Duodenum yaralanmalarýnda tedavi: Deneyimlerimiz ve tüp duodenostominin yeri

AMAÇ
Þiddetli duodenal yaralanmalarda primer onarým ve/veya tüp duodenostomi uygulamalarýnýn etkinliði deðerlendirildi ve bu konudaki deneyimlerimiz sunuldu.
GEREÇ VE YÖNTEM
Duodenum yaralanmasý nedeniyle ameliyat edilen 67 hasta deðerlendirildi. Ameliyat tekniði, primer onarým ve tüp duodenostomi uygulanan hastalar olarak sýnýflandýrýldý.
BULGULAR
Elli dokuz hastada penetran ve sekiz hastada ise künt duodenum yaralanmasý mevcuttu. En sýk yaralanan duodenum kýsým ikinci segmentti. Her iki tedavi grubu arasýnda morbidite ve mortlite oraný açýsýndan bir fark yoktu. Morbidite geliþmeyen 35 hastada hastanede yatýþ süresi, tüp duodenostomi uygulanan grupta 18,53±1,85 gün ve primer onarým uygulanan grupta ise 11,45±1,92 gün olup, bu sonuç istatistiksel olarak anlamlýydý. Morbidite geliþen 32 hastada hastanede kalýþ süresi ise tüp duodenostomi uygulanan grupta 47.05±10.46 gün ve primer onarým uygulanan grupta 47,05±10,46 gün idi. Bu sonuç istatistiksel olarak anlamlý deðildi.
SONUÇ
Þiddetli duodenum yaralanmalarýnda primer onarým uygun bir tedavi yöntemidir. Tüp duodenostomi uygulamasý, hastanede kalýþ süresini artýrdýðý gibi hastanýn klinik gidiþatýna ek bir katkýsý olmadýðý görülmüþtür.

Management of duodenal injury: our experience and the value of tube duodenostomy

BACKGROUND
The aim of this study was to report our experience with duodenal injuries and determine if primary repair and/or tube duodenostomy are valid options for definitive operative repair of severe duodenal injuries.
METHODS
Sixty-seven patients who underwent surgery for duodenal injuries were evaluated. Management of duodenal injury was classified as primary repair and tube decompression.
RESULTS
Fifty-nine patients were injured by a penetrating mechanism, and eight were injured by blunt mechanism. The most common injury site was in the second portion of the duodenum. There were no significant differences between the two groups with respect to morbidity and mortality rate. In 35 patients without morbidity, the mean length of hospital stay was 18.53±1.85 days in the tube duodenostomy group and 11.45±1.92 days in the primary repair group, and the difference was statistically significant. In the 32 patients with morbidity, the mean length of hospital stay was 47.05±10.46 days in the tube duodenostomy group and 49.86±10.86 days in primary repair group, but there was no statistically significant difference between the groups.
CONCLUSION
Primary repair is suitable in the vast majority of duodenal injuries; tube duodenostomy increases the length of hospital stay and does not improve clinical outcome.