Dalak travmasý - I. Basamak Travma Merkezi’ndeki deneyimimiz

AMAÇ
Non-operatif tedavinin dalak travmalý hastalar üzerindeki etkilerini belirlemek üzere, I. Basamak Travma Merkezimizde Ocak 2007 ile Haziran 2008 tarihleri arasýnda retrospektif bir çalýþma yürütüldü.
GEREÇ VE YÖNTEM
Hasta demografisi, dalak yaralanmasý biçimi, bilgisayarlý tomografi (BT) evrelemesi, kan transfüzyon gereksinimi, cerrahi bulgular, hastanede kalýþ ve takip ile ilgili bilgiler toplandý. Splenik yaralanmanýn kanýtý olarak ve yaralanmanýn evresini belirlemek üzere, karýn ultrasonografisi ve BT tarama sonuçlarý kullanýldý. Hastalar splenektomi ve non-operatif gruplarýna ayrýldý. Bulgular non-parametrik Mann-Whitney U testiyle analiz edildi.
BULGULAR
Altmýþ yedi hasta çalýþmaya alýndý. Evre I yaralanmasý olan bütün hastalarla evre II yaralanmasý bulunan 13 hastanýn 12’si non-operatif olarak tedavi edilirken, evre III 16 hastanýn 9’u, evre IV 14 hastanýn 12’si ve evre V bütün hastalar cerrahi yöntemle tedavi edildi. Bu nedenle, ne kadar yüksek yaralanma derecesi söz konusu ise o kadar çok operatif tedavi gerçekleþti. Operatif grubun ortalama Yaralanma Þiddet Skoru (20,12), non-operatif grubun Yaralanma Þiddet Skorundan (11,9) anlamlý þekilde daha yüksek bulundu (p=0,001). Operatif ve non-operatif gruplardaki ortalama hastane kalýþlarý, sýrasýyla 12,8 ve 8,3 gün idi.
SONUÇ
Dalak travmasýnýn non-operatif tedavisi kabul edilebilir sonuçlarla uygulanabilmektedir.

Splenic trauma - our experience at a level I Trauma Center

BACKGROUND
A retrospective study was performed to identify the effect of non -operative management on splenic trauma patients and its implications at our Level I Trauma Centrer between January 2007 and June 2008.
METHODS
Data regarding patient demography, mode of splenic injury, computerized tomography (CT) grading, blood transfusion requirement, operative findings, hospital stay, and follow-up were collected. The results of abdominal sonography and CT scan were utilized as proof of splenic injury and to determine the grade of injury. Subjects were divided into splenectomy and non-operative groups. Results were analyzed using non-parametric Mann-Whitney U tests.
RESULTS
Sixty-seven patients were enrolled in this study. All patients with grade I injury and 12 of 13 patients with grade II injury were managed non-operatively, whereas 9 of 16 patients with grade III injuries, 12 of 14 patients with grade IV injuries and all patients with grade V injuries were managed operatively. Thus, the higher the grade of injury, the greater the likelihood of operative management. The mean Injury Severity Score of the operative group was 20.12, significantly higher (p=0.001) than in the non-operative group, at 11.9. Mean hospital stays in the operative and non-operative groups were 12.8 and 8.3 days, respectively.
CONCLUSION
Non-operative management of splenic trauma can be performed with an acceptable outcome.