Ulus Travma Acil Cerrahi Derg. 2013; 19(4): 337-342 | DOI: 10.5505/tjtes.2013.89411

Künt dalak yaralanmalarýnda ameliyatsýz tedavi: Derecelendirme tek kriter midir?

Bülent Koca¹, Koray Topgül², Saim Savaþ Yürüker¹, Hamza Çýnar¹, Bekir Kuru^1
1Ondokuz Mayýs Üniversitesi Týp Fakültesi Genel Cerrahi Ad, Samsun
²Medical Park Samsun Hastanesi Genel Cerrahi Bölümü, Samsun

Amaç: Bu çalýþmada, künt dalak yaralanmasýna ameliyatsýz yaklaþým sonuçlarýný irdelemeyi, yaralanma derecesinin önemini yeniden deðerlendirmeyi amaçladýk.
Gereç Ve Yöntem: Cerrahi dýþý yöntemle tedavi edilen 31 künt dalak yaralanmalý olgu geriye dönük olarak incelendi. Hastalar izole dalak travmasý (DT) grubu ve çoklu travma (ÇT) grubu olmak üzere iki gruba ayrýldý. Ýki grup arasýnda yatýþ süresi, kan replasmaný ihtiyacý, ameliyatsýz izlem baþarýsý ve travma sonrasý komplikasyonlar karþýlaþtýrýldý. Hastalar kontrol karýn ultrasonografisi (US) ve bilgisayarlý tomografi (BT) ile deðerlendirildi. Elde edilen sonuçlar postsplenik travma komplikasyonlarý ile ilgili olarak deðerlendirildi.
Bulgular: Amerikan Travma Cerrahisi Derneði organ hasarý skoruna göre, olgularýn %25,8’inde derece 1, %32,2’sinde derece 2, %29’unda derece 3 ve %12,9’unda derece 4 yaralanma vardý. Transfüzyon miktarýnýn yaralanma derecesi ile doðrudan orantýlý olduðu görüldü. Ortalama yatýþ süresi MT grubunda daha uzundu. Derece 4 yaralanma ve çoklu travmalý olan 14 hasta ile tüm hastalar ameliyatsýz yöntem ile baþarýyla tedavi edildi. MT grubunda bir hastada splenik psödoanevrizma geliþti. Bir hastada geç dalak rüptürü tanýsý kondu.
Sonuç: Hemodinamik stabilite konservatif tedavi endikasyonu için en önemli ölçüttür. Ancak, iyi seçilmiþ olgularda 4. derece dalak yaralanmasý olan ve dalak dýþý yaralanmalar da ameliyatsýz tedavi ile baþarýlý bir þekilde tedavi edilebilir.

Anahtar Kelimeler: Künt dalak travmasý, komplikasyon; yaralanma derecelendirmesi; ameliyatsýz tedavi.

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Non-operative treatment approach for blunt splenic injury: is grade the unique criterion?

Bülent Koca¹, Koray Topgül², Saim Savaþ Yürüker¹, Hamza Çýnar¹, Bekir Kuru^1
1Department Of Surgery, Ondokuz Mayýs University, Faculty Of Medicine, Samsun, Turkey
²Department Of Surgery, Medical Park Samsun Hospital, Samsun, Turkey

Background: We aimed to investigate the results of a non-operative approach to blunt spleen injury to re-evaluate the importance of injury grade.
Methods: Thirty-one blunt splenic trauma cases subjected to nonoperative treatment were evaluated retrospectively. The patients were classified into two groups as isolated spleen trauma (ST) group and multi-trauma (MT) group. The hospitalization and blood replacement needs, success of non-operative follow-up, and post-traumatic complications were compared between the two groups. The patients were evaluated via follow-up abdominal ultrasonography (US) and computerized tomography (CT). The results were evaluated with regard to post-splenic trauma complications.
Results: According to the organ injury scale of the American Association for the Surgery of Trauma, 25.8% were grade-1, 32.2% grade-2, 29% grade-3, and 12.9% grade-4 injuries. It was observed that the transfusion amount was directly proportional to the injury grade. All patients with grade-4 injury and 14 patients with MT were treated successfully with the non-operative method. Splenic pseudoaneurysm developed in one patient in the MT group. One patient was diagnosed with late splenic rupture.
Conclusion: Hemodynamic stability is the most important criterion for the indication of non-operative treatment. However, in wellselected cases, patients with grade 4 splenic traumas and those with extra-splenic injuries could also be treated successfully with the non-operative method.

Keywords: Blunt splenic trauma, complication; injury grade; nonoperative management.

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