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

Yıl 2021, Cilt: 28 Sayı: 2, 301 - 308, 15.06.2021

Serdar Kırmızı Süleyman Emre Akın

https://doi.org/10.17343/sdutfd.874071

Öz

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.

Anahtar Kelimeler

Trauma, Abdominal injury, Tube thoracostomy, Thoracotomy

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

Öz

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

Kaynakça

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