Ulus Travma Acil Cerrahi Derg. 2007; 13(3): 222-226

Künt karaciðer travmalarýna konservatif yaklaþým

A. Ziya Anadol, Koray Topgül, Bülent Güngör, Mehmet Bilgin, Mete Kesim
Ondokuz Mayýs Üniversitesi Týp Fakültesi Genel Cerrahi Anabilim Dalý, Samsun

AMAÇ Cerrahi tedavinin morbidite ve mortalitesinin yüksek olabildiði künt karaciðer travma olgularýnda, ameliyat edilmeksizin izlenen iyi seçilmiþ hastalarda yüksek saðkalým oranlarý bildirilmektedir. Bu yazýda, invazif taný ve/veya tedavi yöntemleri uygulanmadan izlenen 19 olgunun sonuçlarý deðerlendirildi. GEREÇ VE YÖNTEM Yatýrýlarak izlenen ve invaziv taný yöntemleri ya da cerrahi tedavi uygulanmayan 19 künt karaciðer travmalý hasta (9 erkek, 10 kadýn; ort. yaþ 46,6; daðýlým 19-73) deðerlendirildi. Hastalarýn demografik özelliklerinin yanýnda, yaþamsal bulgularý, hemodinamik parametreleri, karaciðer iþlev testleri, transfüzyon gereksinimleri, hastanede kalýþ süreleri ve izlem amaçlý yapýlan radyolojik testler kaydedildi. Karaciðerdeki yaralanmanýn sýnýflanmasýnda, Amerikan Travma Cerrahlarý Birliði’nin Organ Yaralanmasý Skorlama Sistemi kullanýldý.
BULGULAR On dokuz hastada radyolojik olarak kanýtlanmýþ karaciðer yaralanmasý vardý. Dokuz hastada evre I, beþ hastada evre II, iki hastada evre III ve üç hastada evre IV yaralanma vardý. On iki hastaya kan transfüzyonu gerekti. Ortalama yatýþ süresi 7,6 gündü. On dört hastada orta derecede transaminaz artýþý görülürken, beþ hasta biyokimyasal olarak normaldi. Bir hastada büyük bir karýn duvarý hernisi meydana geldi ve travmadan üç ay sonra laparoskopik olarak onarýldý. Hiçbir hastaya konservatif tedavinin baþarýsýzlýðý nedeniyle cerrahi uygulanmadý ve hastalarýn hiçbiri kaybedilmedi.
SONUÇ Künt karaciðer travmasý geçiren hastalarda, hemodinamik dengenin saðlanabilmesi ve sürdürülebilmesi þartýyla, konservatif izlem öncelikli yaklaþým olmalýdýr. Cerrahi giriþim kararý, travmaya eþlik eden karýn içi organ yaralanmasýnýn varlýðýna göre alýnmalýdýr. Karaciðer yaralanma skoru konservatif tedavi kararýnýn alýnmasýnda, hemodinamik denge kadar önemli deðildir.

Anahtar Kelimeler: Künt karaciðer travma/ameliyatsýz, künt/radyografi/ultrasonografi; tomografi, X-ýþýný kompütörize; yara.

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Non-operative management of blunt hepatic trauma

A. Ziya Anadol, Koray Topgül, Bülent Güngör, Mehmet Bilgin, Mete Kesim
Department Of General Surgery, Ondokuz Mayýs University, Samsun, Turkey

BACKGROUND Blunt hepatic trauma is frequently seen, particularly as a result of traffic accidents. Given that surgical therapy may have high rates of morbidity and mortality, a selected group of patients may can benefit from conservative management. We herein present, a group of patients with blunt hepatic trauma who were managed without any invasive diagnostic tools and / or surgical intervention. METHODS Nineteen hemodynamically stable patients (9 males, 10 females; mean age 46,6; range 19-73 years) with blunt hepatic trauma were included in the study. Vital signs, hemodynamic parameters, liver function tests, need for transfusion, hospital stay and results of radiological tests were recorded as well as demographic characteristics. Classification of injury was done according to the American Association for the Surgery of Trauma’s Organ Injury Scaling System. RESULTS Nineteen patients had radiologically-proven liver injury. Nine patients had grade I injury, five had grade II, two had grade II and three had grade IV injuries. Twelve patients required blood transfusions. Fourteen patients had mild elevation of transaminases while the remaining five were completely normal. Mean hospital stay was 7.6 days. Blunt trauma was associated with a large abdominal wall hernia in one patient; the defect was repaired laparoscopically three months later. No patient underwent surgery due to the failure of conservative management and there was no death. CONCLUSION For blunt hepatic trauma patients, non-operative management may be the initial therapy if haemodynamic stability can be maintained. The decision for surgical intervention should be given according to the presence of associated intraabdominal injuries. Liver injury score of patients is not as important as the hemodynamic status for determining conservative management.

Keywords: Blunt hepatic trauma/non-operative, nonpenetrating/ radiography/ultrasonography; tomography, X-ray computed; wounds.

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