Çocuklarda özofagus atrezili hastaların geç dönem sonuçları
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Date
2020
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Dicle Üniversitesi, Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Abstract
Amaç: Bu çalışmanın amacı kliniğimizde ameliyat edilmiş olan ve başka merkezlerde
ameliyat edilip tarafımızca takibi yapılan özofagus atrezili hastaların geç dönem izlemdeki
sonuçlarının ve bunları etkileyen faktörlerin araştırılmasıdır.
Gereç ve Yöntem: Kliniğimizde Ocak 2010–Ocak 2020 tarihleri arasında özofagus atrezisi
tanısıyla takip edilmiş 252 hastadan, dosyalarına ulaşılan 214’ünün; demografik verileri,
klinik bulguları, ameliyat verileri, ameliyat sonrası komplikasyonları ve geç dönem izlem
sonuçları retrospektif olarak incelendi. Morbidite ve mortalite açısından belirlenmiş olan risk
faktörleri için karşılaştırma yapıldı.
Bulgular: Çalışmaya alınan 214 hastadan tarafımızca ameliyat edilen 187 hastanın 185’ine
(%98,9) tek evreli veya aşamalı özofagoözofagostomi yapıldı. Uzun aralıklı atrezi olup
definitif ameliyatı yapılmış olan 59 hastanın 57’sine (%96,6) ameliyat esnasında uzatma
teknikleri ile (intraoperatif gerdirme, Livaditis miyotomisi, tübülarize üst poş flebi, midenin
parsiyel toraksa çekilmesi) özofagoözofagostomi yapılabildi, sadece 2 hastada (%0,95)
özofagus replasmanı (gastrik transpozisyon) yapıldı. Özofagoözofagostomi ile onarım yapılan
hastalarda erken dönemde anastomoz darlığı (% 50,2), geç dönemde ise gastroözofageal
reflü (% 52,2) en sık karşılaşılan komplikasyonlardı. Mortalite oranımız % 29,4 olarak
hesaplandı. Prematürite, eşlik eden anomaliler, düşük doğum ağırlığı, VACTERL
birlikteliği, kromozomal anomaliler, solunum desteği ihtiyacı, sepsis ve uzun aralıklı atrezi
mortaliteyi etkileyen değişkenlerdi. Uzun dönemde en sık komplikasyonlar GÖR, büyüme
ve gelişme geriliği, solunum sistemi sorunları, yutma güçlüğü, skolyoz ve toraks deformitesi,
özofagus divertikülü idi.
Sonuç: Mümkün olduğunca hastalara primer özofagoözofagostomi yapılmasını önermekteyiz.
Özofagus atrezili hastalar hipotirodi açısından araştırılmalı. Anastomoz darlığının tedavisinde
balon dilatasyonu önermekteyiz. Anastomoz kaçağı varsa nazojejunal tüp takılarak varsa
anne sütü verilerek ve konservatif olarak tedavi edilebilir. GÖR geç dönemde sık
görülmektedir. Davranış ve medikal tedavi ile GÖR’lü hastaların çoğu tedavi edilebilir. ÖA
hastalar uzun dönemde GÖR, büyüme gelişme geriliği, solunum sistemi sorunları, yutma
güçlüğü, skolyoz ve toraks deformitesi ve özofagus divertikülü açısından izlenmelidir. Düşük
doğum ağırlığının, kalp problemlerinin, prematürite ve VACTERL birlikteliğinin
mortalitesinin yüksek olduğu unutulmamalı.
