ÖZOFAGUS ATREZİLİ YENİDOĞANLARDA ANESTEZİK RİSKLER, MORBİDİTE VE MORTALİTE

Year 2020, Volume: 27 Issue: 3, 359 - 366, 01.09.2020

Bilge Aslan Feray Aydın

https://doi.org/10.17343/sdutfd.638056

Abstract

Giriş:
Özofagus atrezisi (ÖA), özofagusun proksimal ve distal bölümlerinin  bağlantısının olmamasıdır ve 3000-4500 canlı
doğumda bir görülür. Özofagus atrezisi ve trakeoözofageal fistül (TÖF),
beslenme ve solunum sorunlarından dolayı ilk birkaç saatin içinde acilen tanı
konulması gereken konjenital bir anomalidir. Bu defekt, oral sekresyon artışı
ve beslenme anında aspirasyon ve regürjitasyona yol açar. TÖF’lü bebekte,
ağlama ve öksürme anında, hava fistül yolu ile mideye geçer, sonuç olarak mide
ve ince barsak genişler. ÖA’ da onarım ve postoperatif komplikasyonlarla
mücadele etmek genellikle zordur.

Amaç:
Amacımız, özofagus atrezisinde perioperatif yaklaşım, ÖA onarımı sonrası erken
gelişen sonuçlar, komplikasyonlarla ilişkili olabilecek faktörler ve mortaite
oranlarını tanımlamayı amaçladık.

          Gereç ve Yöntemler: Ocak 2010 - Ocak
2018 tarihleri arasında Zekai Tahir Burak Eğitim ve Araştırma Hastanesi’nde
cerrahi onarım geçirmiş olan özofagus atrezili hastaları retrospektif olarak
inceledik. Her grupta yüksek prematürite oranı (% 30), majör kardiyak (% 15) ve
diğer cerrahi malformasyonlar (% 10) bulundu. Özefagus anastomoz cerrahisi
uygulamada ortanca süre en fazla 70 günlük, en kısa 1  günlük bebekler şeklindeydi  (ortalama fark 59 gün,% 95 CI 48.1-70 gün, P
= 0.01).

          Bulgular: Uzun dönem özofagus
atrezisi ameliyatı acil primer anastomoz (n = 10), gecikmiş primer anastomoz (n
= 11), özofagus uzatma teknikleri (n = 12) ve primer özofageal replasman (n =
0) idi. Uzun süreli özofagus atrezisi, zor entübasyon insidansını artırmıyordu
(OR 2.8,% 95 CI 0.6-22.1, P = 0.15), intraoperatif hipoksemi (OR 1.6,% 95 CI
0.6-4.5, P =0 .45) veya hipotansiyon (OR 0.9,% 95 CI 0.5-1.8, P = 0.98) tespit
edildi. Cerrahi süre (180.2- 210.3 dakika, ortalama fark ([% 95 CI], 30
dk [5.5-50.4 dakika], P = 0.03) ve ameliyat sonrası mekanik
ventilasyonda kalma süresi ortalama (180-250.8 saat, ortalama fark [95% CI]
91.8 [34.5-149.1 saat], P <0.01) uzun olmayan özefagus grubu için (tek
seans) daha kısaydı. Genel hastane içi mortalite % 8'idi (ortalama % 7.2, uzun
aşamalı operasyon için % 14 uzun veya 
kısa süreli özefagus atrezisi için % 2.2, % 95 CI 0.4-14, P = 0.85).

             Sonuç: Aşamalı cerrahi gerektiren uzatmalı özofagus atrezi olan
bebeklerde ve normal özofagus atrezisi olan bebeklerde perioperatif
komplikasyon insidansı benzerdir. Bununla birlikte, uzun süreli onarım için
mevcut cerrahi yaklaşımlar daha uzun anestezik maruziyet, özofagus
devamlılığını korumak için çoklu prosedürler gerektirir. Bu durum mortalite ve
morbidite oranını artırır.

ABSTRACT:

Introduction:
Esophageal atresia (OA) is the absence of connection between the proximal and
distal parts of the esophagus and occurs every 3000-4500 live births.
Esophageal atresia and tracheoesophageal fistula (TOF) is a congenital anomaly
which should be diagnosed promptly within the first few hours due to feeding
and respiratory problems. This defect leads to increased oral secretion and
aspiration and regurgitation during feeding. In TOF infants, when crying and
coughing, air passes through the fistula into the stomach, resulting in
enlarged stomach and small intestine. It is often difficult to combat repair
and postoperative complications in OA. The aim of this study was to define the
perioperative approach in esophageal atresia, early outcomes after OA repair,
factors that may be associated with complications and mortality rates.

          Material
and Methods: We retrospectively reviewed patients with esophageal atresia who
underwent surgical repair in Zekai Tahir Burak Training and Research Hospital
between January 2010 and January 2018. High prematurity rate (30%), major
cardiac (15%) and other surgical malformations (10%) were found in each group.
The median duration of esophageal anastomosis surgery was 70 days and shortest
1 day (mean difference 59 days, 95% CI 48.1-70 days, P = 0.01).

          Results:
Long-term esophageal atresia surgery was emergency primary anastomosis (n =
10), delayed primary anastomosis (n = 11), esophageal lengthening techniques (n
= 12), and primary esophageal replacement (n = 0). Long-term esophageal atresia
did not increase the incidence of difficult intubation (OR 2.8, 95% CI
0.6-22.1, P = 0.15), intraoperative hypoxemia (OR 1.6, 95% CI 0.6-4.5, P =
0.45) or hypotension (OR 0.9, 95% CI 0.5-1.8, P = 0.98). Surgical time (180.2 -
210.3 minutes, mean difference ([95% CI], 30 min [5.5-50.4 minutes], P = 0.03))
and the mean duration of postoperative mechanical ventilation (180-250.8 hours,
mean difference [95% CI) 91.8 [34.5-149.1 h], P <0.01) was shorter for the
non-long esophageal group (single session) Overall in-hospital mortality was 8%
(average 7.2%, 14% for long-term operation, long or short-term esophageal
atresia) 2.2%, 95% CI 0.4-14, P = 0.85).

             Conclusion:
The incidence of perioperative complications is similar in infants with
prolonged esophageal atresia requiring gradual surgery and in infants with
normal esophageal atresia. However, longer surgical approaches for long-term
repair require multiple procedures to maintain esophageal continuity, with
longer anesthetic exposure. This increases the mortality and morbidity rates.

Keywords

Anestezi, Yenidoğan, Özafaguz Atresizi

Supporting Institution

YOK

Project Number

YOK

Thanks

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