bsbd@balikesir.edu.tr www.bau-sbdergisi.com ÖZET Hamilelik sırasındaki delici travmalar günümüz şiddet toplumunda giderek artan bir problem haline gelmektedir. Delici travma sonucu fetal, plasental, kord ve intraabdominal organ hasarları rapor edilmiştir. Bu travmaların derecesinin belirlenip tedavisinin yapılması için sıklıkla eksploratif laparotomi gerekli olmaktadır. 26 yaşında gebe hasta ateşli silah yaralanması sonrası hastanemiz acil servisine getirildi. Operasyon odasında preoperatif olarak yapılan sonografi muayenesinde fetal kalp atımının ciddi bradikardik (30 atım/dk) ve uterusun koagulum ile dolu olduğu saptandı. Hasta acil olarak eksploratif laparotomi için operasyona alındı. Operasyon esnasında uterus sol round ligament etrafından aktif kanamalı bir adet küçük giriş deliği ve bir adet çıkış deliği gözlendi. Diğer batın içi organlarda herhangi bir yaralanma yoktu. Maternal vital bulguların stabilizasyonundan sonra sezaryen gerçekleştirildi ve 420 gr ölü fetus çıkarıldı. Uterin defektler primer olarak kapatıldı. Hasta operasyon sonrası altıncı gün taburcu edildi.Anahtar Kelimeler: ateşli silah yaralanması, travma, delici yaralanma, gebelik, laparotomi SUMMARY Penetrating trauma during pregnancy is an increasing problem in today's ever -violent society. Multiple direct fetal, placental, cord and intraabdominal organs injuries have been reported as a result of penetrating. Laparotomy is often required for determine the degree of trauma as well as treatment. A 26-year-old pregnant woman was brought into the emergency department of our hospital after suffering a gunshot wound. A preoperative transabdominal ultrasonography examination in the operating room determined that the fetal heart rate was severely bradycardic (30 beats/min) and the uterus was filled with coagulum. The patient was taken urgently to the operation for exploratory laparotomy. One bullet entry point was found at the root of the round ligament, and one bullet-exit point was at the posterior wall of the uterus and that site was actively bleeding. No injury was found to the other intraabdominal organs. After stabilization of the maternal vital signs, it was carried out a cesarean section and and a 420 g exanimate female fetus was taken out. The uterine defects were closed primarily. The patient was discharged on the 6th postoperative day
ÖzetAmaç: Günümüzde benign uterin patolojiler için abdominal histerektomi (AH), vajinal histerektomiden (VH) fazla yapılmaktadır. Total laparoskopik histerektomi (TLH) ise her iki yönteme nazaran daha kısa iyileşme süresi ve günlük hayata dönüşün hızlı olması nedeniyle daha yaygın yapılmaya başlanmıştır. Biz bu çalışmada kliniğimizde yapılan AH, VH ve TLH'ların sonuçlarını karşılaştırdık. Yöntem: Bu çalışmada Bağcılar EAH Kadın Doğum Kliniği'nde 2010 Aralık-2011 Aralık tarihleri arasında benign nedenlerle histerektomi yapılan olgular geriye dönük olarak karşılaştırıldı. Bu sürede 139 AH (%56.8), 61 VH (%24.9), 45 TLH (%18.3) yapılmıştı. Olguların yaşları, pariteleri, hastanede kalış süreleri, komplikasyonları, hematokrit değişiklikleri ve operasyon süreleri kaydedildi. İstatistik analizleri yapıldı. Bulgular: AH, VH, TLH'larda ortalama yaş sırasıyla 49.5, 59 ve 51,6 idi. Parite ortalaması sırasıyla 3, 4.5 ve 4.3'tü. Hastanede ortalama kalış süreleri 3.8, 3.8 ve 2.9 gün olarak bulundu. TLH olgularının operasyon süresi (139.27±36.48 dakika); AH (66.91±11.64 dakika) ve VH (47.50±9.68 dakika) grubundaki olguların operasyon süresinden anlamlı olarak uzun bulundu (p<0.01). Olguların hematokrit değişiklikleri benzer saptandı. TLH'larda komplikasyon oranı biraz daha yüksek bulundu. Sonuç: ABD'de halen histerektomilerin %70'e yakını abdominal olarak yapılmaktadır. ACOG tarafından birinci sırada VH, ikinci sırada TLH, son olarak AH'lerin tercih edilmesi önerilmiştir. Kliniğimiz yeni bir klinik olmasına rağmen VH ve TLH'ların toplamı AH'lere yakın olarak bulunmuştur. (Ha se ki T›p Bül te ni 2013; 51: 