Tonsillektomi ve adenotonsillektomi yapılan hastaların endikasyon, komplikasyon, postoperatif sonuçlar ve beklenti -sonuç ilişkileri açısından değerlendirilmesi
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Tarih
2011
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmanın amacı, tonsillektomi ve adenotonsillektomi yapılan çocuk hastaların erken ve geç dönem postoperatif sonuçları ile ailelerinin ameliyat sonrası düşüncelerini araştırmak; bulguları hedef – sonuç ilişkisinde değerlendirmektir. Hastalar ve Metod: Çalışmaya Eylül 2008 ile Ekim 2011 tarihleri arasında kliniğimizde tonsillektomi ve adenotonsillektomi yapılan 34'ü erkek(%52.3), 31'i kız(%47.7) olmak üzere 65 çocuk hasta dahil edildi. Hastaların preoperatif yaş ortalaması 7.09±2.30 (min. 4, maks. 13) idi. 11 tanesi (%16.9) kronik/hipertrofik tonsillit, geri kalan 54 tanesi (%83.1) ise adenoid vejetasyon ile birlikte kronik/hipertrofik tonsillit tanısı bulunan çocuklar arasından rastgele seçilerek oluşturuldu. Kontrol amaçlı çağırılan tüm hastaların anamnezleri ve postoperatif şikayetleri anne/babalarından alındı. Çoktan seçmeli ve/veya ucu açık 19 kalem soruyu cevaplamaları istendi. Cevapların ardından hastaların muayeneleri yapılarak son klinik bulguları not edildi. Bulgular: Postoperatif takip süresi ortalama 15.18±7.4 ay(min. 1 – maks. 36) idi. Ameliyatın bizim hastanemizde yapılması için verilen kararda en etkili faktör %55.4 ile fakülte olması iken, bu ameliyata karar verinceye kadar başvurulan KBB uzmanı sayısının ortalama 2.55±1.87 (min. 1 – maks. 10) olduğu öğrenildi. Ameliyatın etkinliği 10 üzerinden ortalama 8.55±1.39 (min. 4 – maks. 10) olarak tespit edildi. Tedavi sonrası hastaların 19'u (%29.2) aynı şikayetlerin devam ettiğini, 36'sı (%55.4) şikayetlerinin tamemen geçtiğini ve 10'u (%15.4) eskisine nazaran daha iyi olduğunu bildirdi. Cerrahi öncesi yaşıtlarına göre gelişme geriliği bulunan 39 hastanın(%60), postoperatif 24'ünde (%61.5) farkedilir bir gelişme olduğu söylendi. 4(%6.2) hasta tekrar başa dönebilseydik bu operasyonu yaptırmazdım yanıtını verdi. Çocukların, 25(%38.5)'inin okul öncesi olduğu, 1(%1.5)'inin özel eğitim öğrencisi olduğu, 19(%29.2)'unun cerrahi sonrası derslerindeki başarının ailenin farkedeceği düzeyde arttığı, 20(%30.8) çocuğun ise ders başarı düzeyinin aynı kaldığı saptandı. Hastaları erken postoperatif dönemde en fazla rahatsız eden semptomlar arasında ilk sırada ağrı(%35), ikinci sırada yutma güçlüğü(%32) ve üçüncü sırada iştahsızlık gelmekteydi(%15). Hastaların yaşları ile iyileşme süreleri arasında ve yapılan cerrahi ile iyileşme süreleri arasında anlamlı bir ilişki tespit edilemedi. Cinsiyete, yaşa ve tanıya bağlı olarak dağılım yapıldığında iyileşme süresi, komplikasyon gelişimi gibi diğer değişkenlerde de anlamlı bir fark bulunamadı. Sonuç: Sonuç olarak preoperatif değerlendirmelerde daha dikkatli olunması, sistemik hastalıklar yönünden detaylı sorgulanması, hasta ve ebeveynlerinin cerrahiden tam olarak ne beklediklerinin bilinmesi ve cerrahi kararın buna göre verilmesi gerektiği anlaşılmıştır. Seçilmiş hastalarda yapılacak adenotonsillektominin daha memnun edici sonuçlar verdiği görülmüştür.
