HEMODYNAMIC STABILITY IS THE MOST IMPORTANT FACTOR IN NONOPERATIVE MANAGEMENT OF BLUNT SPLENIC TRAUMA

Since 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.

HEMODÝNAMÝK STABÝLÝTE KÜNT DALAK TRAVMASININ NONOPERATÝF TEDAVÝSÝNDE EN ÖNEMLÝ FAKTÖRDÜR

Ocak 1998'den itibaren kliniðimizde, künt dalak yaralanmalý seçilmiþ çocuk ve eriþkin olgularda non-operatif tedavi yöntemini tercih ediyoruz. Ocak 1998-Mayýs 2000 tarihleri arasýnda künt dalak yaralanmasý nedeniyle kliniðimize baþvuran 26 olgudan 20'sine, yaralanma derecesi ve yaþ sýnýrlamasý dikkate alýnmaksýzýn hemodinamik stabiliteyi esas alan non-operatif tedavi protokolümüzü uyguladýk. Non-operatif tedavi uygulanan hastalara tanýsal amaçlý bilgisayarlý tomografi (BT) çekildi. Künt dalak yaralanmasý olan hastalarýmýzdaki non-operatif tedavi oraný %76.9' dur (çocuk hastalarda; %83.3, eriþkin hastalarda: %71.4). Non-operatif tedavi uygulanan olgularýmýzda komplikasyon ve mortalite gözlenmedi. Preoperatif deðerlendirme sonucu acil cerrahi giriþim uygulanan 6 hastada yandaþ yaralanmalar mevcuttu. Operatif ve non-operatif tedavi uygulanan gruplar arasýnda yaþ açýsýndan anlamlý bir fark bulunmadý (p=0.421). Ameliyat edilen hastalardaki ortalama aperatif dalak yaralanma derecesi 3 iken, non-operatif tedavi uygulanan hastalardaki BT ile deðerlendirilen ortalama dalak yaralanma derecesi 2.6 idi (p=0.572). Hastanede kalýþ 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). Sonuçlarýmýza göre, yaralanmanýn bilgisayarlý tomografi ile derecelendirilmesi ve yaþ sýnýrlamasý dikkate alýnmaksýzýn, non-operatif tedavi uygulanacak hastalarýn seçiminde hemodinamik stabilite esastýr.