112-5) Anahtar Kelimeler: Histerektomi, endikasyonlar, post-operatif değişiklikler Abs tractAim: Lately, vaginal hysterectomies (VH) are being performed more frequently than abdominal hysterectomies (AH) for benign pathologies. Even then, total laparoscopic hysterectomy (TLH) has been widely done because of its shorter recovery time. In this study, we compared the results of AH, VH and TLH performed in our clinic. Methods:In this study, we retrospectively evaluated the hysterectomies performed between December 2010 and December 2011 for benign uterine pathologies in the Obstetric and Gynecology Clinic at Bağcılar Training and Research Hospital. It is a retrospective study. During this time, 139 AH (56.8%), 61 VH (24.9%), and 45 TLH (18.3%) were done. Data including age, parity, length of hospital stay, change in hematocrit, and length of the operations were recorded. Statistical analysis was performed.Results:The average age of patients who underwent AH, VH and TLH was 49.5.0, 59 and 51.6, respectively. The average parity was 3.0, 4.5 and 4.3, respectively. The average length of hospital stay was 3.8, 3.8, and 2.9 days, respectively. Duration of operation (139.27+/-36.48 min) in TLH group was longer than in AH (66.91+/-11.64 min) and VH groups (47.50+/-9.6 min) (p<0.01). Changes in hematocrit were similar in the groups. Complications related to TLH seem to be a little more than other procedures. Conclusion:Nearly 70% of all hys...
Genital prolapse is one of the most significant problems which lowers the quality of life measures of middle and older aged women. A continuously growing number of women are being operated due to this indication. Objective: This study intends to asses the clinical outcome and the impact on quality of life of uterine sacrospinous ligament fixation (USLF) conducted with a mesh stabilizing anchor set in the present clinic following vaginal hysterectomy. Materials and Methods: Twenty-one patients, diagnosed with genital prolapse and for whom vaginal hysterectomy and (USLF) with the Surelift nesh stabilizing anchor set were performed from April 2010 to June 2013, were assesed in this study. Posterior colporrhaphy was performed in all cases, as well. The cuff level was used to asses the anatomical recovery one year following the surgery. Postoperative relaxation of the vaginal cuff line below the hymenal level was defined as failure. Quality of life (P-QOL) questionarries validated for Turkish women were used preoperatively and on their first year to asses patient satisfaction. Clinical outcome and impact on quality of life were analyzed in all these cases by using t-test for paired samples. Results: The mean age of the patients was 67.4 (min-max:43-84) years; mean parity 5.4 (min-max: 2-13). The mean operation time was 56 ± 12 minutes. The mean postoperative follow-up period was 21.4 months. Preoperative mild bleeding (two), postoperative severe pain (three), and micturition problems (one) were found. Therapeutic results and patint satisfaction were evaluated in the 12 th month postoperavely: In 18 / 21 (85%) patients, the cuff was located above the hymenal ring. P-QOL scores validated for Turkish women were 52.5 ± 12.9 preoperatively and 11.08 ± 7.9 postoperatively (t-test for paired samples revealed a significant difference; (p = 0.04). Conclusion: The treatment of genital prolapse through the abdominal route includes the sacrocolpopexy operation with or without hysterectomy. This method, most of the time, requires a laparotomy if not performed by a specifically trained laparoscopist. It has a longer operation time and mesh erosions are feared complications compared to vaginal route. In sacrospinous fixation cases added to vaginal hysterectomy, operation times are shorter and especially preferable in patients where medical problems coexist. Operative success and patients' satisfaction seems to be provided by this technique.
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