KOLON YARALANMALARININ ACÝL CERRAHÝ TEDAVÝSÝNDE KOLOSTOMÝSÝZ PROSEDÜRLER

Bu çalýþmada 1990-1995 yýllarý arasýndaki 5 yýllýk periyod içinde Ankara Numune Hastanesi Acil Cerrahi Servisinde tedavi edilen 57 travmatik kolon yaralanmak hasta retrospektif olarak incelendi. 57 hastanýn 23'ü (%40) ateþli silah yaralanmasý (ASY), 22'si (%39) delici kesici alet Yaralanmasý (DKAY) ve 12'si de (%21) künt travmaya baðlý kolon yaralanmasý idi. Hastalarýn 17'sinde (%30) sað kolon, 18'inde (%31) transvers kolon ve 22'sinde de (%39) sol kolon yaralanmasý tespit edildi. Hastalarýn 44'üne (%77) primer onarým (primer sütür ve/veya rezeksiyon + anastomoz), 13'üne de (%23) kolostomi uygulandý. Hastalar kolon yaralanmasýnýn lokalizasyonu, eþlik eden organ yaralanmasý, penetran abdominal travma indeksi (PATI), Colonic Injury Severity Scale (CISS), yaralanma ile ameliyat arasýnda geçen süre, hemodinamik durum ve tahmini kaybedilen kan miktarý gibi risk faktörlerine göre deðerlendirildi. Mortalite oraný %44 idi ve hemodinamik instabilite, uzun süre devam eden sok, yaralanma ile ameliyat arasýnda geçen sürede gecikme, yaralanan organ sayýsýnýn fazlalýðý prognozu etkileyen faktörler olarak tespit edildi.

PROCEDURES WITHOUT COLOSTOMY IN THE SURGICAL EMERGENT TREATMENT OF COLONIC INJURIES

In this study; The records of 57 patients with traumatic colon injuries treated at the Ankara Numune Hospital-Emergency Surgery Department during a 5 year period from 1990 to 1995, were retrospectively reviewed. Twenty-three patients of 57 (40%) had gunshot wounds, 22 (39%) had stab-wounds and 12 (21%) had blunt colonic injuries. Right colon injuries were found in 17 patients (30%), transverse colon injuries in 18 patients (31%), and left colon injuries in 22 patients (39%). Primary repair, including suture repair and resection with anastomosis, was performed in 44 patients (77%) and colostomy in 13 (23%). Patients were evaluated according to the risk factors such as location of colonic injury, associated visceral injuries, penetrating abdominal trauma index (PATI), colonic injury severity scale (CISS), the time from injury operation, hemodynamical status and estimated blood loss. Mortality rate was 14% and hemodynamic instability, long acting shock, delaying time between injury and operation, and multiple visceral injuries were found co-efficient factors to prognosis.