Özofagus Atrezisi Operasyonu Sonrası Gelişen Dirençli Atelektazinin rhdn ase ile Tedavisi

Abstract

Özefagus atrezisinin cerrahisi sonrası dirençli atelektazi gelişen hastaların tedavisinde rhDNase uygulanması daha önce literatürde bildirilmemiştir. Bu çalışmayla biz, özofagus atrezisi operasyonu sonrasında gelişen ve konvansiyonel yöntemlerle düzelmeyen, sağ akciğer atelektazili iki olgunun rhDNase ile tedavi sonuçlarını sunmayı amaçladık.On beş günlük kız bebek özofageal atrezi ve distal trakeoözofageal fistül nedeniyle opere edildikten 11 gün sonra sağ akciğerinde atelektazi gelişti. Standart tedavilere cevap alınamadı. Postoperatif 20. gün rijit bronkoskopi yapıldı. Atelektazi kısmen açıldı ancak tekrar etti. 26. gün nebulüzatörle rhDNase tedavisi başlandı. 2 gün boyunca, günde 3 kez 1.25mg dozda rhDNase uygulandı. Her 3 dozluk tedavi sonunda kontrol akciğer grafileri çekildi. İkinci gün sonunda hastanın atelektazisinin tamamen düzeldiği görüldü ve tekrar etmedi.Özofageal atrezi ve distal trakeoözofageal fistül nedeniyle 3 günlükken opere edilen, 7 günlük erkek bebekte, sağ akciğerde atelektazi gelişti. Hastaya standart atelektazi tedavileri uygulandı, fakat atelektazide düzelme olmadı. Postoperatif 9.gün hastaya rhDNase tedavisi başlandı. Hastaya, ilk olguda uygulandığı şekliyle, 2 gün boyunca rhDNase tedavisi uygulandı. İkinci gün sonunda hastanın atelektazisinin tamamen düzeldiği görüldü ve tekrar etmedi.Özefagus atrezisi operasyonu geçirmiş yenidoğanlarda postoperatif gelişen dirençli atelektazilerin tedavisinde rhDNase alternatif olabilir

Keywords

• Dornaz alfa, Özefagus atrezisi, Postoperatif akciğer atelektazisi, rhDNaz, Yenidoğan

Treatment of Resistant Atelectasis After Esophageal Atresia Repair with rhdn ase

Abstract

There is no previous literature report on the use of rhDNase treatment in patients developing resistant atelectasis after esophagus atresia surgery, to the best of our knowledge. We aimed to present the results of rhDNase treatment in two cases that developed right lung atelectasis after esophageal atresia repair and did not respond to conventional treatment.A 15-day-old girl was operated for esophageal atresia with distal tracheoesophageal fistula and developed right lung atelectasis on the postoperative 11th day. Standard conservative treatment failed and rigid bronchoscopy was performed on the postoperative 20th day. The atelectasis partly improved but subsequently recurred. We started nebulization with rhDNase on postoperative day 26 and three doses per day were administered for 2 days with each dose containing 1.25 mg of rhDNase. A chest X-ray was obtained at the end of the three doses. A full recovery in the patient’s atelectasis was observed after 2 days and no recurrence occurred.A 7-day-old boy who underwent esophageal atresia with distal tracheoesophageal fistula repair when 3 days old developed right atelectasis. The patient received standard treatment but the atelectasis did not improve. The patient was treated with rhDNase for two days starting on the 9th postoperative day using the same dose as the first case. A full recovery in the patient’s atelectasis was observed after 2 days and no recurrence occurred. We found rhDNase treatment to be potentially useful to cope with resistant atelectasis of postoperative origin in newborns that have undergone surgical intervention for esophagus atresia

Keywords

• Dornase alpha, Esophageal atresia, Postoperative pulmonary atelectasis, rhDNase, Newborn

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