Jejunoileal Obstruksiyonlarda Mortalite ve Morbiditeyi Etkileyen Faktörler
Amaç: Yenidoğanlarda acil cerrahi tedavi gerek- tiren barsak obstruksiyonlarının başlıca sebebi jejunoileal atreziler ve mekonyum ileuslarıdır. Bu çalışmanın amacı yenidoğanların jejunoileal obst- ruksiyonlarında mortalite ve morbitideyi etkileyen faktörleri ortaya koymaktır. Gereç ve Yöntem: Ocak 2004 - Aralık 2012 yılları arasında jejunoileal obstruksiyon nedeniyle opere edilen yenidoğanların tüm dosya kayıtları mortalite ve morbidite açısından retrospektif olarak değer- lendirildi. Bulgular: 9 yıllık süre boyunca opere edilen intesti- nal obstruksiyonlu 44 olgunun 34ü(%77,2) jejuno- ileal atrezi, 10u mekonyum ileusu olup jejunoileal atrezilerin %41i prematüre idi. Atrezili olguların 2si(%5,8) gastroşizis ve 1i(%2,9) Meckel invaji- nasyonu ile birlikteydi. 17 olguda (%38,6) prena- tal tanı konulmuştu. Mekonyum ileuslu olguların 2sinin (%20) ve JİAli olguların 15inin (%44) prenatal tanısı vardı. Ameliyatta 34 jejunoileal at- rezili olgudan(%77,2); 6sının Tip 1(%17,6), 8inin Tip 2(%23,5), 5inin Tip 3A(%14,2), 11inin Tip 3B(%24,4), 4ünün Tip 4(%11,8) olduğu saptandı. Ayrıca 9unda (%20,4) malrotasyon, 1inde (2,9) Meckel divertikülü, 1inde (%2,9) intrauterin invaji- nasyon, 1inde (%2,9) mekonyum peritoniti mevcut- tu. 28 olguya(%82,3) primer rezeksiyon anastomoz, 2sine(%5,8) ostomi, birine enterotomi-web eksiz- yonu yapılmıştı. Malrotasyon olan 9 olguya(%20 ,4) ayrıca Ladd prosedürü, 4 olguya(%11,6) appen- dektomi yapılmıştı. Rezeksiyonu takiben bir olguda kısa barsak sendromu gelişti. 19 olguda(%43) to- tal parenteral nutrisyon yapıldı. Jejunoileal atrezi olgularının %79,5i, mekonyum ileus olgularının %90ı yaşadı Sonuç: Jejunoileal obstruksiyonlu yenidoğanlarda kistik fibrozis ve kısa barsak sendromu morbiditeyi ve mortaliteyi arttırmaktadır. Postoperatif dönem- de kısa barsak sendromu gelişen olgularda TPN ve büyüme hormonu desteği, antibiotiklerin etkin kullanılması, yoğun bakım şartlarının iyileşmesi ve hemşirelik bakımının iyileşmesi jejunoileal atrezili olgularda mortalite ve morbiditeyi azaltmaktadır
Effecting Factors of The Mortality and Morbidity in The Jejunoileal Obstruction
Objective: Jejunoileal atresia and meconium ileus are seen common among major causes of intestinal obstructions of the newborns requiring emergency surgical treatment. The aim of this study is determi- ned effecting factors of the mortality and morbidity in the jejunoileal obstruction in newborns. Material and Method: This study is designed as a retrospectively from all records of the neonates with jejunoileal obstructions hospitalised in between Ja- nuary 2004 and January 2013. Results: 44 newborns were opertated due jejuno- ileal obstruction during the 9 years period. 34 of them were intestinal atresia (77,2%), the others had meconium ileus. Prenatal diagnosis was suggestive of intestinal obstruction in 15 fetuses (44%). %41of 34 intestinal atresia was premature. At the time of surgery, 34 (77,2%) of the jejunoileal atresias were classified 6(17,6%) as type I(mucosal), 8(23,5 %) as type II(atretic fibrous cord), 5(14,2 %) as type IIIa(V-shaped mesenteric defect), 11(24,4%) as type IIIb(apple peel atresia), and 4(11,8%) as type IV(- multiple atresias). Other findings in operation had included malrotation in 9(20,4%), meconium peri- tonitis in 1(2,9%), Meckel diverticulum in 1(2,9%), and intrauterine intussusception in 1(2,9%). Operative management included resection of the atresia with primary bowel anastomosis in 28 neonates (82,3%), temporary ostomy in 2(5,8%), with intestinal resection in 30(88,1% of those), en- terotomy with web excision in 1(2,9%). Ladd proce- dure was performed in those neonates with malro- tation 9(20,4%) and Meckel diverticulectomy was performed in 1 neonate, and incidental appende- ctomy was performed in 4 neonates (11,6%). Fol- lowing resection, 1 patients (2,9%) had resultant short-bowel syndrome. Mortality for neonates with with jejunoileal atresia was 7 cases (20,5%). Ten neonates (22,7 %) had cystic fibrosis documented by sweat chloride determinations. The long-term survival rate for children with jejunoileal atresia, 79,5%; and with meconium ileus 90%. Conclusion: In neonates with jejunoileal obstructi- on short bowel syndrome and cystic fibrosis incre- ases morbidity and mortality. TPN and growth hor- mone support, effective use of antibiotics, intensive care conditions improve, and the improvement of nursing care in patients reduces mortality and mor- bidity in the postoperative period of patients with meconium ileus with/without jejunoileal atresia and ultrashort-bowel syndrome.
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