Ulus Travma Acil Cerrahi Derg. 2006; 12(1): 35-42

Künt karaciðer travmasýnda uyguladýðýmýz cerrahi yöntemlerin deðerlendirilmesi

Sadullah Girgin, Ercan Gedik, Ýbrahim Halil Taçyýldýz
Dicle Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Diyarbakýr, Türkiye

AMAÇ
Künt karaciðer travmasý nedeniyle ameliyat edilen hastalar, cerrahi yöntem, mortalite ve morbidite açýsýndan deðerlendirildi.
GEREÇ VE YÖNTEM
Künt karaciðer travmasý nedeniyle ameliyat edilen 159 hasta (116 erkek; 43 kadýn; ort. yaþ 33.6; daðýlým 15-67) travma etkeni, karaciðer yaralanma þiddeti, taný yöntemleri, yandaþ yaralanmalar, tedavi þekli, mortalite ve morbidite yönünden retrospektif olarak incelendi. Küçük karaciðer yaralanmalarýnda (evre I ve II) minör tedavi teknikleri uygulandý. Büyük karaciðer yaralanmasý (evre III, IV, V) olan 40 hastaya debridman, selektif ligasyon, omental tamponad (DSO), 12 hastaya rezeksiyonel debridman ve Pringle manevrasý ile birlikte karaciðer içinde kanayan damarlarýn direkt kontrolü (RD), 23 hastaya derin matress sütür (DMS) ve 9 hastaya perihepatik packing (PP) uygulandý.
BULGULAR
Travma oluþturan etkenler 102 hastada trafik kazasý, 43 hastada yüksekten düþme ve 14 hastada darp idi. Yüzelli dokuz hastaný n 84'ünde büyük ve 75'inde küçük karaciðer yaralanmasý mevcuttu. Yandaþ organlarda yaralanma 104 hastada vardý ve en sýk dalak yaralanmasý saptandý. Ortalama kan transfüzyonu miktarý DSO'da 4.3 ünite, DMD'de 6.2 ünite, RD'de 5.5 ünite ve PP'de 9.5 ünite idi. Karaciðer onarýmý için geçen ortalama cerrahi süre, DSO, RD, DMS ve PP için 34.7, 38.1, 26 ve 18.2 dk idi. Karaciðer yaralanmasýna baðlý komplikasyonlar sonucu DMD grubundaki morbidite oranýnýn, DSO ve RD gruplarý na göre daha yüksek olduðu belirlendi ve sonuç istatistiksel anlamlýydý (p<0.001). Büyük karaciðer yaralanmalý hastalarý n %29.4'ü, küçük karaciðer yaralanmalý hastalarýn %12'si kaybedildi. Mortalite oraný %21.3'tü.
SONUÇ
Künt karaciðer travmasýnda uygulanan DSO ve RD yöntemleri, kan transfüzyonu miktarýný ve ameliyat süresini artýrmamýþtýr ve DMD yöntemi ile tedavi edilen gruba göre düþük mortalite ve morbidite oranýna sahiptir.

Anahtar Kelimeler: Karýn yaralanmalarý, debridman; hematom/etyoloji/mortalite/cerrahi; karaciðer/yaralanma; karaciðer hastalýðý/etyoloji/mortalite/cerrahi; dikiþ teknikleri; retrospektif calýþma; vena kava inferior.

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Evaluation of surgical methods in patients with blunt liver trauma

Sadullah Girgin, Ercan Gedik, Ýbrahim Halil Taçyýldýz
Department Of General Surgery Medicine Faculty Of Dicle University, Diyarbakýr, Turkey

BACKGROUND
We evaluated the surgical methods, morbidity and mortality in patients who had surgery for blunt liver trauma.
METHODS
We retrospectively reviewed 159 patients (116 males, 43 females; mean age 33.6; range 15 to 67 years) with blunt hepatic trauma regarding the cause and severity of liver injury, diagnostic procedures, associated injuries, management, morbidity, and mortality. Simple hepatorrhaphy was done in minor liver injuries (Grade I, II). To manage severe liver trauma (Grade III-V), debridement, selective hepatic artery ligation and omentum packing of the laceration (DSO) in 40; resectional debridement (RD) with direct control of bleeding vessels within the liver by the Pringle maneuver in 12; deep matress suture (DMS) in 23; and perihepatic packing (PP) in 9 patients were performed.
RESULTS
The causes of trauma were motor vehicle accidents in 102, falls from height in 43 and violence induced blunt trauma in 14 patients. Among 159 patients, 84 had severe liver injuries and 75 had minor liver injuries. Associated organ injuries were present in 104 patients and splenic injury was the most common. Mean units of blood transfusions in DSO, DMS, RD and PP were 4.3, 6.2, 5.5 and 9.5 respectively. Mean time for liver surgery in DSO, RD, DMS and PP were 34.7, 38.1, 26 and 18.2 minutes respectively. Morbidity rate was higher in DMS group than in DSO and RD groups, and the difference was statistically significant (p<0.001). Twenty-five patients (29.4%) died of severe liver injuries and 9 (12%) died of minor liver injuries. The overall mortality rate was 21.3%.
CONCLUSION
DSO, and RD methods don’t increase operation time and amount of blood transfusion. They cause less morbidity and mortality when compared to DMS.

Keywords: Abdominal injuries, debridement; hematoma/etiology/mortality/surgery; liver/injuries; liver diseases/etiology/mortality/surgery; suture techniques; retrospective studies; vena cava inferior.

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