Künt Dalak Yaralanmalarında Cerrahi Tedavi ile Nonoperatif Yaklaşımın Klinik Sonuçlarının Karşılaştırılması

Amaç: Künt travma sonrasında meydana gelen dalak yara- lanmalarında hemodinamik olarak stabil olan ve peritoneal irritasyon bulgularının olmadığı hastalarda nonoperatif yak- laşım günümüzde tercih edilen seçenektir. Radyolojik tet- kiklerdeki gelişmeler ve anjioembolizasyon uygulamasının yardımıyla giderek artan oranlarda başarı sağlanmaktadır. Çalışmamızda kliniğimize künt abdominal travma sonrasında dalak yaralanması tanısıyla başvuran hastalarda uygulanan nonoperatif yaklaşım ile cerrahi tedavinin klinik sonuçlarını karşılaştırmayı amaçladık. Yöntemler: Kliniğimizde künt dalak yaralanması nedeniyle nonoperatif yaklaşım ve cerrahi ile tedavi edilen toplam 56 hasta retrospektif olarak incelendi. Her iki yöntemle de tedavi edilen hastalar yaş, cinsiyet, yaralanma derecesi, hastanede yatış süresi, mortalite, komplikasyon gelişimi, ek yaralanma durumu ve ek hastalık açısından değerlendirildiler. Bulgular: Cerrahi uygulanan grupta toplam 29 (51,78 %) hasta varken cerrahi uygulanmayan grupta 27 ( 48,2 %) hasta vardı. Cerrahi uygulanan grupta yaralanma derecesi cerrahi uygulanmayan gruba göre anlamlı derecede yüksek olarak tespit edildi (p

Comparison of the Clinical Outcome of Nonoperative Management and Surgical Treatment of Blunt Splenic Trauma

Objective: Nonoperative management is the preferred treatment option of blunt splenic injury in appropriate conditions. İncreasing success is achieved with the help of advanced imaging techniques and angioembolization procedure. We aimed to compare clinical outcomes of Nonoperative Management and Surgical Intervention in patients with blunt splenic injury. Methods: Records of 56 patients who were treated by nonoperative management or surgical intervention in our clinic were reviewed retrospectively. Patients were evalu- ated in terms of age, gender, grade of injury, mortality, length of hospital stay, complications, presence of addi- tional injuries and concomitant disease in both groups. Results: There were 29 patients (51.78%) in the surgery group and 27 patients (48.2%) in the nonoperative man- agement group. Grade of injury was determined signifi- cantly higher in surgical treatment group (p<0.001). Addi- tional injury was observed more in the group treated with surgery (p: 0.033). Infectious complication rate was found higher in surgically treated group (<0.001). There was no significant difference between the groups in terms of age, gender, mortality, length of hospital stay, presence of con- comitant disease. Conclusion: Nonoperative management is the appropri- ate method in treatment of blunt splenic injury in patients who were hemodinamically stable and have no signs of peritoneal irritation. Nonoperative management is increas- ingly being implemented in conjunction with improvements in imaging methods. Angioembolization is a treatment that increases the success rate of nonoperative management and implementation of this method in trauma centers is an important target. Surgical intervention is inevitable in cas- es when the nonoperative management is inappropriate.

Kaynakça

1. Schroeppel TJ, Croce MA. Diagnosis and management of blunt abdominal solid organ injury. Curr Opin Crit Care 2007;13:399–404. 2. Millikan JS, Moore EE, Moore GE, Stevens RE. Alterna- tives to splenectomy in adults after trauma. Repair, partial resection, and reimplantation of splenic tissue. Am J Surg 1982;144:711-716. 3. Krause KR, Howells GA, Bair HA, et al. Nonoperative man- agement of blunt splenic injury in adults 55 years and older: a twenty-year experience. Am Surg 2000;66:636-640. 4. Bain IM, Kirby RM. 10 year experience of splenic injury. An increasing place for conservative management after blunt trauma. Injury 1998;29:177-182. 5. Watanabe S, Ishi T, Kamachi M, Takahashi T. Computed to- mography and nonoperative treatment for blunt abdominal trauma. Jpn J Surg 1990;20:56-63. 6. Olthof DC, Joosse P, van der Vlies CH, et al. Prognostic fac- tors for failure of nonoperative management in adults with blunt splenic injury: a systematic review. J Trauma Acute Care Surg 2013;74:546-557. 7. Moore EE, Cogbill TH, Jurkovich GJ, et al. Organ in- jury scaling: spleen and liver (1994 revision). J Trauma 1995;38:323-324. 8. Tan KK, Chiu MT, Vijayan A. Management of isolated splen- ic injuries after blunt trauma: an institution’s experience over 6 years. Med J Malaysia 2010;65:304-306. 9. Miller PR, Chang MC, Hoth JJ, et al. Prospective trial of angiography and embolization for all grade III toV blunt splenic injuries: nonoperative management success rate is significantly improved. Am Coll Surg 2014;218:644–648. 10. Velmahos GC, Zacharias N, Emhoff TA, et al. Management of the most severely injured spleen: a multicenter study of the Research Consortium of New England Centers for Trauma (ReCONECT). Arch Surg 2010;145:456–460. 11. Peitzman AB, Heil B, Rivera L, et al. Blunt splenic injury in adults: Multiinstitutional Study of the Eastern Association for the Surgery of Trauma. J Trauma 2000;49:177-187. 12. Dehli T, Bagenholm A, Trasti NC, et al. The treatment of spleen injuries: a retrospective study. Scand J Trauma Re- susc Emerg Med 2015;23:85. 13. Okuş A, Sevinç B, Ay S, et al. Conservative management of abdominal injuries. Ulus Cerrahi Derg 2013;29:153-157. 14. Soo KM, Lin TY, Chen CW, et al. More becomes less: management strategy has definitely changed over the past decade of splenic injury- a nationwide population-based study. Biomed Res Int 2015;2015:124969. 15. Pachter HL, Guth AA, Hofstetter SR, Spencer FC. Changing patterns in the management of splenic trauma: the impact of nonoperative management. Ann Surg 1998;227:708-719. 16. Feliciano DV, Bitondo CG, Mattox KL, et al. A four-year experience with splenectomy versus splenorrhaphy. Ann Surg 1985;201:568-575.

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