Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Bir Çocuk Cerrahının Bronkoskopi-Özofagoskopi Tecrübeleri: Beş Yıllık Retrospektrif Çalışma
Bronchoscopy-Esophagoscopy Experiences of a Pediatric Surgeon: 5 Years Retrospective Study
Olga Devrim AYVAZa , Ayşenur CELAYİRa
aSağlık Bilimleri Üniversitesi Zeynep Kamil Kadın ve Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi, Çocuk Cerrahisi ABD, İstanbul, Türkiye
Turkiye Klinikleri J Med Sci. 2023;43(2):160-70
doi: 10.5336/medsci.2022-92508
Article Language: TR
Full Text
ÖZET
 Amaç: Bu çalışmada, 3. basamak eğitim araştırma hastanesinde göreve başlayan bir çocuk cerrahisi uzmanının acil, yarı acil ve elektif durumlarda rijid bronkoskopi ve özofagoskopi deneyimlerinin ortaya konulması amaçlanmıştır. Gereç ve Yöntemler: Çocuk acil polikliniğimize Ocak 2016-Aralık 2021 tarihleri arasında yabancı cisim aspirasyonu, yabancı cisim yutma, korozif madde içimi ve yutma güçlüğü tanılarıyla başvuran ve tek hekim tarafından rijid özofagoskopi ve/veya bronkoskopi yapılan çocukların hastane kayıtları geriye dönük olarak incelendi. Bulgular: Kliniğimizde 54 hastada toplam 58 özofagoskopi ve/veya bronkoskopi yapıldı. Kırk üç hastaya özofagoskopi yapıldı. Özofagoskopi yapılan hastaların 20'si (%47) korozif madde içimi, 16'sı (%37) özofagusta yabancı cisim, 3'ü (%6,9) anastomoz darlığı ve 1'i (%2,2) özofagus darlığı tanılıydı. Yabancı cisim aspirasyon öyküsü olan 3 (%6,9) olguda bronkoskopide yabancı cisim olmaması üzerine özofagoskopi yapılmıştı. On beş hastaya bronkoskopi yapıldı. Özofagoskopide yabancı cisim saptanmayan bir hastada bronkoskopi de yapıldı. Korozif madde içimi ön tanılı özofagoskopi yapılan hiçbir hastada peroperatif komplikasyon görülmedi. Özofagusta yabancı cisim ön tanısıyla özofagoskopi yapılan 1 hastada yabancı cismin iyatrojenik migrasyonu oldu. Bronkoskopi yapılan birer hastada kanama ve bronkospazm gelişti. Hiçbir hastada postoperatif komplikasyon görülmedi. Sonuç: Bronkoskopi ve özofagoskopi gerek anestezi açısından gerekse cerrahi açıdan hekimleri tedirgin eden bir invaziv işlemdir. Anamnezi kesin veya şüpheli olan hastalarda; klinik ve radyolojik bulguların normal olabileceği de göz önünde bulundurulmalıdır. Tanının bir an önce doğrulanması ve erken tedavi ile morbiditenin ve mortalitenin azaltılması sağlanabilir. Dokuya saygılı cerrahi teknikle teorik bilgi eksikliği olmadan, işlem kaynaklı komplikasyon oranı minimuma indirilebilir.

Anahtar Kelimeler: Bronkoskopi; özofagoskopi; yabancı cisim; komplikasyonlar; çocuk
ABSTRACT
 Objective: In this study, it was aimed to reveal the experiences of a pediatric surgeon who started to work in a 3rd level training-research hospital, with rigid bronchoscopy and esophagoscopy in emergency, semi-emergency or elective situations. Material and Methods: This study was performed retrospectively from hospital records in children who underwent rigid esophagoscopy and/or bronchoscopy by a single physician with various diagnoses such as foreign body aspiration, foreign body in the esophagus, ingestion of corrosive substances, and dysphagia between January 2016-December 2021. Results: A total of 58 esophagoscopy and/or bronchoscopy were performed in 54 patients in our clinic. Esophagoscopy was performed in 43 patients. Twenty (47%) had ingestion of corrosive substances, 16 (37%) had foreign bodies, 3 (6.9%) had anastomotic stenosis and 1 (2.2%) was diagnosed with esophageal stricture. Esophagoscopy was performed in 3 (6.9%) cases with a history of foreign body aspiration because there was no foreign body in bronchoscopy. Bronchoscopy was performed on 15 patients. Bronchoscopy was also performed in a patient whose foreign body was not detected in esophagoscopy. No peroperative complications were observed in any patient who underwent esophagoscopy with a pre-diagnosis of corrosive substance ingestion. Iatrogenic migration of foreign body occurred in a patient who underwent esophagoscopy. Bleeding and bronchospasm developed in 1 patient each. No postoperative complications were observed in any of the patients. Conclusion: Bronchoscopy and esophagoscopy are invasive procedures that make physicians uneasy both in terms of anesthesia and surgery. In patients with a definite or doubtful anamnesis; it should also be taken into account that clinical and radiological findings could be normal. Diagnosis can be confirmed as soon as possible and morbidity and mortality can be reduced with early treatment. With a tissue-respecting surgical technique, the rate of procedure-related complications can be minimized without lack of theoretical knowledge.

