Özofagus atrezili olgularla ilgili 17 yıllık deneyim (1991 - 2007)
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Dosyalar
Tarih
2009
Yazarlar
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmanın amacı kliniğimizde bakım ve tedavisi yapılan özofagus atrezili yenidoğanlardaki sorunları ve gelişmeleri ortaya koymaktır.Gereç ve yöntem: Çalışmada kliniğimizde son 17 yılda tedavisi yapılan özofagus atrezili 118 olgu geriye dönük olarak irdelendi. Olgular başvuru yıllarına göre Grup I (1991-1998) ve Grup II (1999-2007) olmak üzere iki ana gruba ayrıldı. Tüm hastalar prenatal öykü, doğum şekli ve zamanı, başvuru zamanı, tanı yöntemleri, ameliyata alınma zamanı, cerrahi teknikler, ek anomali, komplikasyonlar ve mortalite oranları açısından değerlendirildi.Bulgular: Olguların ortalama başvuru ağırlığı 1960±5.35 gram idi. Doğumların %75'i hastane ve %25'i evde gerçekleştirildi. Bebeklerin %85'i miyadında ve %15'i erken doğum idi. Bebeklerin %55'inde prenatal polihidroamnioz hikayesi saptandı. Vakaların hastaneye gelme zamanları ortalama 5.9±1.42 gündü. Kliniğimize başvurduğunda olguların tamamına yakını ön tanılı idi. Ek anomali %39 oranında saptandı. Grup I'deki olgular acil, Grup II' deki olgular ise hasta stabilize edildikten sonra elektif şartlarda ameliyata alındı. Cerrahi teknik olarak olguların çoğuna primer onarım ve uc uca anastomoz yapıldı. En sık rastlanan ameliyat sırası komplikasyon plevranın iyatrojenik açılması idi. En sık rastlanan ameliyat sonrası erken dönem komplikasyonlar atelektazi ve pnömoni; geç dönem komplikasyon ise GÖR idi. Olguların ortalama %56'sı kaybedilirken, bu oran Grup I'de %76, Grup II'de %45 olarak tespit edildi. En sık ölüm nedeni solunum yetersizliği, pnömoni ve anastomoz kaçağı idi.Sonuç: Kliniğimizde geriye dönük olarak yapılan bu çalışma, çocuklarda en sık rastlanan anomalilerden biri olan özofagus atrezisinde; düzeltilmiş yoğun bakım koşulları ve artmış cerrahi deneyimin, preoperatif ve postoperatif komplikasyonları ve mortaliteyi gittikçe azalttığını ortaya koymaktadır.Anahtar kelimeler: Özofagus atrezisi, mortalite, komplikasyon.
This study aimed to reveal the problems and progresses observed in the newborns with esophageal atresia treated in our department.Material and methods: The study population consisted of 118 newborns with esophageal atresia treated during the last 17 years retrospectively. Patients were divided into 2 groups as Group I (1991-1998) and Group II (1999-2007) according to the years of diagnosis. All patients were also assessed regarding the prenatal history, delivery method and time, time of admission, diagnostic procedures, time of surgery, surgical techniques, associated anomaly, complications, and mortality rates.Results: The mean weight of the cases was 1960±5.35 gr when they were admitted, 75% of deliveries was performed in hospital and 25% was at home. 85% of the babies was in term and 15% was preterm. Prenatal polyhydramnios story was detected in 55% of babies. The mean admittion time of the cases was 5.9±1.42 days. Almost all the patients admitted to our department had prediagnosis. The associated anomaly rate was 39%. Patients in Group I were operated immediately, and the ones in Group II were operated in elective conditions after being stabilized. As surgical technique, primary repair and end-to-end anastomosis were carried out in most of the cases. The most common intraoperative complication was iatrogenic pleural opening. The most common early period postoperative complications were pneumonia and atelectesia; late complication was gastroesophageal reflux. Overall mortality was 56% and this rate was 76% for Group I and 45% for Group II. Respiratory insufficiency, pneumonia, and anastomotic leakage were the most common causes of mortality.Conclusions: This retrospective study performed in our department showed that corrected intensive care conditions and the developments in surgical techniques decreased preoperative and postoperative complications and mortality rates in esophageal atresia, which was one of the most anomalies seen in newborns.Key words: Esophageal atresia, mortality, complication.
This study aimed to reveal the problems and progresses observed in the newborns with esophageal atresia treated in our department.Material and methods: The study population consisted of 118 newborns with esophageal atresia treated during the last 17 years retrospectively. Patients were divided into 2 groups as Group I (1991-1998) and Group II (1999-2007) according to the years of diagnosis. All patients were also assessed regarding the prenatal history, delivery method and time, time of admission, diagnostic procedures, time of surgery, surgical techniques, associated anomaly, complications, and mortality rates.Results: The mean weight of the cases was 1960±5.35 gr when they were admitted, 75% of deliveries was performed in hospital and 25% was at home. 85% of the babies was in term and 15% was preterm. Prenatal polyhydramnios story was detected in 55% of babies. The mean admittion time of the cases was 5.9±1.42 days. Almost all the patients admitted to our department had prediagnosis. The associated anomaly rate was 39%. Patients in Group I were operated immediately, and the ones in Group II were operated in elective conditions after being stabilized. As surgical technique, primary repair and end-to-end anastomosis were carried out in most of the cases. The most common intraoperative complication was iatrogenic pleural opening. The most common early period postoperative complications were pneumonia and atelectesia; late complication was gastroesophageal reflux. Overall mortality was 56% and this rate was 76% for Group I and 45% for Group II. Respiratory insufficiency, pneumonia, and anastomotic leakage were the most common causes of mortality.Conclusions: This retrospective study performed in our department showed that corrected intensive care conditions and the developments in surgical techniques decreased preoperative and postoperative complications and mortality rates in esophageal atresia, which was one of the most anomalies seen in newborns.Key words: Esophageal atresia, mortality, complication.
Açıklama
Anahtar Kelimeler
Özofagus atrezisi, Mortalite, Komplikasyonlar, Esophageal atresia, Mortality, Complications
Kaynak
WoS Q Değeri
Scopus Q Değeri
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Künye
Bilirim, A. (2009). Özofagus atrezili olgularla ilgili 17 yıllık deneyim (1991 - 2007). (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Çocuk Cerrahisi Anabilim Dalı, Konya.
