý. Tüm olgularda etken ateþli silah yaralanmasý idi. Özefagus yaralanmasý tanýsý 5 olguda özefagografi, 2 olguda ise cerrahi eksplorasyon sýrasýnda kondu. Olgularýn yaralanma ile cerrahi tedavileri arasýnda geçen süre ortalama 30 saat (6 saat ile 48 saat arasý) idi. Olgularýn tümüne oblik servikal insizyon (anterior sternokleidomastoid insizyon) ile yaklaþýldý. Özefagus yaralanmasý için 3 olguda sadece drenaj, 3 olguda iki tabaka primer onarým ve drenaj ve 1 olguda ise servikal T-tüp özefagostomi + totale yakýn servikal özefageal eksklüzyon uygulandý. Trakea onarýmý tek tek, tek tabaka olarak polypropylene veya polyglycolic acid sütür kullanýlarak yapýldý. Tüm olgulara geniþ spektrumlu antibiotik verildi. Eþlik eden yaralanmalar pnömotoraks (n=3), hemotoraks (n=2), hemopnömotoraks (n=2), larinks (n=1) ve n.laryngeus inferior (n=1) idi. Larinks yaralanmasý olan olguya yaygýn hasar nedeniyle kalýcý trakeostomi yapýldý. Postoperatif servikal özefageal kaçak (n=1), trakeoözefageal fistül (n=1), özefageal stenoz (n=1) ve pnömoni (n = 1) serimizdeki komplikasyonlarý oluþturdu. Serimizde mortalite oraný %42.8 (3 olgu) dir: Bu üç olguyu sepsis nedeniyle kaybettik. Tüm seri için hastane kalýþ süresi 5 ile 99 gün arasýnda olup ortalama 36.8 gün idi. Komplikasyon sayýsý trakea ve özefagus yaralanmalarýnýn erken taný ve tedavileri ile azaltýlabilir. Özellikle trakeal onarýmýn tehlikeye atýlmamasý ve trakeoözefageal fistül geliþimini önlemek için her iki yaralanmanýn onarýmý bittikten sonra yaralanma zamaný ve cerrahi onarým arasýndaki geçen süreye bakýlmaksýzýn canlý bir doku flebi, sternokleidomastoid adele ilk seçenek olmak üzere konulmalýdýr.

COMBINED GUNSHOT WOUNDS OF TRACHEA AND ESOPHAGUS

Between January 1980 May 1997 23 cases with tracheobronchial injuries were treated in our clinic. In 7 (30.4%) of theses there were combined tracheal and esophageal injuries. The cause was gunshot wound injury in all patients. Diagnosis of esophageal injury has been made by esophagography in 5, and by surgical exploration in two cases. The duration of time between the injury and surgical management was 30 hours frange, 648 hours). Surgical approach was made by anterior sternocleidomastoid incision in all cases. Operative techniques included drainage(3), two-layer dosure(3), and cervical tube esophagostomy + near total esophageal exclusion (1) for esophageal injuries. Tracheal repair was done with a single layer interrupted polypropylene or polyglycolic acid sutures. Associated injuries were pneumothorax (3), hemothorax(2), hemopneumothorax(2), larynx(1), and n.Laryngens inferior(1). Permanent tracheostomy was performed in one patient with severe laryngeal injury. Complications were cervical esophageal leak(1), tracheoesophageal fistula EF(1), esophageal stenosis(1), andpneumonia(1). The morbidity rate in our series was 42.8%. The cause of mortality in these 3 cases was sepsis. The mean length of hospital stay was 36.8 days (frange, 5 99 days). The number of complications can be lowered by prompt recognition of the injuries and repair of the trachea and esophagus. In order to protect the tracheal repair and prevent TEF formation a viable tissue, Sternocleidomastiod muscle being the first choice should be placed between the repairs regardless of the time between the injury and surgery.