Ulus Travma Acil Cerrahi Derg. 2012; 18(1): 37-42 | DOI: 10.5505/tjtes.2012.89137

Hemodinamik açýdan stabil, göðüs altý veya ön karýn bölgesinde býçak yaralanmasý olan hastalarda tanýsal peritoneal lavaj

Shahriar Hashemzadeh, Kamran Mameghani, Rohollah F Fouladi, Elnaz Ansari
Tebriz Týp Bilimleri Üniversitesi, Göðüs Cerrahisi Anabilim Dalý, Tebriz, Ýran

AMAÇ
Torakoabdominal býçak yaralanmalarý bulunan ve hemodinamik açýdan stabil olan hastalarýn tedavisi halen tartýþmalýdýr. Bu çalýþmada, bu tip hastalardaki tanýsal peritoneal lavaj (TPL) sývýsýndaki eritrosit sayýsýndaki optimal deðer tartýþýldý.
GEREÇ VE YÖNTEM
Hemodinamik yönden stabil ve torakoabdominal býçak yaralanmasý olan 388 hasta çalýþmaya alýndý. Laparotomi yönünden açýk bir endikasyona sahip olmayan olgularda, peritoneal kavite 1000 cc serum fizyolojikle yýkandý ve akýntý sývýsýndaki eritrosit sayýsý analiz edildi. Karýn yaralarýnda >100,000/mm3 ve alt göðüs yaralarýnda >10,000/mm3 seviyesinde eritrosit sayýsý eksploratuvar laparotomi (konvansiyonel yaklaþým) için endikasyonlar olarak kabul edildi. Geriye dönük yapýlan analizde, eritrosit sayýsý için yeni eþik deðerler hesaplandý.
BULGULAR
Konvansiyonel yaklaþýmýn duyarlýlýðý ve özgüllüðü, sýrasýyla %90 ve %84 olmuþtur. Karýn yaralarýnda >15,000/mm3 ve alt göðüs yaralarýnda >25,000/mm3 seviyesindeki eritrosit sayýsý, operasyon gereksinimi olan veya olmayan hastalarýn ayýrt edilmesinde, sýrasýyla %94 ve %96’lýk bir duyarlýlýk ve özgüllük ile en uygun eþik deðeri bulundu.
SONUÇ
Tanýsal peritoneal lavaj sývýsýnda eritrosit sayýsý ile ilgili yeni eþik deðer, torakoabdominal býçak yaralanmalarý bulunan ve hiçbir açýk operasyon endikasyonu bulunmayan TPL hastalarýnýn tedavisine kullanýlabilir.

Anahtar Kelimeler: Torakoabdominal býçak yaralanmalarý, laparotomi; torakotomi; tanýsal peritoneal lavaj; eritrosit.

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Diagnostic peritoneal lavage in hemodynamically stable patients with lower chest or anterior abdominal stab wounds

Shahriar Hashemzadeh, Kamran Mameghani, Rohollah F Fouladi, Elnaz Ansari
Departmnet Of Thoracic Surgery, Tabriz University Of Medical Sciences, Tabriz, Iran

BACKGROUND
Managing hemodynamically stable patients with thoracoabdominal stab wounds is still under dispute. This study aimed at discussing cut-off points of red blood cell (RBC) count in diagnostic peritoneal lavage (DPL) effluent in these patients.
METHODS
Three hundred and eighty-eight patients with thoracoabdominal stab wounds and hemodynamically stable status were enrolled. In cases without a clear indication of laparotomy, the peritoneal cavity was washed out with 1000 ml of normal saline and the effluent fluid was analyzed for RBC count. RBC counts of >100,000/mm3 in abdominal wounds and of >10,000/mm3 in lower chest wounds were considered as indications for exploratory laparotomy (conventional approach). New cut-off points for RBC count were calculated in backward analysis.
RESULTS
Sensitivity and specificity of the conventional approach were 90% and 84%, respectively. RBC counts >15,000/mm3 in abdominal wounds and >25,000/mm3 in lower chest wounds were the best cut-off points in distinguishing patients with and without need of operation, with a sensitivity and specificity of 94% and 96%, respectively.
CONCLUSION
New cut-off points of RBC count in DPL effluent may promote management of patients with thoracoabdominal stab wounds and no obvious indication for operation.

Keywords: Thoracoabdominal stab wounds, laparotomy; thoracotomy; diagnostic peritoneal lavage; red blood cell.

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