Diyafragma yaralanmaları: Defekt uzunluğunun erken tanı ve mortalitedeki rolü (Deneysel çalışma)

Amaç: Diyafragma rüptürlerinin doğal seyrinde, defekt uzunluğunun erken tanı ve mortalitedeki rolünü araştırmaktır. Yöntem: Çalışma, 18 adet dişi tavşanın kullanıldığı 3 grupta gerçekleştirildi. Bu gruplardan birincisinde 0,5 cm, ikincisinde 1,5 cm ve üçüncüsünde ise 3 cm uzunluğunda posterolateral diyafragma kesisi oluşturuldu. Epigastrik bölgeden intraperitoneal injekte edilen meglumin amidotrizoatın (Urografin®;7 mg/kg) transdiyafragmatik geçişi radyolojik olarak ilk gün 1, 15 ve 60. dakikalarda 3 kez kontrol edildi. Postoperatif takip, klinik ve radyolojik olarak iki hafta sürdürüldü. Bulgular: Erken radyolojik tanı, defektin en büyük olduğu III. grupta (% 83,3) en anlamlı idi. Akciğer grafilerinde ilk gün herhangi bir herniasyon bulgusu görülmedi. Ayrıca grup III’de deneklerin yarısında (% 50) herniasyon bulgusu birinci hafta sonunda saptandı. İkinci hafta sonunda ise sadece I. ve II. gruplarda herniasyon bulgusu vardı. Radyolojik tanı oranı toplam % 55,5 idi. En yüksek tanı oranı % 83,3 ile III. grupta görülürken, grup I ve grup II’de bu oranlar sırasıyla % 33,3 ve % 50 oldu. En yüksek mortalite oranı % 50 ile III. grupta görüldü. Sonuç: Diyafragma rüptürünün boyutu büyüdükçe, erken tanı oranı artmaktadır. Mortalite ile visseral herniasyon arasında çok yakın paralellik olduğu görüldü. Mortalitenin de erken dönemde defekt büyüklüğü ile anlamlı oranda yükseldiği belirlendi.

Diaphragm injuries: The role of size of the defect in the earlier diagnosis and mortality (An experimental study)

Objective: To investigate the role of the defect length during natural course of untreated diaphragm injuries at the time of earlier diagnosis and death in a rabbit model. Methods: This study was performed on total 18 female New Zeland rabbits in 3 groups. In study groups, an one-centimeter to first group, 1.5-cm to second group, and 3-cm to third group with length of posterior phrenotomy incision was made. Diaphragmatic transition of meglumin amidotrizoat (Urografin®;7mg /kg) injected intraperitoneal from epigastric part of abdomen was examined three times on each the first, the fifteenth, and the sixtieth minutes by chest X-ray. Clinical and radiological follow-up were made to all animals at 2 weeks postoperatively. Results: The earlier radiologic diagnosis was statistically significant at group III (83.3%) with the longest defect. No evidence of visceral herniation was seen on radiographic examination first day. Radiographic herniation finding was revealed on half of subject in only the third group (50%) at the first week, but only group I and II at the second week. Radiological diagnosis ratio was 55.5%, totally. Highest diagnosis ratio was 83.3% in group III, but 33.3% and 50% in group I and II. The highest mortality rate (50%) was in group III. Conclusion: The earlier diagnostic rate significantly rises due to length of the diaphragm rupture. Relationship between visceral herniation and mortality is very high. At early period, the death ratio significantly rises due to length of the diaphragm rupture.

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