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Procena efikasnosti ezofagoplastike gastričnim tubusom kao metode zamene jednjaka kod dece u zavisnosti od etioloških faktora

Evaluation of efficacy of gastric tube esophagoplasty as esophageal replacement method in children regarding the etiological factors

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2016
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Author
Miličković, Maja D.
Mentor
Savić, Đorđe
Committee members
Stajević, Mila
Maliković, Aleksandar
Jovanović, Danica
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Abstract
Najčešća indikacija za zamenu jednjaka kod dece je atrezija jednjaka (AJ) posle neuspeha primarnog ili odloženog primarnog anastomoziranja atretičnih krajeva jednjaka. Kaustične stenoze (KS) jednjaka su najčešća indikacije za zamenu jednjaka u zemljama u razvoju. Zamenu jednjaka je moguće izvršiti desnim ili levim kolonom, slobodnim jejunalnim graftom ili jejunalnim graftom na peteljci, gastričnim tubusom ili celim želucem. Nema preciznih podataka u vezi prednosti jedne metode u odnosu na drugu. Najuspešnijom metodom se smatra ona sa kojom hirurg postiže najbolje rezultate. Metoda zamene jednjaka reverznim gastričnim tubusom je počela sa primenom na Institutu za zdravstvenu zaštitu majke i deteta Srbije “Dr Vojkan Čupić” 1990. godine. Najčešća komplikacija ove metode je pacijalna dehiscencija anastomoze izmeĎu proksimalnog kraja jednjaka i gastričnog tubusa. Rezultat zaceljivanja je stenoza anastomoze. Većina dehiscencija i stenoza ezofagogastrične anastomoze leči se konzervativnim met...odom. Postoje izveštaji o većoj incidenci dehiscencije i stenoze ezofagogastrične anastomoze kad je ona lokalizovana u vratu nego kad je lokalizovana u grudnom košu,dok je anastomoza u grudnom košu praćena težim komplikacijama. Anastomoza u grudnom košu znači postojanje veće dužine prirodnog jednjaka, što pozitivno utičena proces gutanja i pasaže hrane. Lokalizacija ezofagogastrične anastomoze može biti odreĎena inicijalnim tretmanom. Ciljevi ove studije su: 1) utvrĎivanje uspešnosti metode zamene jednjaka reverznim gastričnim tubusom u odnosu na etiološki faktor, 2) utvrĎivanje uspešnosti ove metode u odnosu na inicijalni tretman (gastrostoma, cervikalna ezofagostoma, dilataciona terapija), 3) utvrĎivanje uspešnosti ove metode u odnosu na lokalizaciju anstomoze i 4) doprinos odreĎivanju mesta ove operativne tehnike u spektru operativnih metoda za zamenu jednjaka kod dece...

The main indication for esophageal replacement in the pediatric population is esophageal atresia (EA) after failure to achieve primary or delayed primary end-to-end anastomosis. Caustic injuries (CS) are the most frequent indication for esophageal replacement in less developed countries. Esophageal replacement is possible with right or left colon, pedicle or free jejunal graft, gastric tube or whole stomach. There is lack of evidence to demonstrate that one method is clearly superior to others. Probably, the most successful surgical technique is the one surgeon performed the best. Reverse gastric tube esophagoplasty has been performed in Institute for mother and child health care of Serbia “Dr Vukan Cupic”, since 1990. The most common complication of this method is an anastomotic leak between the gastric tube and the proximal part of the esophagus that becomes stenotic over time. However, most ofthese complications respond well to conservative treatment.. There are reports of higher in...cidence of leakage at the site of cervical gastro-esophageal than thoracic anastomosis, but leakage at the site of thoracic anastomosis seems to carry a more detrimental complication. Anastomosis in the chest means the presence of normal esophagus at greater length, which conveniently can affect the process of swallowing and passage of food. Localization of esophagogastric anastomosis can be determinated by initial treatment. The aims of this study are: 1) to establish the efficacy of gastric tube esophagoplasty in children regarding the etiological factors, 2) to establish the efficacy of gastric tube esophagoplasty in children regarding the initial treatment (gastrostomy, cervical esophagostomy and dilatation therapy), 3) to establish the efficacy of gastric tube esophagoplasty in children regarding the localization of anastomosis 4) to establish the overall efficacy of this method comparing with other methods for esophageal replacement...

Faculty:
University of Belgrade, School of Medicine
Date:
31-08-2016
Keywords:
reverzni gastrični tubus / reverse gastric tube / esophageal replacement / esophageal atresia / caustic esophageal strictures / zamena jednjaka / atrezija jednjaka / kaustična stenoza jednjaka
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Handle
https://hdl.handle.net/21.15107/rcub_nardus_6703
URI
http://eteze.bg.ac.rs/application/showtheses?thesesId=3936
https://nardus.mpn.gov.rs/handle/123456789/6703
https://fedorabg.bg.ac.rs/fedora/get/o:13236/bdef:Content/download
https://fedorabg.bg.ac.rs/fedora/get/o:13311/bdef:Izvestaj/download
http://vbs.rs/scripts/cobiss?command=DISPLAY&base=70036&RID=48244239

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