OUR CONSERVATIVE MANAGEMENT RESULTS IN BLUNT ABDOMINAL TRAUMA

We analyzed 59 cases of intraabdominal solid organ injury treated at the Surgical Emergency Service of Istanbul Medical School between January 1 996 and January 2001. Fiftysix of these cases suffered blunt and 3 penetrating trauma. Twentythree cases had injuries involving the liver, 14 spleen, 5 kidney, 6 liver and spleen, 6 liver and kidney, 6 spleen and kidney and four liver and kidney. In 4 of splenic and 5 of hepatic injuries Grade IV injuries were detected. Among the cases, 21% were Grade I, 45 % were Grade II, 19 % were Grade III, and 15 % were Grade IV. Associated injuries were: head trauma in 34 cases (57.6 % - Glasgow Coma Score under 7 in 6 rases), thoracic trauma in 19 cases (32 %), pelvic fracture in 6 cases (10%), vertebral compression fracture in 3 cases (5 %). One patient with splenic (Grade III) and hepatic (Grade II) injury, and one patient with Grade IV splenic injury required surgery during close follow-up due to hemodynamic instability. Our failure rate for conservative treatment of solid organ injuries is 3.3 %. Three patients with polytraum in the ICU died (5 % mortality rate). Conservative management in solid organ injuries is gaining more popularity every day. Our wort, and current studies accept physiologic parameters in the follow-up of solid organ injuries. Conservative treatment guided with hemodynamic stability, accounts almost a 98% success rate.

SOLÝD ORGAN YARALANMALARINDA KONSERVATÝF TEDAVÝ SONUÇLARIMIZ

Çalýþmamýzda Ocak 1996 - Ocak 2001 dönemleri arasýnda Ýstanbul Üniversitesi, Ýstanbul Týp Fakültesi Genel Cerrahi Ana Bilim Dalý Acil Cerrahi servisine baþvuran ve intraabdominal solid organ yaralanmasý tespit edilerek konservatif olarak takip ve tedavi edilen 59 hasta prospektif olarak incelendi. 56 olguda künt, 3 olguda penetran travma mevcuttu. Olgulardan 23'ünde karaciðer, 14'ünde dalak, 5'inde böbrek, 6'sýnda karaciðer ve dalak, 4'ünde karaciðer ve böbrek, 6'sýnda dalak ve böbrek, Tinde karaciðer, dalak ve böbrek yaralanmasý tespit edilmiþtir. Dalak yaralanmalarýnýn 4'ü, karaciðer yaralanmalarýnýn 5'i Grade IV þiddetinde yaralanma olup, olgularýn % 21'i Grade 1, % 45'i Grade II, % 19'u Grade 3, % 15'i ise Grade IV yaralanma idi. Yandaþ yaralanma olarak 34 olguda (%57.6) kafa travmasý (6 olguda Glasgow 7 nin altý), 28 olguda (% 47) uzun kemik kýrýðý, 19 olguda (%32) toraks travmasý, 6 olguda (%10) pelvis fraktürü, 3 olguda (%5) ise vertebralarda kompresyon fraktürü saptanmýþtýr. Konservatif tedavide baþarýsýzlýk oraný bir olguda 3.3 olarak gerçekleþmiþtir. Multitravmalý olan ve yoðun bakým ünitesinde takip edilen hastalardan 3'ü (% 5) kaybedilmiþtir. Solid organ yaralanmalarýnýn tedavisinde konservatif yaklaþým giderek daha çok merkezde ve daha çok sayýda hastada uygulanmaktadýr. Bizim çalýþmamýz ve bu konudaki güncel araþtýrmalar, solid organ yaralanmalarýn takibinde fizyolojik parametreleri temel almaktadýr. Ayrýca, yeterli radyolojik verilerle desteklenen, deneyimli bir cerrahi ekip tarafýndan yönetilen konservatif tedavi þeklinin % 98'lere varan baþarý saðladýðý ve hasta seçiminde hemodinamik stabilitenin olmazsa olmaz þart olduðu gösterilmiþtir.