Abordaje clínico quirúrgico del trauma de abdomen, Hospital Nacional de Especialidades Guayaquil Dr. Abel Gilbert Pontón. 2009-2010
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2011
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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La decisión de una intervención quirúrgica en el momento justo influencia dramáticamente en el pronóstico del paciente, sin embargo el cómo saber cuando y donde realizar dicho procedimiento constituye un dilema médico tanto para el que recibe como para el que tiene que tratarlo. En este contexto la presente revisión evalúa el perfil de complejidad y abordaje del trauma abdominal en pacientes ingresados en el Hospital Nacional de Especialidades Guayaquil “Dr. Abel Gilbert Pontón”. Para la caracterización de la población en riesgo; se identifico los mecanismos de lesión más frecuentes; describiendo los criterios en el manejo preoperatorio y métodos de diagnóstico; técnicas quirúrgicas realizadas y órganos afectos; valorando la evolución de los pacientes. La metodología utilizada fue un estudio tipo descriptiva correlacional con diseño no experimental, transversal que incluyo a pacientes con diagnóstico de trauma de abdomen ingresados entre el 2009 al 2010, se analizaron 209 expedientes de los cuales solo 178 reunieron criterios de inclusión. Siendo el grupo más afecto el sexo masculino (83%) con una edad comprendida entre 20 a 40 años (78.5%) y proveniente de zona urbana (79%). El método diagnóstico frecuentemente realizado fue el lavado peritoneal en un porcentaje entre 79% a 96%. El trauma de abdomen abierto es la principal causa de ingreso al área de emergencia por lesiones a nivel abdominal (79%) generalmente producido por arma de fuego con un valor de 51%. El sistema digestivo fue el más afectado del 47% al 58% , la intervención quirúrgica más practicada con un porcentaje similar en ambos tipos de trauma fue la enteroanastomosis del 21 al 24%, seguida de la hepatorrafía en un 15% en el trauma abierto y rafia de vejiga en el trauma cerrado con un valor de 19%. Por lo general independientemente del tipo de trauma abdominal la mayoría fueron intervenidos con una evolución favorable del 96 a 100%.
The decision for surgical intervention at the right time dramatically influence patient prognosis, however the how to know when and where to perform the procedure is a medical dilemma for both the recipient and for those who have to deal with it. In this context the present review assesses the complexity and profile approach to abdominal trauma patients admitted to the National Hospital Specialties Guayaquil "Dr. Abel Gilbert Ponton ". To characterize the population at risk is identified the most common mechanisms of injury, describing the criteria in preoperative management and diagnostic methods and surgical techniques affected organs; valuing patient outcomes. The methodology used was a descriptive correlational study nonexperimental, cross included patients diagnosed with abdominal trauma admitted between 2009 and 2010, 217 cases were analyzed of which only 178 met inclusion criteria. The most affected group were male (83%) aged between 20 and 40 years (78.5%) and from urban areas (79%). The diagnostic method frequently peritoneal lavage was performed in a percentage between 79% to 96%. The open abdominal trauma is the leading cause of admission to the emergency area at abdominal injuries (79%) usually caused by firearm with a value of 51%. The digestive system was the hardest hit of 47% to 58%, more practiced surgery with a similar percentage in both types of trauma was enteroanastomosis from 21 to 24%, followed by 15% hepatorrafía in open trauma raffia bladder in blunt trauma with a value of 19%. Usually whatever type of abdominal trauma were operated with most favorable development of 96-100%
The decision for surgical intervention at the right time dramatically influence patient prognosis, however the how to know when and where to perform the procedure is a medical dilemma for both the recipient and for those who have to deal with it. In this context the present review assesses the complexity and profile approach to abdominal trauma patients admitted to the National Hospital Specialties Guayaquil "Dr. Abel Gilbert Ponton ". To characterize the population at risk is identified the most common mechanisms of injury, describing the criteria in preoperative management and diagnostic methods and surgical techniques affected organs; valuing patient outcomes. The methodology used was a descriptive correlational study nonexperimental, cross included patients diagnosed with abdominal trauma admitted between 2009 and 2010, 217 cases were analyzed of which only 178 met inclusion criteria. The most affected group were male (83%) aged between 20 and 40 years (78.5%) and from urban areas (79%). The diagnostic method frequently peritoneal lavage was performed in a percentage between 79% to 96%. The open abdominal trauma is the leading cause of admission to the emergency area at abdominal injuries (79%) usually caused by firearm with a value of 51%. The digestive system was the hardest hit of 47% to 58%, more practiced surgery with a similar percentage in both types of trauma was enteroanastomosis from 21 to 24%, followed by 15% hepatorrafía in open trauma raffia bladder in blunt trauma with a value of 19%. Usually whatever type of abdominal trauma were operated with most favorable development of 96-100%
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TRAUMATISMOS ABDOMINALES, CIRUGIA ABDOMINAL, EPIDEMIOLOGIA DESCRIPTIVA, HOSPITAL DE ESPECIALIDADES GUAYAQUIL DR. ABEL GILBERT PONTON, CANTON GUAYAQUIL, ECUADOR, ABORDAJE QUIRURGICO