Toraks travmalarýna baðlý geç komplikasyonlar

AMAÇ: Kliniðimize Mart 2010–Aralýk 2019 tarihleri arasýnda toraks travmasý sonucu müracaat etmiþ 412 olgu geriye dönük olarak incelenerek, künt ve penetran toraks travmalarý sonucu geliþen geç komplikasyonlar deðerlendirilmiþ ve travmayla ilgilenen hekimlere bu komplikasyonlarýn yönetimi için bir öngörü sunulmasý amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Dört yüz on iki toraks travmalý olgudan bu çalýþmanýn ana temasýný oluþturan geç dönem komplikasyon geliþmiþ 62 olgu (%15.04) yaþ, cinsiyet, travma tipi, travma nedeni, travmanýn ilk geliþtiði dönemde geliþen toraks patolojileri ve yandaþ organ patolojileri, geliþen geç dönem komplikasyonlarý ve bunlara yönelik tedavi yöntemleri ile mortalite açýsýndan incelendi.
BULGULAR: Toraks travmasýna baðlý geç komplikasyon geliþmiþ 62 olgunun 47’si (%75.80) erkek, 15’i (%24.20) kadýn, yaþ ortalamasý 56.98±21.22 olarak tespit edildi. Posttravmatik geç dönem komplikasyon geliþen olgularýn travma tipi deðerlendirildiðinde künt travmalarýn %90.33 (n=56), penetran travmalarýn %9.47 (n=6) oranýnda olduðu ve künt travma olgularýnda en sýk nedenin trafik kazasý (%66.07), penetran travmalarda ise delici-kesici alet yaralanmasý (%83.33) olduðu saptandý. En sýk geliþen toraks patolojisi künt travmalarda pulmoner kontüzyon (%75), penetran travmalarda ise hemopnömotoraksdýr (%66.66). Gruplar ayrý ayrý incelendiðinde penetran travmalar için en sýk görülen geç dönem komplikasyon retansiyone hemotoraks (%66.66) iken, künt travmalý olgularda en sýk (%41.07) pnömonidir. Retansiyone posttravmatik hemotoraks tablosu ile gelen hastalarýn 17’sinde video yardýmlý torakoskopik cerrahi, sekiz olguya torakotomi uygulandý. Posttravmatik ampiyemle gelen olgularýn yedisine torakoskopi, dört olguya torakotomi ile dekortikasyon yapýldý. Geç komplikasyon geliþen olgularýn altýsý hayatýný kaybetdi. Mortalite oraný %9.67’dir. Mortalite geliþen olgularýn %83.33’ünde geç komplikasyon türü olarak pnömoni tespit edildi.
TARTIÞMA: Travma ile ilgilenen hekimlerin, ilk bakýda tespit edemeyecekleri ve daha sonra karþýlarýna gelebilecek geç dönem komplikasyonlar açýsýndan, hastanýn yaþý, tavma tipi baþta olmak üzere birçok etken faktörü gözününde bulundurarak hastasýnýn tedavi modalitelerini belirlemeleri uygun olacaktýr.

Late complications due to thoracic traumas

BACKGROUND: A total of 412 patients who applied to our clinic after a thoracic trauma between March 2010 and December 2019 were examined retrospectively In this study, late complications that developed as a result of blunt and penetrating thoracic traumas were evaluated and it was aimed to present a prediction for the management of these complications to physicians who are dealing with trauma.
METHODS: Among the 412 thoracic trauma cases, 62 cases (15.04%) who developed late-term complications which constituted the main theme of this study were evaluated in terms of age, gender, the type of trauma, the cause of trauma, thorax, and concomitant organ pathologies that developed when the trauma first occurred, the late-term complications, and the treatment methods for them while considering mortality.
RESULTS: Of 62 patients with late complications due to thoracic trauma, 47 (75.80%) were male, 15 (24.20%) were female, and the average age was 56.98±21.22. When the trauma type of the patients who developed posttraumatic late-term complications was evaluated, blunt traumas were seen in 90.33% (n=56) of the cases, whereas penetrating traumas were seen in 9.47% (n=6). Traffic accidents were the most common cause in blunt trauma cases (66.07%), whereas pointed and sharp-edged weapon injuries were the most common in penetrating traumas (83.33%). The most common thorax pathology is pulmonary contusion (75%) in blunt traumas and hemopneumothorax in penetrating traumas (66.66%). When the groups were analyzed separately, the most common late-term complication for penetrating traumas was retained hemothorax (66.66%), while pneumonia was the most common (41.07%) in blunt trauma cases. Video-assisted thoracoscopic surgery was performed in seventeen patients with retained post-traumatic hemothorax and thoracotomy was performed in eight cases. Seven patients with post-traumatic empyema underwent thoracoscopy, and four patients underwent decortication with thoracotomy. Six of the patients who developed late-term complications died. The mortality rate is 9.67%. Pneumonia was detected as a late complication type in 83.33% of cases with mortality.
CONCLUSION: It will be appropriate for the physicians who are interested in trauma to determine the treatment modalities of the patients by considering many factors such as the age of the patient and the trauma type in terms of the late complications that they will not be able to detect at first glance.