Trakeobronşiyal yaralanmalar : 15 olguluk bir serinin değerlendirilmesi
Küçük Resim Yok
Tarih
2001
Yazarlar
Melih Kaptanoğlu
Aydın Nadir
Ersin Erbaş
Uğur Gönlügür
Zehra Seyfikli
Kasım Doğan
İlhan Günay
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu makalede 1994-2001 yıllarında trakeobronşiyal yaralanması olan hastaların değerlendirilmesi, tanı ve tedavide karşılaşılan güçlüklerin ve çözümlerinin tartışılması amaçlandı. Trakeobronşiyal yaralanması olan 15 hastanın kayıtları retrospektif olarak incelendi. Hastalar yaralanmanın türü, fizik muayene bulguları, tanı yöntemleri, yaralanmanın lokalizasyonu ve tedavi yöntemleri açısından değerlendirildi. En genç hasta 1, en yaşlısı 58 yaşında, medyan yaş 15 idi. Etiyolojide kunt toraks travmaları %87'lik bir oranla ilk sırada yer almaktaydı. Tanı için 13 hastaya bronkoskopi yapıldı. Bilgisayarlı tomografiyi (BT) kunt toraks travması olgularında rutin olarak uygulanmamaktadır, bu nedenle sadece geç atelektazi ile gelen 2 ve mediastinal amfizemi olan hastalardan 2'sine BT çekilmiştir. Hastaların 5'ine hemen, 5'ine ilk 24 saatte müdahale edilmiştir, 3 hasta konservatif yöntemlerle takip edilirken 2 hasta ise gecikmiş olarak tedavi edilmiştir. Hastaların %62'sinde bronkoplastik teknikler uygulanmıştır. Serimizde mortalite yoktur, iki hastanın ise yaralanmaları ta-nmamamış, bunlardan biri 1. ay, diğeri 3. ayda bronkoplastik tekniklerle onarılmıştır. Serimizdeki hastaların 8'i (%53) 17 yaşın altındaydı. Trakeobronşiyal yaralanma insidansımız, aynı sürede izlenen 1100 (erişkin= 902, çocuk= 198) toraks travmalı hastamız göz önüne alındığında %1.4'tür. Erişkinlerdeki ve çocuklardaki insidans ise ardışık olarak %0.7 ve 4'tür. Özellikle çocuklardaki değer literatüre göre yüksektir. Bunu da trafik ve iş kazalarının ülkemizde yüksek olmasına bağlamaktayız. Bu yaralanmalar %20'ye varan oranlarda atlanabilmektedir ve ortalama 3 ay içinde hastalar geri gelmektedirler. Bronş yaralanması şüphesi devam ettiği sürece bronkoskopi tekrarından çekinilmemelidir. Vasküler ve parenkima hasarının eşlik etmediği, hayati tehlike göstermeyen bronş rüptürlerinde, majör rezeksiyonlardan kaçınılmalı, gerekirse durum stabilleşince bronş rüptürleri gecikmiş olarak onarılmalıdır.
This study is aimed to assess the patients, who had tracheobronchial injury and to discuss the difficulties either in diagnosis or treat-ment, between 1994 and 2001. Records of 15 patients were investigated retrospectively. Etiology of trauma, physical findings, diagnostic measures, location of the injuries and treatment options were evaluated. The youngest patient was l and the oldest one was 58 years old. The median age was 15 years. Blunt trauma was the major etio-logic factor (87%). Bronchoscopy was performed in 13 patients for diagnosis. Computerised tomography (CT) is not performed rou-tinely in blunt thoracic trauma, therefore, it was performed in 4 patients who had late atelectasis (n=2) and mediastinal emphysenıa (n=2). Five of the patients were operated urgently, f ive were operated within 24 hours, three were followed conservatively and lesions in two patients were repaired in a delayed fashion. Bronchoplastic procedures were applied commonly (62%). We had no mortality. Lesions of the two patients were recognised lately and one of them was operated one month, the other was operated three months later by Bronchoplastic techniques. Eight (53%) of the patients in our series were under 17 years. Our tracheobronchial trauma incidence was 1.4% in 1100 (adult=902, pediatric=198) patients who had thoracic trauma at the same period. incidence of tracheobronchial trauma for adults and for pediatric patients were 0.7% and 4 respectively. Particularly, the incidence in pediatric patients is higher than mentioned in the literature and it is probably due to higher rates of traffic and labour accidents in our country. These kind of injuries might be underdiagnosed at a ratio of 20% and most of these patients are admitted to hospital within 3 months. Repeated bronchoscopies should be performed in the suspected cases. Anatomic resections should avoided, in patients who do not have lethal vascular and paranchymal damage. Under these circumstances "delayed repair" should be the procedure of choice,
This study is aimed to assess the patients, who had tracheobronchial injury and to discuss the difficulties either in diagnosis or treat-ment, between 1994 and 2001. Records of 15 patients were investigated retrospectively. Etiology of trauma, physical findings, diagnostic measures, location of the injuries and treatment options were evaluated. The youngest patient was l and the oldest one was 58 years old. The median age was 15 years. Blunt trauma was the major etio-logic factor (87%). Bronchoscopy was performed in 13 patients for diagnosis. Computerised tomography (CT) is not performed rou-tinely in blunt thoracic trauma, therefore, it was performed in 4 patients who had late atelectasis (n=2) and mediastinal emphysenıa (n=2). Five of the patients were operated urgently, f ive were operated within 24 hours, three were followed conservatively and lesions in two patients were repaired in a delayed fashion. Bronchoplastic procedures were applied commonly (62%). We had no mortality. Lesions of the two patients were recognised lately and one of them was operated one month, the other was operated three months later by Bronchoplastic techniques. Eight (53%) of the patients in our series were under 17 years. Our tracheobronchial trauma incidence was 1.4% in 1100 (adult=902, pediatric=198) patients who had thoracic trauma at the same period. incidence of tracheobronchial trauma for adults and for pediatric patients were 0.7% and 4 respectively. Particularly, the incidence in pediatric patients is higher than mentioned in the literature and it is probably due to higher rates of traffic and labour accidents in our country. These kind of injuries might be underdiagnosed at a ratio of 20% and most of these patients are admitted to hospital within 3 months. Repeated bronchoscopies should be performed in the suspected cases. Anatomic resections should avoided, in patients who do not have lethal vascular and paranchymal damage. Under these circumstances "delayed repair" should be the procedure of choice,
Açıklama
Anahtar Kelimeler
Kulak, Burun, Boğaz
Kaynak
Türk Toraks Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
2
Sayı
3