Browsing by discipline "Paediatric Surgery"
Now showing items 1-5 of 5
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(2016)Napanuoratyrä eli omfaloseele on synnynnäinen vatsanpeitedefekti, jossa vatsaontelon elimiä työntyy napanuoraan. Omfaloseele pyritään korjaamaan vastasyntyneenä palauttamalla elimet vatsaonteloon tyräpussista ja sulkemalla tyräportti sekä iho Jättiomfaloseeleksi kutsutaan napanuoratyrää, joka on niin kookas, että primaarisulku kaikkien vatsanpeitteiden kerrosten osalta ei ole mahdollista. Tässä tutkimuksessa vertailtiin eri menetelmiä, silloin kun omfaloseelen täydellinen primaarisulku ei ollut mahdollista. Tutkimuksen tavoite oli tutkia, onko allografti-iho eli elinluovuttajalta saatu glyserolissa säilötty osaihonsiirre parempi jättiomfaloseelen tyräpussin suojaustapa kuin muut tällä hetkellä käytössä olevat hoitotavat. Tutkimusaineistoon kerättiin HYKSin Lastenklinikalla vuosina 1990-2015 hoidetut jättiomfaloseelepotilaat. Aineisto koostuu 12 potilaasta, joista kuudelle oli käytetty omfaloseelepussin suojausta allografti-iholla ja kuudelle ihon sulkua tai tyräpussin hoitoa paikallishoitoaineilla. Oman ihon sulku on paras menetelmä jättiomfaloseelen tyräpussin suojaamiseksi, mikäli se voidaan tehdä kiristyksettömästi. Allografti-iho toimii biologisena sidoksena epitelisaation ajan ja on turvallinen hoitovaihtoehto silloin kun vastasyntyneen anestesiaan ja suurempaan leikkaussalitoimenpiteeseen liittyy riskejä tai arvellaan, että oman ihon sulku ei onnistuisi ilman haavakomplikaatioita.
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(2016)Aim. We aimed to assess complications and functional outcomes of restorative proctocolectomy (RPC) with ileoanal anastomosis (IAA) performed on children with total colonic aganlionosis (TCA) in relation to patients with ulcerative colitis (UC). Methods. Medical records on complications, stool frequency, day- and nighttime continence, enterocolitis/pouchitis and fecal calprotectin levels of HD patients who underwent RPC with IAA in a single center were compared to similarly treated patients with pediatric-onset UC. Results. Median operative age of HD patients was 1.6 months and 5.6 years at follow-up. Fourteen patients received J-pouch and two straight IAA. Stool frequency for daytime was 3.5 and nighttime 0. Total continence rate was 79%. At least two enterocolitis/pouchitis episodes occurred in 81%, while histologically verified pouch inflammation was observed in 27%. An increased value of fecal calprotectin was observed in 4. Conclusion. Outcomes were encouraging. Stool frequency and fecal continence appeared better preserved and the frequency of histological pouch inflammation and fecal calprotectin levels were lower than in UC patients.
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(2014)Objectives: To analyse retrospectively population-based results of congenital tracheal stenosis repair in neonates and small children in Finland Methods: Data on infants and children who were operated for congenital tracheal stenosis in Helsinki Children`s Hospital (HCH) between August 1988 and May 2013, were analysed retrospectively. Fiberoptic bronchoscopy was performed perioperatively and in the follow-up in all patients. The median follow-up time was 7 years (range 1- 20years). Results: Thirteen children were operated for congenital tracheal stenosis. Resection with end-to-end anastomosis was used in 12 patients and slide tracheoplasty in one patient. The median age at the operation was 2.9 months (range, 6 days - 19 months). Eight patients (62%) had associated cardiovascular defects which were corrected during the same operation. The median length of stenosis was 35% (range, 25 - 60%) from the total length of the trachea. The median length of postoperative mechanical ventilation was 10 days (range, 5 - 19 days). The median length of intensive care treatment was 15 days (range, 7 - 40 days). One patient died due to hypoplastic lung tissue and fibrosis, and multiorgan failure. One patient required reoperation and three other patients needed balloon bronchodilatations postoperatively. There was no late mortality. All the 12 survivors had good outcome. Conclusion: Resection with end-to-end anastomosis presented a good long-term outcome with up to 55% of stenotic segment of the trachea.