Objective: The aim of this study is to investigate the results of the late follow-up of patients with esophageal atresia who were operated in our clinic and followed up in other centers and the factors affecting them. Materials and Methods: Of the 252 patients who were followed up with the diagnosis of esophageal atresia between January 2010 and January 2020 in our clinic, 214 of them whose files were accessed; demographic data, clinical findings, operation data, postoperative complications and late follow-up results were evaluated retrospectively. Comparison was made for risk factors determined in terms of morbidity and mortality. Results: Single-stage or staged esophagoesophagostomy was performed in 185 (98.9%) of 187 patients who were operated on from 214 patients included in the study. Oesophagoesophagostomy was performed with lengthening techniques (intraoperative stretching, Livaditis myotomy, tubularized upper pouch flap, partial pulling of the stomach to the thorax) in 57 of 59 patients (96.6%) who had long intermittent atresia and had definitive surgery, only 2 patients esophageal replacement (gastric transposition) was performed. In patients who were repaired with esophagoesophagostomy, anastomotic stricture in the early period (50.2%) and in the late period, gastroesophageal reflux (52.2%) were the most common complications. Our mortality rate was 29.4%. Prematurity, concomitant anomalies, low birth weight, VACTERL association, chromosomal abnormalities, need for respiratory support, sepsis and long-range atresia were variables that affected mortality. The most common complications in the long term were gastroesophageal reflux, growth and developmental delay, respiratory system problems, dysphagia, scoliosis and thoracic deformity, and esophageal diverticulum. Conclusion: We recommend that patients undergo primary esophagoesophagostomy whenever possible. Patients with esophageal atresia should be investigated in terms of hypothyroidism. We recommend balloon dilation in the treatment of anastomotic stricture. If anastomotic leak is present, nasojejunal tube can be inserted and breast milk should be given if possible, it can be treated conservatively. Gastroesophageal reflux is common in the late period. Most patients with gastroesophageal reflux can be treated with behavior and medical treatment. Patients with esophageal atresia must be examined for gastroesophageal reflux, growth retardation, respiratory system problems, dysphagia, scoliosis and thoracic deformity, and esophageal diverticulum. It should not be forgotten that the mortality rate of birth weight, heart problems, prematurity and VACTERL association is high.
Objective: The aim of this study is to investigate the results of the late follow-up of patients with esophageal atresia who were operated in our clinic and followed up in other centers and the factors affecting them. Materials and Methods: Of the 252 patients who were followed up with the diagnosis of esophageal atresia between January 2010 and January 2020 in our clinic, 214 of them whose files were accessed; demographic data, clinical findings, operation data, postoperative complications and late follow-up results were evaluated retrospectively. Comparison was made for risk factors determined in terms of morbidity and mortality. Results: Single-stage or staged esophagoesophagostomy was performed in 185 (98.9%) of 187 patients who were operated on from 214 patients included in the study. Oesophagoesophagostomy was performed with lengthening techniques (intraoperative stretching, Livaditis myotomy, tubularized upper pouch flap, partial pulling of the stomach to the thorax) in 57 of 59 patients (96.6%) who had long intermittent atresia and had definitive surgery, only 2 patients esophageal replacement (gastric transposition) was performed. In patients who were repaired with esophagoesophagostomy, anastomotic stricture in the early period (50.2%) and in the late period, gastroesophageal reflux (52.2%) were the most common complications. Our mortality rate was 29.4%. Prematurity, concomitant anomalies, low birth weight, VACTERL association, chromosomal abnormalities, need for respiratory support, sepsis and long-range atresia were variables that affected mortality. The most common complications in the long term were gastroesophageal reflux, growth and developmental delay, respiratory system problems, dysphagia, scoliosis and thoracic deformity, and esophageal diverticulum. Conclusion: We recommend that patients undergo primary esophagoesophagostomy whenever possible. Patients with esophageal atresia should be investigated in terms of hypothyroidism. We recommend balloon dilation in the treatment of anastomotic stricture. If anastomotic leak is present, nasojejunal tube can be inserted and breast milk should be given if possible, it can be treated conservatively. Gastroesophageal reflux is common in the late period. Most patients with gastroesophageal reflux can be treated with behavior and medical treatment. Patients with esophageal atresia must be examined for gastroesophageal reflux, growth retardation, respiratory system problems, dysphagia, scoliosis and thoracic deformity, and esophageal diverticulum. It should not be forgotten that the mortality rate of birth weight, heart problems, prematurity and VACTERL association is high.
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Keywords
Morbidite, Mortalite, Özofagus atrezisi, Trakeaözofageal fistül, Geç dönem, Morbidity, Mortality, Esophageal atresia, Tracheaesophageal fistula, Late period
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Çal, S. (2020). Çocuklarda özofagus atrezili hastaların geç dönem sonuçları. Yayımlanmamış uzmanlık tezi, Dicle Üniversitesi, Diyarbakır.
