Böbrek travmalı hastaların takip ve tedavi sonuçlarının değerlendirilmesi
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Dosyalar
Tarih
2017
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Künt karın travması nedeniyle böbrek yaralanması olan olgularda uygulanan operatif ve nonoperatif tedavilerin etkinliğini birbirleri ile karşılaştırarak ortaya koymaktır. Gereç ve Yöntem: Çalışmamızda, Ocak 2005 ile Aralık 2015 tarihleri arasında künt karın travması nedeniyle Necmettin Erbakan Üniversitesi Meram Tıp Fakültesine başvuran, yapılan tetkiklerde böbrek yaralanması tespit edilen ve çocuk cerrahisi kliniğine yatırılıp takip ve tedavi edilen 41 olgu retrospektif olarak incelendi. Hastaların yaş ve cinsiyet gibi demografik özelliklerinin yanısıra, travma mekanizması, abdominal tomografi ile böbreklerdeki yaralanma derecesi ve ek organ yaralanmalarının olup olmadığı, hematürinin varlığı, kan transfüzyonu miktarı, hastanede kalış süresi ile birlikte operatif ve nonoperatif olarak tedavi edilen hastaların dağılımı tespit edildi. Olgular yaralanma derecesine göre hafif, orta ve ciddi olmak üzere 3 gruba ayrıldı. Grup 1; grade 1+2, grup 2; grade 3, grup 3; grade 4+5 olgulardan oluşuyordu. Ayrıca geç dönemde yapılan kontrol sintigrafisi ile böbrek fonksiyonları belirlenerek, operatif ve nonoperatif tedavinin erken ve geç dönemdeki etkinliği ve yüksek gradeli yaralanmalarda operatif ve nonoperatif tedavinin uygulanma kriterleri değerlendirildi. Bulgular: Olguların 18'i kız (% 43,9), 23'ü erkekti (% 56,1). Hastaların ortalama yaşı 10 (1-17) idi. En sık travma nedeni trafik kazası (% 65,9) olup, olguların 16'sında (% 39) izole böbrek yaralanması varken, 25 olguda (% 61) multipl organ yaralanması mevcuttu. Olguların 8'inde grade 1, 4'ünde grade 2, 12'sinde grade 3 renal travma tespit edildi. Geriye kalan 16 olguda (12'si evre 4, 4'ü evre 5) ise ciddi renal travma belirlendi. Ciddi renal travmalı olgulardan 4'üne (% 25) cerrahi girişim uygulandı ( 1'ine JJ stent yerleştirilmesi, 2'sine renorafi, 1'ine pyeloplasti). Geriye kalan 12 olgu ise nonoperatif olarak tedavi edildi. Bu olgulardan ulaşılabilen 10 tanesine geç dönemde (ortalama 40 ay) yapılan MAG3 sintigrafisinde 3'ünün (% 30) yaralanan böbrekleri nonfonksiyone idi (diferansiyel fonksiyonu % 0). Cerrahi girişim uygulanan 4 olgunun diferansiyel fonksiyonları ise % 31,16 ± 10,8 (% 25-% 40 arası) idi. Sonuç: Stabil hastalarda nonoperatif tedavi en iyi yaklaşımdır. Anjiografi ve selektif embolizasyon ilk basamak tedavilerdir. Üriner ekstravazasyon endoürolojik veya perkütan teknikler ile tedavi edilmektedir. Ancak ciddi renal travmalı, nonoperatif olarak tedavi edilen olgularda geç dönemde azımsanmayacak düzeyde atrofik veya nonfonksiyone böbreklerin oluşabileceği unutulmamalıdır. Kanaması durdurulamayan, hemodinamik dengesi bozulan ve/veya parçalanmış böbreğe sahip olan hastalarda operatif tedavinin yararlı olacağını düşünüyoruz. Komplikasyonlar nadirdir, ancak yine de böbrek fonksiyon testleri ve tansiyon ölçümleri ile hastalar takip edilmelidir. Erken ve geç dönem renal fonksiyonlar arasında belirgin bir fark olmaması, erken dönemde uzun dönemdeki renal fonksiyonların öngörülebileceğini göstermiştir. Sonuç olarak, bu zor olgular için bir algoritma ya da standart bir tedavi yolu yoktur. İyi bir sonuç elde edilebilmesi için yaklaşım olabildiğince bireyselleştirilmelidir. Anahtar Kelimeler: Renal travma, operatif tedavi, nonoperatif tedavi, diferansiyel fonksiyon.