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(2016)Background. Operative mortality after complete atrioventricular septal defect (cAVSD) repair has improved vastly. Less improvement has been demonstrated regarding late mortality and reoperation rates. There is evident lack of particularly comprehensive population based studies analyzing history and progress of the ever-changing operative results. Objectives. The purpose of this study was to determine the long-term outcome, atrioventricular valve reoperation rate, and risk factors of mortality and reoperation during the 50-year period of corrective surgery of complete atrioventricular septal defect at single institution. Methods. This is a 5 million population based retrospective study of all cAVSD-operated patients in Finland between 1962-2014, consisting of 388 consecutive patients. Data was collected using Childrens Cardiac Surgical Registry of Children's Hospital at the Helsinki University Hospital, Finland. Mortality data and reoperation rates were analyzed on a decade by decade basis. Results. Since the early era, overall mortality has been 17.4%, out of which 10.9% has been comprised by operative mortality. The operative results have improved significantly through the decades, and eventually the last decade showed no mortality. Total of 23 late deaths occurred, out of which 20 were directly heart related. Half of the late mortality occurred during the first postoperative year. The only significant risk factor for overall mortality was earlier decade of operation (p<0,001). Reoperation rates have not decreased but rather increased over decades (p=0,621) and have been performed mainly during the first year after the primary operation. Actuarial freedom from left side AV valve reoperation at 15 years was 90,9%. Conclusions. There has been outstanding improvement in surgical results through years even though the general operative approach has remained the same. Rates of reoperation have not been declining, but the reoperations are dated to early childhood years. The improvement in results is still ongoing.
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(2018)Empyeeman, eli märkäisen keuhkopussintulehduksen, esiintyvyys lapsilla kasvaa. Kultaista standardia ensilinjan hoidolle ei kuitenkaan vielä ole, vaan toimintatavat vaihtelevat alueittain. Kaksi yleisintä hoitovaihtoehtoa ovat videoavusteinen torakoskopia (VATS) ja pleuradreneeraus. Tämän retrospektiivisen tutkimuksen tarkoituksena oli vertailla näitä hoitomuotoja, yhtenäistää lasten empyeemojen ensilinjan hoitoa ja tukea näyttöön perustuvaa toimintatapaa erityisesti Helsingin lastenklinikalla. Aineisto koostui Helsingin lastenklinikalla vuosina 2001-2016 hoidetuista potilaista, joilla oli pneumonian komplikaationa saatu empyeema. Potilaista 25 hoidettiin primaaristi pleuradreenillä ja 25 VATS:lla. Ryhmät olivat samankaltaisia iän ja sukupuolijakauman suhteen, eikä ajalla oireiden alusta sairaalahoitoon hakeutumiseen ollut merkittäviä eroja. Analyysin käytettiin Mann-Whitney U -testiä sekä Fischerin tarkkaa testiä. Primaaristi VATS:lla hoidetulla potilailla oli lyhyempi sairaalahoidon kesto (11 päivää vs. 18 päivää, p=0.0006), pienemmät kokonaiskustannukset (15747e vs. 25037e, p=0.0011) ja vähemmän uusintatoimenpiteitä (20% vs. 88%, p<0.0001). Pleuradreenillä hoidetuilla potilailla oli enemmän komplikaatioita, mutta ero ei saavuttanut tilastollista merkitsevyyttä (28% vs. 56%, p=0.0845). Antibioottihoidon kestolla ei ollut tilastollisesti merkitsevää eroa ryhmien kesken (19 päivää vs. 22.5 päivää, p=0.076). Aikainen VATS lyhensi sairaalahoidon kestoa, pienensi kokonaiskustannuksia ja aiheutti vähemmän uusintaoperaatiota pleuradreeniin verrattuna. Lapsipotilailla molemmat hoitovaihtehdot vaativat leikkaussaliolosuhteet ja anestesian. Videoavusteista torakoskopiaa voidaan tämän tutkimuksen valossa suositella ensilinjan hoidoksi lasten empyeemoissa. (198 sanaa)
Now showing items 1-5 of 5