Trakeoplasti: 10 Yıllık Deneyimin Sonuçları

Öz

Amaç: Trakeal stenozlar genel olarak; edinsel ve konjenital, ekstrensek ve intrensek ya da kısa segment – uzun segment stenozlar olarak ayrılmaktadır. Etyopatolojik olarak farklılıkları olsa da konservatif yaklaşımın yeterli olmadığı hastalarda, endoskopik veya cerrahi tedaviye ihtiyaç duyulmaktadır. Biz de çalışmamızda trakeoplasti yaptığımız hastalarımızdaki tecrübelerimizi paylaşmak istedik. Yöntem: Son 10 yılda kliniğimizde trakeoplasti yapılan hastaların tıbbi kayıtları geriye dönük olarak incelenerek demografik özellikleri, cerrahi yöntem, erken ve geç sonuçlar değerlendirilmiştir. Bulgular: Ocak 2013 - Ocak 2023 arasında kliniğimizde trakeostomi açılan 226 hastanın 32 tanesine trakeoplasti işlemi uygulandı. 17’si erkek, 15’i kız hastanın yaşları 3 ay ile 15 yaş arasında değişmekte idi. Hastaların trakeostomili kalma süresi ortalama 8 ay, trakeoplasti yaşı ortalama 2,5 yaş olarak saptandı. Hastaların 17’sine endoskopik işlem uygulanırken, 21’ine açık cerrahi işlem uygulandı. 5 hasta endoskopik işlemden fayda görmeyip sonrasında yama trakeoplasti uygulandı, 1 hastaya ise dilatasyon sonrası rezeksiyon-anastamoz yapıldı. Açık cerrahi işlem olarak 9 hastaya yama trakeoplasti, 1 hastaya sliding trakeoplasti, 11 hastaya ise rezeksiyon-anastamoz yapıldı. Açık cerrahi sonrası hiçbir hastanın dilatasyon ihtiyacı olmazken yama trakeoplasti ve rezeksiyon-anastamoz yapılan birer hastanın re-operasyon ihtiyacı oldu. Hastaların post-op izlem süresi ortalama 4,5yıl olup, hiçbirinde işlem sonrası trakeostomi ihtiyacı olmadı. Sonuç: Son 20 yılda gelişen cerrahi ve endoskopik teknikler sayesinde bu hastaların sağkalımı belirgin şekilde düzelse de terapötik işlemlere bağlı gelişen yüksek morbidite oranları hala kabul edilebilir düzeyin üzerindedir. Hasta bakımı kanıta dayalı standartlar yerine her kurumun geçmiş tecrübe ve uzmanlığı temelinde yürütülmektedir. Multidisipliner bir yaklaşımla çocuk için en iyi uzun dönem hava yolu sonuçlarının alınması sağlanmalıdır.

Anahtar Kelimeler

• trakeoplasti
• yama
• sliding
• pediatrik

Destekleyen Kurum

yok

Etik Beyan

Çalışma için 21.11.2023 tarihinde Karadeniz Teknik Üniversitesi Tıp Fakültesi Bilimsel Araştırmalar Etik Kurulundan onaylanmıştır. 2023/213 Sayılı Karar

Tracheoplasty: Outcomes of a 10-Year Experience

Öz

Objective: Tracheal stenoses are generally classified as acquired vs. congenital, extrinsic vs. intrinsic, or short-segment vs. long-segment stenoses. Despite etiopathological differences, endoscopic or surgical interventions are required for patients in whom conservative management proves insufficient. In this study, we aimed to share our clinical experience with patients who underwent tracheoplasty. Methods: The medical records of patients who underwent tracheoplasty in our clinic over the last 10 years were retrospectively reviewed. Demographic characteristics, surgical methods, and early and late-term outcomes were evaluated. Results: Between January 2013 and January 2023, 32 out of 226 patients who underwent tracheostomy in our clinic were treated with tracheoplasty. Of these patients, 17 were male and 15 were female, with ages ranging from 3 months to 15 years. The mean duration of tracheostomy was 8 months, and the mean age at the time of tracheoplasty was 2.5 years. Endoscopic procedures were performed on 17 patients, while 21 patients underwent open surgical procedures. Five patients who did not benefit from endoscopic intervention subsequently underwent patch tracheoplasty, and one patient underwent resection-anastomosis following dilatation. Regarding open surgery, patch tracheoplasty was performed in 9 patients, slide tracheoplasty in 1, and resection-anastomosis in 11. While none of the patients required dilatation following open surgery, one patient each from the patch tracheoplasty and resection-anastomosis groups required re-operation. The mean postoperative follow-up period was 4.5 years, and none of the patients required a tracheostomy after the procedure. Conclusion: Although the survival of these patients has significantly improved over the last 20 years due to evolving surgical and endoscopic techniques, the high morbidity rates associated with therapeutic procedures remain above acceptable levels. Patient care is often conducted based on the historical experience and expertise of individual institutions rather than evidence-based standards. A multidisciplinary approach must be adopted to ensure the best long-term airway outcomes for the child.

Anahtar Kelimeler

• Tracheoplasty
• Patch
• Pediatric
• Sliding

Destekleyen Kurum

None

Etik Beyan

The study was approved by the Scientific Research Ethics Committee of Karadeniz Technical University Faculty of Medicine on November 21, 2023. Decision No. 2023/213.

Kaynakça

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