Batına Nafiz Kesici Delici Alet Yaralanmaları;131 Olgunun Retrospektif Analizi: Gereksiz Laparatomiler Azaltılabilir mi?Mehmet Akif Üstüner1, Enver İlhan1, Mehmet Yıldırım1, Ahmet Aykas1, Abdullah Şenlikci1, Vermi Değerli2, Hilmi Güngör11İzmir Eği̇ti̇m Ve Araştırma Hastanesi̇,genel Cerrahi̇ Anabi̇li̇m Dalı 2İzmi̇r Eğitim Ve Araştırma Hastanesi,acil Servis Anabilim Dalı
GİRİŞ ve AMAÇ: Kesici delici alet yaralanmaları(KDAY) acil servise sık başvuru nedenlerinden biridir.Biz bu çalışmamızda gereksiz laparatomi oranları pre- operatif tetkik ve muayenelerle azaltılabilir mi sorusuna cevap aradık.
YÖNTEM ve GEREÇLER: xxxxxx Acil Servis Kliniği’ne 2008-2013 yılları arasında kesici delici alet yaralanması ile başvuran hastaların elektronik kayıtları retrospektif olarak incelendi. BULGULAR: Toplam 30 356 hastanın 29 367(%96.7)’si ayaktan tedavi edildi.Bunların 274 (%27.7)’ü Genel Cerrahi Kliniği’ne yatırıldı.Bu hastaların 131(%47.8)’i batına nafiz yaralanmaydı.Opere edilen 120 hasta gerekli laparatomi(terapötik) 30 hasta (%25)Grup A ve gereksiz laparatomi (non terapötik+negatif laparatomi) 90 hasta(%75)Grup B olarak ikiye ayrıldı.A grubunda 8 (%26.7) hastaya torax tüpü takılırken,B grubunda 5 (%5.6) hastaya torax tüpü takıldı.Negatif laparatomi yapılan 2 hastadan birinde rastlantısal mezenter iskemi görülüp segmental ince barsak rezeksiyonu+uç ileostomi uygulanırken,diğerinde enflame apendiks görülerek apendektomi yapıldı.Apendiksin histopatolojisi karsinoid tümör olarak geldi
TARTIŞMA ve SONUÇ: USG ve BT nin negatif olduğu,alkollü,vitalleri stabil,anemisi ve torax travması olmayan genç hastalarda konservatif tedavi güçlü bir seçenek olmalıdır.
Anahtar Kelimeler: Kesici delici alet yaralanmaları, laparatomi, karın duvarı
Penetratıng Stab Wounds To The Abdominal Wall: Retrospective Analysıs Of 131 Cases: Could Unnecessary Laparotomies Be Reduced?Mehmet Akif Üstüner1, Enver İlhan1, Mehmet Yıldırım1, Ahmet Aykas1, Abdullah Şenlikci1, Vermi Değerli2, Hilmi Güngör11Izmır Educatıon And Research Hospıtal Department Of General Surgery 2İzmi̇ Educatıon And Research Hospital, Department Of Emergency Services
INTRODUCTION: : Penetrating stab wounds (PSW) are among the most frequent causes of admissions to the emergency department.The current study attempted to answer the question of whether unnecessary laparotomies could be reduced by preoperative tests and physical examinations
METHODS: The electronic records of patients admitted to the Emergency Service of the Ministry of xxxxxxx between 2008 and 2013 with penetrating stab wounds were retrospectively examined
RESULTS: : 29367 (96.7%) of total 30,356 patients were ambulatory patients. Of these patients, 274 (27.7%) were hospitalized in general surgery clinics. 131 (47.8%) of these patients had abdominal injuries.120 patients who were operated on were divided into two groups as necessary laparotomy (therapeutic) in Group A, which consisted of 30 patients (25%) and unnecessary laparotomy (nontherapeutic+negative laparotomy) in Group B, which consisted of 90 patients (75%).While a thorax tube was inserted to eight patients (26.7%) in Group A, a thorax tube was inserted to five (5.6%) patients in Group B. Accidental mesenteric ischemia was observed in two patients in which negative laparotomy was conducted, and while in one of them segmental small intestinal resection and terminal ileostomy was performed, an inflamed appendix was observed and appendectomy was performed. The histopathology of appendix was consistent with carcinoid tumor.
DISCUSSION AND CONCLUSION: Conservative treatment should be a strong option in young patients who have stable hemodynamic conditions and who have no alcohol intake, or anemia and thoracic trauma, and in which US and CT are negative.
Keywords: Wounds stab, laparotomy, abdominal wall
Mehmet Akif Üstüner, Enver İlhan, Mehmet Yıldırım, Ahmet Aykas, Abdullah Şenlikci, Vermi Değerli, Hilmi Güngör. Penetratıng Stab Wounds To The Abdominal Wall: Retrospective Analysıs Of 131 Cases: Could Unnecessary Laparotomies Be Reduced?. . 2015; 25(3): 143-150
Sorumlu Yazar: Mehmet Akif Üstüner, Türkiye |
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