TRAVMAYA SEKONDER TÜP TORAKOSTOMİ/ TORAKOTOMİ UYGULANAN HASTALARDA EŞ ZAMANLI GÖRÜLEN KARIN YARALANMALARI VE YÖNETİMİ

Amaç Toraks abbreviated injury scale skoru 2 ve üzeri torakoabdominal yaralanmalarda uygulanan tedavi yaklaşımı ve sonuçlarını paylaşarak literatüre katkı sunmak. Gereç ve Yöntem Çalışma Ocak 2017-Aralık 2020 tarihleri arasında Yozgat Şehir Hastanesi’nde retrospektif olarak gerçekleştirildi. Travma sonrası tüp torakostomi veya torakotomi yapılmış hastalar tespit edildi. Ardından eş zamanlı karın organ yaralanması ve diyafragma yaralanması olan 18 yaşından büyük hastalar belirlendi. Hastaların demografik özellikleri, labaratuvar değerleri, görüntüleme raporları, uygulanan tedavi yöntemleri, perioperatif verileri hastane elektronik kayıtlı hasta bilgilerinden elde edildi. Bulgular Toraks abbreviated injury scale skoru 2 ve üzeri olan toplam 119 hastanın 23’ünde (% 19,3) torakoabdominal yaralanma saptandı. Torakoabdominal yaralanmalarda toraksa yönelik girişimlerin 19’unu (% 82,6) tüp torakostomi ve 4’ünü (% 17,4) torakotomi oluşturuyordu. Başlangıçta tüp takılan hiçbir hastada torakotomi endikasyonu oluşmadı ve tüp torakostomi yeterli bir tedavi oldu. Tüm torakoabdominal travmaların laparotomi oranı ise % 44,8 ’idi. Cerrahi tedavinin anlamlı bir şekilde penetran yaralanmalarda daha sık tercih edildiği görüldü. Dalak (% 35) ve karaciğer (% 32,5) sırasıyla en sık yaralanan organlardı. Solid organ yaralanmaları toplam yaralanan organların % 74,2’ini oluşturuyordu ve bunların % 76’sında konservatif tedavi uygulandı. Diafragma ve içi boş organ yaralanmalarının tamamında cerrahi tedavi yapıldı. Toplam iki hastada (% 8,7) ölüm görüldü ve bu vakalar torakotomi uygulanan hastalardı. Sonuç Torakoabdominal travmaların yönetimi travmanın kaynağına, hastanenin donanımına ve cerrahın deneyimine göre değişebilir. Penetran yaralanmalarda torakotomi ve laparotomi oranları daha yüksektir. Künt yaralanmalarda tüp torakostomi ve konservatif tedavi genellikle yeterli olmaktadır ve ikinci basamak bir hizmet hastanesinde de başarıyla uygulanabilir.

Anahtar Kelimeler:

Travma, Karın yaralanması, Tüp torakostomi, Torakotomi

MANAGEMENT OF CONCURRENT ABDOMINAL INJURIES IN PATIENTS WHO UNDERWENT THORACOSTOMY/THORACOTOMY SECONDARY TO TRAUMA

Objective To contribute to the literature by sharing the treatment approach and results of thoracoabdominal injuries with a thorax abbreviated injury scale score of 2 or above. Materials and Methods The study was carried out retrospectively at Yozgat City Hospital between January 2017 and December 2020. Patients who underwent tube thoracostomy or thoracotomy after trauma were identified. Subsequently, patients older than 18 years of age with concurrent abdominal organ injury and diaphragmatic injury were identified. The demographic characteristics, laboratory values, imaging reports, treatment methods, and perioperative data were obtained from the electronic recorded patient information of the hospital. Results Thoracoabdominal injuries were detected in 23 (19.3%) of 119 patients with a thorax abbreviated injury scale score of 2 or above. In thoracoabdominal injuries, 19 (82.6%) of the attempts to the thorax comprised tube thoracostomy, and 4 (17.4%) thoracotomy. Thoracotomy was not indicated in any of the patients who had a tube inserted at the beginning, and tube thoracostomy was a sufficient treatment. The laparotomy rate of all thoracoabdominal traumas was 44.8%. Surgical treatment was significantly more preferred in penetrating injuries. Spleen (35%) and liver (32.5%) were the most frequently injured organs, respectively. Solid organ injuries comprised 74.2% of the total injured organs, and conservative treatment was applied in 76% of these cases. Surgical treatment was performed in all diaphragm and hollow organ injuries. Death occurred in two patients (8.7%) in total and these cases were patients who underwent thoracotomy. Conclusion Management of thoracoabdominal trauma vary depending on the source of the trauma, the hospital's equipment, and the surgeon's experience. Thoracotomy and laparotomy rates are higher in penetrating injuries. Tube thoracostomy and conservative treatment are usually sufficient in blunt traumas and can be successfully applied in secondary service hospitals.

Keywords:

Trauma, Abdominal injury, Tube thoracostomy, Thoracotomy,

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