KARIN TRAVMALARINDA NEGATÝF LAPAROTOMÝ SORUNU

Bu retrospektif çalýþmada 1985-1994 yýllarý arasýnda Çukurova Üniversitesi Týp Fakültesi Genel Cerrahi Anabilim Dalý'nda karýn travmasý nedeniyle laparotomi yapýlan 888 hastanýn kayýtlarý incelendi ve negatif laparotomi sýklýðý araþtýrýldý. Hastalarýn 399(%45) 'u künt karýn, 489(%55) 'u penetran karýn travmalý idi. Penetran yaralanmalarýn 171(%35)'i ateþli silah (AS), 318(%55)'i delici kesici alet (DKA) yaralanmasýna baðlý idi. Künt travmalarýnda negatif laparatomi oraný %16,5, nonterapötik laparotomi oraný ise 2,3 olarak bulundu. Negatif laparatomi ve nonterapötik laporotomi oranlarý AS yaralanmalarýnda %7, %1,2 DKA yaralanmalarýnda ise %22,7 ve %2,5 idi. Künt karýn travmalarýnda ve AS yaralanmalarýnda negatif laparotomi oranlarý literatürle uyumlu idi. DKA yaralanmalarýnda ise Negatif laparotomi ve nonterapötik laparotomi oranlarý seçici gözlem, lokal yara eksplorasyonu ve tanýsal peritoneal lavaj uygulayan gruplara göre yüksek bulundu. DKA yaralanmalarýnda dikkatli fizik muayene, yara eksplorasyonu ve tanýsal peritoneal lavajýn negatif laparotomi oranýný azaltacaðý ve morbiditeyi önleyeceði düþüncesindeyiz.

THE PROBLEM OF NEGATIVE LAPAROTOMY IN ABDOMINAL TRAUMA

In this retrospective study, the records of 888 patients whom were treated because of abdominal trauma in Çukurova University, School of Medicine, Department of General Surgery between 1985 and 1994 were reviewed and the incidence of negative laporotomy was investigated. Three hundred-ninty-nine(%45) patients had blunt abdominal trauma 499(55%) had penetrating abdominal trauma. Penetrating abdominal trauma included 171 (35%) gunshot wounds, 318(65%) stab wounds. Of 399(35%) patients with blunt abdominal trauma, the incidence of negative laporotomy was 66 (16.5%) and 9 (2.3%) patients had nontherapeutic laparotomy. The incidence of negative laporotomy was 12(7%) and 2 (1.2%) patients had nontherapeutic laparotomy in 171(35%) patients with gunshot wounds. Of 388 (65%) patients with stab wounds, the incidence of negative laparotomy was 72(22.7%) and 8(2.5%) patients had non therapeutic laparotomy. The incidence of negative laparotommy was found similar with literature in the patients with blunt abdominal trauma and gunshod wounds. The patients with stab wounds, the incidence of negative laporotomy was higher than patients managed by selective conservative treatment. We believe that the incidence of negative laparotomy will reduce by careful physical examination, local wound exploration and diagnostic peritoneal lavage and also prevent to morbidity in patients with stab wounds.