Ulus Travma Acil Cerrahi Derg. 2010; 16(4): 339-343

Diyafram yaralanmalarýnda taný süreci ve yönetim: Künt ve penetran travmalý hastalara yaklaþým

Atilla Çelik¹, Ediz Altinli¹, Neset Koksal¹, Kasim Caglayan², Mehmet Ali Uzun¹, Dogan Erdogan¹, Omer Faruk Ozkan^1
1Haydarpaþa Numune Eðitim Ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Ýstanbul
²Kars Devlet Hastanesi, Genel Cerrahi Kliniði, Kars.

AMAÇ
Travmalý hastalarda en sýk gözden kaçan yaralanmalardan birisi diyafram yýrtýðýdýr. Tespit edilmesi halinde tedavi için laparatomi veya torakotomi gerekmektedir. Bu çalýþmanýn amacý, ameliyat öncesinde ve ameliyat esnasýnda tespit edilen diyafram yaralanmalý, hastalarýn tanýsal süreçlerini, mortalite ve morbidite oranlarý eþliðinde deðerlendirmektir.
GEREÇ VE YÖNTEM
Kliniðimize yedi yýllýk süre içinde kabul edilen 16 diyafram yaralanmalý hastada cerrahi giriþim, eþlik eden yaralanmalar, hastanede kalýþ süresi, transfüzyon gereksinimi, mortalite ve morbidite oranlarý retrospektif olarak irdelendi.
BULGULAR
Yedi yýlda 16 hasta diyafram yaralanmasý nedeniyle tedavi edildi. Kadýn/erkek oraný 2/14 idi. Hastalarýn 15’i ameliyat edilirken bir hasta konservatif tedavi edildi.
SONUÇ
Diyafram yaralanmalarý son yýllarda giderek artmaktadýr. Yaralanma þiddeti skoru yüksek hastalarda diyafram yaralanmasý olasýlýðý mutlaka düþünülmelidir.

Anahtar Kelimeler: Algoritm, diyafram yaralanmasý; yaralanma þiddet skoru; yönetim.

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Diagnostic process and management of diaphragmatic injuries: approach in patients with blunt and penetrating trauma

Atilla Çelik¹, Ediz Altinli¹, Neset Koksal¹, Kasim Caglayan², Mehmet Ali Uzun¹, Dogan Erdogan¹, Omer Faruk Ozkan^1
12nd Department Of General Surgery, Haydarpasa Numune Teaching And Research Hospital, Istanbul, Turkey
²Department Of General Surgery, Kars State Hospital, Kars, Turkey

BACKGROUND
Diaphragmatic rupture is one of the most commonly missed injuries in trauma cases. Traditionally, laparotomy or thoracotomy has been the treatment of choice for this condition. We aimed to evaluate the diagnostic process in patients with diaphragmatic injuries (DIs) who were diagnosed with diaphragm rupture during the preoperative or intraoperative course together with morbidity and mortality rates.
METHODS
Sixteen patients with DIs were admitted to our department during the last seven-year period. Surgical procedure, accompanying injuries, duration of hospital stay, transfusion necessity, and morbidity and mortality rates were analyzed retrospectively.
RESULTS
In seven years, 16 patients were treated and followed-up for DI. Female/male ratio was 2/14. Fifteen patients were operated and one was treated conservatively. The mortality rate was 2/16.
CONCLUSION
DIs are being seen with increasing frequency in recent years. In patients with high Injury Severity Score (ISS), probability of DI should be taken into consideration.

Keywords: Algorithm, diaphragm injury; Injury Severity Score; management.

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ATIF KOPYALA