POSTOPERATIVNE KOMPLIKACIJE I NJIHOVA KORELACIJA SA OPERATIVNOM TEHNIKOM U LEČENJU GASTROSHIZE
Sažetak
Uvod: Gastroshiza predstavlja kongenitalni paraumbilikalni defekt prednjeg trbušnog zida sa evisceracijom abdominalnih organa. Savremeni pristup lečenju gastroshize doprineo je boljim rezultatima, što dokazuje stopa mortaliteta koja iznosi 5% – 10%.
Cilj rada: Cilj rada je da se proceni učestalost komplikacija i smrtnog ishoda u populaciji usled gastroshize, kao i povezanost primenjenih hirurških tehnika u lečenju sa istim.
Materijal i metode: Retrospektivnom kohortnom studijom obuhvaćeno je 75 bolesnika sa dijagnozom gastroshize, koji su u periodu od 2000. do 2020. godine lečeni u Institutu za zdravstvenu zaštitu majke i deteta Srbije ,,Dr Vukan Čupić“. Primenom ekskluzionih kriterijuma dobijen je uzorak sačinjen od 61 bolesnika. Formirane su dve kohorte ispitanika na osnovu primenjene hirurške metode, i to: primarno reponiranje i fascijalno zatvaranje defekta (hirurška kohorta gastroshiza – HKG), odnosno primarno odloženo reponiranje defekta primenom silastične vrećice (silastična kohorta gastroshiza – SKG).
Rezultati: Hiruršku kohortu gastroshiza je činilo 38 pacijenata, dok je silastičnu kohortu gastroshiza činilo 23 ispitanika. Utvrđeno je da je nekrotični enterokolitis (engl. necrotizing enterocolitis – NEC) bio statistički značajno češća komplikacija kod ispitanika iz silastične kohorte gastroshiza (5/23, odnosno 21,7% u SKG-u i 0/38 u HKG-u; RR 0,32, 95% CI: 0,22 – 0,47; p = 0,003). Nije dokazana statistička značajnost razlike u odnosu na učestalost drugih komplikacija: ileus (0/23 u SKG-u i 5/38, odnosno 13,2% u HKG-u; RR 0,59, 95% CI: 0,47 – 0,73, p = 0,069), kompartment sindrom (0/23 u SKG-u i 2/38, odnosno 5,3% u HKG-u; RR 0,61, 95% CI: 0,50 – 0,75, p = 0,263) i smrtni ishod (2/23, odnosno 8,7% u SKG-u i 2/38, odnosno 5,3% u HKG-u; RR 1,26, 95% CI: 0,46 – 3,43, p = 0,600).
Zaključak: Nije utvrđen jedinstveni dokaz o superiornosti jedne metode nad drugom. Rizici od nastanka ileusa i kompartment sindroma su veći pri primeni tehnike primarnog fascijalnog zatvaranja defekta, dok je rizik od nastanka NEC-a i smrtnog ishoda veći prilikom primene silo metode. Izbor metode u lečenju gastroshize zavisi od abdominovisceralne disproporcije, kao i izgleda evisceriranih creva procenjenih pomoću Prognostičkog skora gastroshize (engl. Gastroschisis Prognostic Score – GPS).
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