Çocuklarda Genitoüriner Sistem Travmaları

Yıl 2014, Cilt: 8 Sayı: 4, 186 - 191, 01.04.2014

Bilge Karabulut Fatma Özcan Müjdem Nur Azılı Atilla Şenaylı Fatih Akbıyık Ervin Mambet Emrah Şenel Yusuf Ziya Livanelioğlu Tuğrul Tiryaki

Öz

Amaç: Bu çalışma ile genitoüriner sistem (GÜS) travmalarının oluş mekanizması, tedavi yaklaşımları ve uzun dönem izlem sonuçları değerlendirilerek renal travma (RT) üzerine etki eden faktörlerin belirlenmesi hedeflendi.Gereç ve Yöntemler: Şubat 2010 ile Temmuz 2012 tarihleri arası GÜS travması geçiren hastaların dosyaları geriye dönük olarak incelenerek yaş, cinsiyet, travma tipi ve şiddeti, ek travma varlığı, takip, tedavi açısından verileri toplandı. RT’ler Travma Organ Şiddet Ölçeğine göre grade 4 ve 5 olanlar şiddetli, diğerleri şiddetli olmayan olarak ayrıldı. Grade 2 ve üzeri travma skoru olanlar böbrek fonksiyonu açısından sintigrafik olarak değerlendirildi.Bulgular: Yaşları ortalama 8.82±3.83 (ortanca 8.5y) olan 21’i erkek, 13’ü kız 34 olgu değerlendirmeye alındı. RT 22 olguda, ekstrarenal GÜS travması 12 olguda mevcuttu. Araç dışı trafik kazası (ADTK) 11, araç içi trafik kazası (AİTK) 4, yüksekten düşme (YD) 17 ve patlama sonrası yaralanma 2 olguda tespit edildi. RT’lerden sadece 4’ü (%18) grade 4 ve 5 idi. 13 renal ve 12 ekstrarenal olguda hematüri mevcuttu. RT hastalarının 7’si izole iken 15’inde ise ek travma mevcuttu. RT’lerin 15’i sağ, 7’si sol lokalizasyonluydu. Grade 2 ve üzeri renal travması olan 8 hastadan 4’ünde sintigrafide böbrek fonksiyonlarında düşme tespit edildi. Şiddetli RT’si olan 2 hastada ekspanse olan perirenal koleksiyon nedeni ile jj kateter takılırken, ekstarenal travması olan 9 hastaya operasyon yapıldı. Ekstrarenal yaralanmalarda daha fazla operasyon ihtiyacı ve hematüri tespit edildi. ADTK’larda RT oranları düşük, ekstrarenal ürogenital yaralanmaların oranı yüksek, AİTK’da ve YD’de ise bunun tam tersi geçerliydi. Şiddetli RT’lerde yatış süresi, hematüri, operasyon ihtiyacı, böbrek fonksyonlarında düşme, sol RT oranı, hafif-orta RT’lere göre anlamlı derecede yüksek ayrıca sol RT’lerde böbrek fonksyonlarında düşme sağ RT’lere göre anlamlı derecede yüksek bulundu. Diğer parametreler açısından gruplar arası fark tespit edilmedi.Sonuç: Çocuklarda YD ve AİTK’larında daha fazla oranda RT gerçekleşmektedir. Bu yüzden bu tip travmalarda RT olacağı akılda tutulup buna göre tetkikler planlanmalıdır.

Anahtar Kelimeler

Travma, Ürogenital sistem

Genitourinary System Trauma in Children

Öz

Objective: Patients who suffered from blunt trauma to the genitourinary system (GUS) were evaluated retrospectively for factors related to renal trauma (RT).Material and Methods: Information (age, gender, type and severity of trauma, presence of additional organ injury, follow-up and treatment data) of patients who had experienced GUS trauma between February 2010 and July 2012 were collected from the patient charts. Grade 4 and 5 RT’s were recorded as severe according to the trauma organ severity scale and RT’s above grade 2 were investigated using DMSA scintigraphy. Results: A total of 34 patients consisting of 21 males and 13 females (mean age 8.82) were reviewed. There were 22 cases of RT and 12 cases of extrarenal GUS trauma. There were also 11 Vehicle out Traffi c Accidents (VOTA), 4 Vehicle in Traffi c Accidents (VITA), 17 Falling from Height (FFH), and 2 explosion injury cases were detected. Grade 1 and 2 RT’s were most common but 4 patients (18%) had grade 4 and 5 RT. Hematuria was present in 13 renal and 12 extrarenal cases. The RT was isolated in 7 and together with additional organ injury in 15 cases. The location was the right side in 15 and the left side in 7 RT cases. There were 8 patients who had grade 2 and higher grades of injury and renal scintigraphy revealed decreased function in 4 of these children. A JJ stent was inserted for an expanding perirenal collection in 2 patients. Surgery was required for 9 patients who had exrarenal trauma. The rates of hematuria and surgery were higher in the extrarenal trauma group. The RT rate was low and the extrarenal GUS trauma rate high in the VOTA group while the opposite was true in the VITA and FFH groups. Hospitalization time, hematuria, need for surgery, scintigraphy results revealing decreased renal function, and left RT rates were signifi cantly higher in the severe RT group compared with the non-severe RT group. Scintigraphy results revealing decreased renal function rates were also more common in left RT cases when compared with right RT cases. There was no difference in terms of other parameters. Conclusion: RT rates are higher in children with FFH and VITA so appropriate studies are required

Anahtar Kelimeler

Trauma, Urogenital system

Kaynakça

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