Primer özefagus atrezisi onarımı sonrası anastomoz kaçaklarının yönetimi
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Tarih
2016
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmanın amacı kliniğimizde Özefagus Atrezisi (ÖA) tanısıyla primer onarım yapılan yenidoğanların klinik sonuçlarını değerlendirmek ve ÖA primer onarımı sonrası meydana gelen anastomoz kaçaklarının (AK) yönetimini tartışmaktır. Gereç ve Yöntem: Ağustos 2009–Ocak 2013 tarihleri arasında ÖA tanısıyla primer anastomoz yapılan 82 yenidoğanın kayıtları retrospektif olarak incelendi. Erken dönem kardiyak anomali, prematürite, sepsis, v.b nedenler ile kaybedilen 18 hasta çalışma dışı bırakıldı. Kalan 64 hastanın erken ve geç komplikasyonları incelendi. Hastalar, primer anastomoz sonrası AK gelişen [AK (+), n = 15] ve gelişmeyen [AK (–), n = 49] olarak gruplanarak birbiri ile istatistiksel olarak karşılaştırıldı. Bulgular: 64 yenidoğanın 15’inde (%23) postoperatif AK gelişti ve tümü konservatif tedavi (tüp torakostomi, geniş spektrumlu antibiyotik, erken floroskopik transanastomotik nazojejunal tüp yerleştirilerek anne sütü ile erken besleme) ile iyileşti. Postoperatif komplikasyonlar açısından karşılaştırıldığında AK (+) olan grupta nüks trakeoözefageal fistül insidansı istatistiksel olarak anlamlı bulundu (p<0,001). Anastomoz darlığı, gastroözefageal reflü, trakeomalazi ve özefagus dismotilitesi insidansı her iki grupta benzer bulundu. Sonuç: ÖA onarımı sonrası meydana gelen AK’ları konservatif tedavi (geniş spektrumlu antibiyoterapi, tüp torakostomi ve nazojejunal beslenme) ile cerrahiye ve total parenteral nütrisyona gerek kalmadan tedavi edilebilir. ANAHTAR SÖZCÜKLER: Özefagus atrezisi, anastomoz kaçağı, anastomoz darlığı, trakeoözefageal fistül
Objective: The aim of this study is to evaluate the clinical outcomes of the neonates with esophageal atresia (EA) operated with primary repair and to discuss the management of anastomotic leakage (AL) after surgical repair for esophageal atresia. Methods: Data from 82 neonates with EA who underwent primary repair were retrospectively analyzed. 18 early fatal cases due to cardiac anomaly, prematurity, sepsis, and etc were excluded from the study. The remaining 64 cases were evaluated for early and late complications. Postoperative AL occurred in 15 cases [AL (+), n = 15] and did not in the other 49 cases [AL (–), n = 49] and the results were compared between two groups. Results: In 15 out of 64 (23%) neonates, AL occurred postoperatively. All of the anastomotic leakages were successfully treated with conservative treatment (tube thorocostomy, broad–spectrum antibiotic, nasojejunal breast milk feeding in the early stages via the transanastomotic catheter inserted fluoroscopically. Comparing AL (+) and AL (–) groups for postoperative complications, the incidence of the tracheoesophageal fistula for the AL (+) group was statistically significantly higher than AL (–) group (p<0.001). On the other hand, the incidences for esophageal stricture, gastroesophageal reflux, tracheomalacia and esophageal dysmotility were observed to be similar for both groups. Conclusion: The AL occurred after primary repair of the EA could be treated with conservative treatment (broad–spectrum antibiotic treatment, tube thoracostomy and nasojejunal feeding) without the need for surgical procedure and total parenteral nutrition. KEY WORDS: Esophageal atresia, anastomotic leakage, esophageal stricture, tracheoesophageal fistula
Objective: The aim of this study is to evaluate the clinical outcomes of the neonates with esophageal atresia (EA) operated with primary repair and to discuss the management of anastomotic leakage (AL) after surgical repair for esophageal atresia. Methods: Data from 82 neonates with EA who underwent primary repair were retrospectively analyzed. 18 early fatal cases due to cardiac anomaly, prematurity, sepsis, and etc were excluded from the study. The remaining 64 cases were evaluated for early and late complications. Postoperative AL occurred in 15 cases [AL (+), n = 15] and did not in the other 49 cases [AL (–), n = 49] and the results were compared between two groups. Results: In 15 out of 64 (23%) neonates, AL occurred postoperatively. All of the anastomotic leakages were successfully treated with conservative treatment (tube thorocostomy, broad–spectrum antibiotic, nasojejunal breast milk feeding in the early stages via the transanastomotic catheter inserted fluoroscopically. Comparing AL (+) and AL (–) groups for postoperative complications, the incidence of the tracheoesophageal fistula for the AL (+) group was statistically significantly higher than AL (–) group (p<0.001). On the other hand, the incidences for esophageal stricture, gastroesophageal reflux, tracheomalacia and esophageal dysmotility were observed to be similar for both groups. Conclusion: The AL occurred after primary repair of the EA could be treated with conservative treatment (broad–spectrum antibiotic treatment, tube thoracostomy and nasojejunal feeding) without the need for surgical procedure and total parenteral nutrition. KEY WORDS: Esophageal atresia, anastomotic leakage, esophageal stricture, tracheoesophageal fistula
Açıklama
Anahtar Kelimeler
Özefagus atrezisi, Esophageal atresia, Anastomoz kaçağı, Anastomotic leakage, Anastomoz darlığı, Esophageal stricture, Trakeoözefageal fistül, Tracheoesophageal fistula
