. 2000; 6(4): 275-280 | |||
HEMODYNAMIC STABILITY IS THE MOST IMPORTANT FACTOR IN NONOPERATIVE MANAGEMENT OF BLUNT SPLENIC TRAUMANeşet Köksal1, Mehmet Ali Uzun1, Tolga Müftüoğlu1Haydarpaşa Numune Teaching and Research Hospital, Director of 2nd General Surgery, İstanbul, TurkeySince January 1998, non-operative management of blunt splenic trauma has become the preferred method for the selected paediatric and adult patients in our clinic. Of the 26 patients who were admitted to our clinic because of blunt splenic trauma between January 1998 and May 2000, 20 were elected for non-operative management according to our protocol which was primarily based on hemodynamic status regardless of the age and grading of the injury. Diagnostic computed tomography (CT) was obtained in the patients with non-operative management. Non-operative management rate was 76.9% for patients with blunt splenic trauma (83.3% and 71.4% for the paediatric and adult patients, respectively). All of these cases were managed conservatively without any complication and no mortality was observed. Six patients required emergent surgical exploration based on preoperative evaluation. In all of these 6 cases, associated injuries were present. No significant differences were found with regard to the age of operative and non-operative management groups (p=0.421). The mean operative splenic injury grade was 3 in the patients who underwent surgery, and the mean injury grade based on CT scan was 2.6 in the patients who were managed conservatively (p=0.572). The mean duration of hospitalisation in the patients with operative and non-operative management groups were 7.6 and 8.6 days, respectively (p=0.572). The mean unit of blood transfusion in the patients with operative and non-operative management groups were 1.1 and 0.6, respectively (p=0.453). Our data revealed that hemodynamic stability is the most important factor which could effect the selection of patients for non-operative management outcome regardless of the patient age and computed tomography scan grading of the injury. Keywords: SPLENIC TRAUMA, NONOPERATIVE MANAGEMENTHEMODİNAMİK STABİLİTE KÜNT DALAK TRAVMASININ NONOPERATİF TEDAVİSİNDE EN ÖNEMLİ FAKTÖRDÜRNeşet Köksal1, Mehmet Ali Uzun1, Tolga Müftüoğlu1Haydarpaşa Numune Teaching And Research Hospital, Director Of 2nd General Surgery, İstanbul, TurkeyOcak 1998'den itibaren kliniğimizde, künt dalak yaralanmalı seçilmiş çocuk ve erişkin olgularda non-operatif tedavi yöntemini tercih ediyoruz. Ocak 1998-Mayıs 2000 tarihleri arasında künt dalak yaralanması nedeniyle kliniğimize başvuran 26 olgudan 20'sine, yaralanma derecesi ve yaş sınırlaması dikkate alınmaksızın hemodinamik stabiliteyi esas alan non-operatif tedavi protokolümüzü uyguladık. Non-operatif tedavi uygulanan hastalara tanısal amaçlı bilgisayarlı tomografi (BT) çekildi. Künt dalak yaralanması olan hastalarımızdaki non-operatif tedavi oranı %76.9' dur (çocuk hastalarda; %83.3, erişkin hastalarda: %71.4). Non-operatif tedavi uygulanan olgularımızda komplikasyon ve mortalite gözlenmedi. Preoperatif değerlendirme sonucu acil cerrahi girişim uygulanan 6 hastada yandaş yaralanmalar mevcuttu. Operatif ve non-operatif tedavi uygulanan gruplar arasında yaş açısından anlamlı bir fark bulunmadı (p=0.421). Ameliyat edilen hastalardaki ortalama aperatif dalak yaralanma derecesi 3 iken, non-operatif tedavi uygulanan hastalardaki BT ile değerlendirilen ortalama dalak yaralanma derecesi 2.6 idi (p=0.572). Hastanede kalış süresi aperatif grupta 7.6, non-operatif grupta 8.6 gün idi (p=0.572). Operatif tedavi uygulanan hastalardaki ortalama kan transfüzyonu 1.1 ünite iken, non-operatif tedavi uygulanan hastalarda 0.6 ünite idi (p=0.453). Sonuçlarımıza göre, yaralanmanın bilgisayarlı tomografi ile derecelendirilmesi ve yaş sınırlaması dikkate alınmaksızın, non-operatif tedavi uygulanacak hastaların seçiminde hemodinamik stabilite esastır. Anahtar Kelimeler: DALAK TRAVMASI, NON-OPERATİF TEDAVİNeşet Köksal, Mehmet Ali Uzun, Tolga Müftüoğlu. HEMODYNAMIC STABILITY IS THE MOST IMPORTANT FACTOR IN NONOPERATIVE MANAGEMENT OF BLUNT SPLENIC TRAUMA. . 2000; 6(4): 275-280 |
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