Yener YÖRÜK, Y Altemur KARAMUSTAFAOGLU, Taner TARLADAÇALIŞIR

Factors affecting mortality in traumatic diaphragmatic ruptures

Amaç: Bu çalışmada diyafram rüptürü nedeni ile cerrahi uygulanan hastalarda mortaliteyi ekileyen olası faktörler araştırıldı.Çalışmaplanı:Mayıs 1997 - Mayıs 2009 tarihleri arasında toplam 30 hasta (27 erkek, 3 kadın; ort. yaş 42.6 yıl; dağılım 16-88 yıl) diyafram rüptürü nedeni ile kliniğimizde ameliyat edildi. Hastalar mortaliteyi etkileyen olası faktörler açısından retrospektif olarak değerlendirildi. Yirmi iki hastaya acil cerrahi girişim ilk yedi günde uygulandı. Diğer altı hasta latent fazda ve iki hasta obstrüktif fazda ameliyat edildi.Bul gu lar: Dokuz hastaya torakotomi, dokuz hastaya laparotomi ve 12 hastaya torakotomi ve laparotomi yapıldı. Sekiz hastaya eksploratif laparotomi ile tanı konuldu. Hastanede kalış süresi ortalama 12 gün (1-50 gün) idi. Sekiz hastada morbidite (%27) görülür iken, yedi hastada (%23) mortalite görüldü. Beş hastada eşlik eden yaralanma bulunamaz iken, 25 hastada eşlik eden yaralanmalar vardı. Bu hastaların 16'sında (%53) eşlik eden yaralanmalar için ek cerrahi girişimler gerekti. İleri yaş (p=0.020) ve daha uzun süre yoğun bakım ihtiyacı olması (p=0.020) mortaliteyi negatif yönde etkileyen faktörler olarak bulundu.So nuç: Eşlik eden organ yaralanmaları morbidite ve mortaliteyi etkileyen ana prognostik faktördür. İleri yaş ve travmatik diyafram rüptürüne eşlik eden organ yaralanması olan hastaların mekanik ventilatörden erken ayrılması, agresif tedavi ve yakın takibi, morbidite ve mortaliteyi azaltabilir

Travmatik diyafragma rüptürlerinde mortaliteyi etkileyen faktörler

Background: This study aims to investigate possible factors affecting mortality in patients with traumatic diaphragmatic ruptures. Methods: Between May 1997 and May 2009 a total of 30 patients (27 males, 3 females; mean age 42.6 years; range 16 to 88 years) were operated in our clinic with a diagnosis of traumatic diaphragmatic rupture. The patients were evaluated retrospectively in terms of possible factors affecting mortality. Emergency surgery was performed 22 patients within the first seven days. Other two patients were operated in the latent phase and six patients were operated in the obstructive phase. Results: Thoracotomy was performed in nine patients, laparotomy in nine patients and thoracotomy + laparotomy in 12 patients. Eight patients were diagnosed by explorative laparotomy. The mean duration of hospitalization was 12 days (range, 1-50 days). Morbidity was observed in eight patients (27%), while mortality was seen in seven patients (23%). Five patients had no associated pathology, while various associated pathologies were observed in 25 patients. Additional surgical interventions were required for associated pathologies in 16 of these patients (53%). Older age (p=0.020) and need for longer length of stay in the intensive care unit (p=0.020) were found to be negative prognostic factors affecting mortality. Conclusion: Associated organ injuries are the main prognostic factors which affect morbidity and mortality. Early weaning from mechanical ventilation, aggressive treatment and close follow-up of patients with elderly and those with organ injuries associated with traumatic diaphragmatic ruptures may reduce morbidity and mortality

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