Purpose: The purpose of this study is to reveal both the early and late postoperative results of tonsillectomy and adenotonsillectomy which are performed on pediatric patients. It is also intended to disclose the feelings and thoughts of parents or guardians of the patients. Then, ultimate purpose is to evaluate the findings with regards to intent - result relation. Patients and Methods: Sixty-five pediatric patients with a ratio of 34 male (52.3%) and 31 female (47.7%) participated. All the participants have had either tonsillectomy or adenotonsillectomy operation in our clinic sometime from September, 2008 to October, 2011. The mean age of the patients was found as 7.09±2.30 (min. 4 - max. 13) preoperatively. All the patients were randomly chosen. Considering the patients' diagnosis; 11 (16.9%) of the total patients had chronic/hypertrophic tonsillitis, and remaining 54 (83.1%) patients had cronic/hypertrophic tonsillitis with adenoid vegetation. Anamnesis of all the patients who were called for follow-up were taken from the parents. The parents were asked to complete a survey which consists of 19 multiple choice or/and open ended questions. After survey, patients were examined and latest clinical findings were noted. Results: Average length of postoperative follow-up was 15.18±7.7 months (min. 1 – max. 36). Our clinic being an university research institution was the most influential factor (55.4%) for those who had chosen this clinic for the operations. Findings indicated that; before making final decision on having the operation, patients had been consulted by an avarage of 2.55±1.87 (min 1- max. 10) specialist doctors. Affectiveness of the operations was found as 8.55±1.39 (min. 4 – max. 10) out of 10 point. Nine-teen (29.2%) patients have complained about ongoing problems; 36 (55.4%) of them have not had any complaint; and remaining 10 (15.4%) patients have reported being relatively better. According to the reports, although 39 (60%) of the patients preoperatively had growth defficiency in comparasion to their peers; postoperative reports have been claimed a noticable progress for 24 (61.5%) of growth defficiency suffering patients. On the other hand, 4 (6.2%) patients have reported regret of having the surgery. Twenty-five (38.5%) of the patients were preschool children and 1 (1.5%) was receiving special education. In addition to this, school success of 19 (29.2%) children has increased in an observable level; however, the success level has remained the same for remaining 20 (30.8%) children. The most frequently reported early postoperative semptoms were pain (35%), disphagy (32%), and lack of appetite (15%). No statistically significant relation found between both age – recovery time and type of operation – recovery time. In the cases of grouping patients according to gender, age, or diagnosis; no statistically significant results were found between recovery time, development of complications, and other variables. Conclusion: As conclusion, before making a decision on whether performing an operation, followings need to be considered: More careful preoperative evaluations should be done, detailed investigation regarding patients' systemic diseases need to be done, expectations of patients should be precisely defined. It is observed that adenotonsillectomies performed on picked patients result in higher satisfaction.
Purpose: The purpose of this study is to reveal both the early and late postoperative results of tonsillectomy and adenotonsillectomy which are performed on pediatric patients. It is also intended to disclose the feelings and thoughts of parents or guardians of the patients. Then, ultimate purpose is to evaluate the findings with regards to intent - result relation. Patients and Methods: Sixty-five pediatric patients with a ratio of 34 male (52.3%) and 31 female (47.7%) participated. All the participants have had either tonsillectomy or adenotonsillectomy operation in our clinic sometime from September, 2008 to October, 2011. The mean age of the patients was found as 7.09±2.30 (min. 4 - max. 13) preoperatively. All the patients were randomly chosen. Considering the patients' diagnosis; 11 (16.9%) of the total patients had chronic/hypertrophic tonsillitis, and remaining 54 (83.1%) patients had cronic/hypertrophic tonsillitis with adenoid vegetation. Anamnesis of all the patients who were called for follow-up were taken from the parents. The parents were asked to complete a survey which consists of 19 multiple choice or/and open ended questions. After survey, patients were examined and latest clinical findings were noted. Results: Average length of postoperative follow-up was 15.18±7.7 months (min. 1 – max. 36). Our clinic being an university research institution was the most influential factor (55.4%) for those who had chosen this clinic for the operations. Findings indicated that; before making final decision on having the operation, patients had been consulted by an avarage of 2.55±1.87 (min 1- max. 10) specialist doctors. Affectiveness of the operations was found as 8.55±1.39 (min. 4 – max. 10) out of 10 point. Nine-teen (29.2%) patients have complained about ongoing problems; 36 (55.4%) of them have not had any complaint; and remaining 10 (15.4%) patients have reported being relatively better. According to the reports, although 39 (60%) of the patients preoperatively had growth defficiency in comparasion to their peers; postoperative reports have been claimed a noticable progress for 24 (61.5%) of growth defficiency suffering patients. On the other hand, 4 (6.2%) patients have reported regret of having the surgery. Twenty-five (38.5%) of the patients were preschool children and 1 (1.5%) was receiving special education. In addition to this, school success of 19 (29.2%) children has increased in an observable level; however, the success level has remained the same for remaining 20 (30.8%) children. The most frequently reported early postoperative semptoms were pain (35%), disphagy (32%), and lack of appetite (15%). No statistically significant relation found between both age – recovery time and type of operation – recovery time. In the cases of grouping patients according to gender, age, or diagnosis; no statistically significant results were found between recovery time, development of complications, and other variables. Conclusion: As conclusion, before making a decision on whether performing an operation, followings need to be considered: More careful preoperative evaluations should be done, detailed investigation regarding patients' systemic diseases need to be done, expectations of patients should be precisely defined. It is observed that adenotonsillectomies performed on picked patients result in higher satisfaction.
Açıklama
Anahtar Kelimeler
Kulak, Burun, Boğaz
Kaynak
KBB-Forum
WoS Q Değeri
Scopus Q Değeri
Cilt
10
Sayı
4