To evaluate the efficacy of operative and non operative treatments in patients hospitalized to our clinic due to renal injury after blunt abdominal trauma. Material and Methods: Fourty one patients who have applied to Necmettin Erbakan University Meram Medical Faculty and were treated in our clinic for renal injury occurring after blunt abdominal trauma between January 2005 – December 2015 were assessed retrospectively. Demographic features of patients such as age and gender, mechanism of injury, associated organ injury and grade of renal injury according to the abdominal CT scan, blood transfusion requirement, duration of hospital stay and patients treated operatively or non operatively were determined. Patients were divided into 3 groups according to the severity of renal injury as mild, moderate and severe. Group 1 is composed of patients with grade 1 and grade 2. Group 2 is composed of patients with grade 3. Group 3 is composed of patients with grade 4 and grade 5. Renal functions were determined by scintigraphy in late period. Efficacy of operative and non operative treatments in early and late period and also in high grade renal injuries were evaluated. Results: 18 of patients (% 43,9) were girls and 23 (% 56.1) were boys. The median age was 10 (1-17). The most frequent cause of trauma was determined as traffic accidents (% 65,9). 16 of patients (% 39) had only renal injury and 25 of patients (% 61) had multiple organ injuries. 8 patients had grade 1 renal injury, 4 patients had grade 2 injury and 12 patients had grade 3 injury. Other 16 patients had severe renal trauma (12 of them grade 4 and 4 of them grade 5). 4 of 16 patients (% 25) that have severe renal trauma underwent surgical intervention (JJ stent placement in one patient and renorraphy in 2 patients and pyeloplasty in one patient). Other 12 patients were managed non operatively. 10 of these 12 patients treated conservatively underwent (99m) Tc MAG3 in long period (median 40 months) and previously injured kidneys were non-functional (differential renal function is % 0) in 3 patients (% 10). Median differential renal function was % 31.16 ± 10.8 (ranged from % 25-40) in 4 patients underwent surgery. Conclusion: Non operative treatment is the most appropriate approach in stable patients. Angiography and selective embolisation are the first choice options of treatment. Urinary extravasation is treated by percutaneous and endourological techniques. Severe renal traumas treated conservatively may result in atrophic or non-functional kidneys at long term period. We believe that surgical intervention is useful in persistent bleedings which cause hemodynamic instability and fragmented renal injuries. Complications are rare but patients should be followed by renal function tests and blood pressure measurement. Renal functions at late period can be predicted by measuring at early period because of no difference between early and late values. As a result, there is no algorithm or standard treatment method in these difficult cases. Approach to these patients should be individualized to get good results. Key Words: Renal trauma, operative treatment, non operative treatment, differential function.
To evaluate the efficacy of operative and non operative treatments in patients hospitalized to our clinic due to renal injury after blunt abdominal trauma. Material and Methods: Fourty one patients who have applied to Necmettin Erbakan University Meram Medical Faculty and were treated in our clinic for renal injury occurring after blunt abdominal trauma between January 2005 – December 2015 were assessed retrospectively. Demographic features of patients such as age and gender, mechanism of injury, associated organ injury and grade of renal injury according to the abdominal CT scan, blood transfusion requirement, duration of hospital stay and patients treated operatively or non operatively were determined. Patients were divided into 3 groups according to the severity of renal injury as mild, moderate and severe. Group 1 is composed of patients with grade 1 and grade 2. Group 2 is composed of patients with grade 3. Group 3 is composed of patients with grade 4 and grade 5. Renal functions were determined by scintigraphy in late period. Efficacy of operative and non operative treatments in early and late period and also in high grade renal injuries were evaluated. Results: 18 of patients (% 43,9) were girls and 23 (% 56.1) were boys. The median age was 10 (1-17). The most frequent cause of trauma was determined as traffic accidents (% 65,9). 16 of patients (% 39) had only renal injury and 25 of patients (% 61) had multiple organ injuries. 8 patients had grade 1 renal injury, 4 patients had grade 2 injury and 12 patients had grade 3 injury. Other 16 patients had severe renal trauma (12 of them grade 4 and 4 of them grade 5). 4 of 16 patients (% 25) that have severe renal trauma underwent surgical intervention (JJ stent placement in one patient and renorraphy in 2 patients and pyeloplasty in one patient). Other 12 patients were managed non operatively. 10 of these 12 patients treated conservatively underwent (99m) Tc MAG3 in long period (median 40 months) and previously injured kidneys were non-functional (differential renal function is % 0) in 3 patients (% 10). Median differential renal function was % 31.16 ± 10.8 (ranged from % 25-40) in 4 patients underwent surgery. Conclusion: Non operative treatment is the most appropriate approach in stable patients. Angiography and selective embolisation are the first choice options of treatment. Urinary extravasation is treated by percutaneous and endourological techniques. Severe renal traumas treated conservatively may result in atrophic or non-functional kidneys at long term period. We believe that surgical intervention is useful in persistent bleedings which cause hemodynamic instability and fragmented renal injuries. Complications are rare but patients should be followed by renal function tests and blood pressure measurement. Renal functions at late period can be predicted by measuring at early period because of no difference between early and late values. As a result, there is no algorithm or standard treatment method in these difficult cases. Approach to these patients should be individualized to get good results. Key Words: Renal trauma, operative treatment, non operative treatment, differential function.
Açıklama
Anahtar Kelimeler
Böbrek, Kidney, Cerrahi-operatif, Surgery-operative, Yaralar ve yaralanmalar, Wounds and injuries
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Çoşkun, N. (2017). Böbrek travmalı hastaların takip ve tedavi sonuçlarının değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Çocuk Cerrahisi Anabilim Dalı, Konya.