Keywords: Bronchoscopy; esophagoscopy; foreign body; complications; child
REFERENCES:
  1. Tütüncü AÇ, Dilmen ÖK, Özcan R, Emre Ş, Köksal G, Altıntaş F, et al. Rigid bronchoscopies in pediatric patients with tracheobronchial foreign bodies: Our outcomes. Turk Arch Ped. 2012;47:126-30. [Crossref] 
  2. İnci İ, Özçelik C, Ülkü R, Eren N. Özofagus yabancı cisimleri: 682 olgunun incelenmesi [Esophageal foreign bodies: examination of 682 cases]. GKDC Dergisi. 1999;7:148-52. [Link] 
  3. Ergun E, Ates U, Gollu G, Bahadir K, Yagmurlu A, Cakmak M, et al. An algorithm for retrieval tools in foreign body ingestion and food impaction in children. Dis Esophagus. 2021;34(1):doaa051. [Crossref]  [PubMed] 
  4. Tiryaki T, Mambet E, Şenel E, Akbıyık F, Livanelioğlu Z, Atayurt H. Çocuklarda korozif madde içimi [Ingestion of corrosive substances in children]. Türkiye Çocuk Hast Derg. 2009;3(2):10-4. [Link] 
  5. Bilaçeroğlu S. Bronkoskopide eğitim, yeterlilik ve sertifikasyon. Dalar L, Yılmaz A, editörler. Türkiye Solunum Araştırmaları Derneği Tanısal ve Terapötik Bronkoskopi Uzlaşı Raporu; 2017. p.9-19. [Link] 
  6. Eyüboğlu FÖ. Bronkoskopi [Bronchoscopy]. DocPlayer.biz.32-46. Erişim tarihi: 04.05.23 [Link] 
  7. Çelikkaya ME, Atıcı A, El Ç, Akçora B. Yaygın bir halk sağlığı sorunu: çocuklarda koroziv madde içimi [A common public health problem: corrosive ingestion in children]. İzmir Dr. Behçet Uz Çocuk Hast Dergisi. 2018;8(3):184-8. [Crossref] 
  8. Denizbaşı A. Korozif madde alan hastaların acil tıpta yönetimi [Management of patients with corrosive substance ingestion in the emergency medicine]. Anatolian Journal of Emergency Medicine. 2020;3(1):27-30. [Link] 
  9. Çıtlak HK, Aslan M. Acil servise korozif madde içme nedeniyle başvuran çocukların geriye dönük olarak değerlendirilmesi: on yıllık deneyim [Retrospective evaluation of children admitted to the emergency department due to ingestion of corrosive substances: a ten-year experience]. J Pediatr Emerg Intensive Care Med. 2022;9(1):11-6. [Crossref] 
  10. Aydın E, Özcan R, Emre Ş, Eliçevik M, Tütüncü Ç, Kuroğlu S, et al. Çocukluk çağında koroziv madde içimi: Altı yüz seksen bir olgunun değerlendirilmesi [Ingestion of corrosive substances in childhood: Evaluation of six hundred and eighty-one cases]. Çocuk Cerrahisi Dergisi. 2012;26(1-2):26-31. [Crossref] 
  11. Çelik S, Aydemir B, Tanrıkulu H, Okay T, Doğusoy I. Çocuklarda ve erişkinlerde özofagus yabancı cisimleri: 20 yıllık deneyim [Esophageal foreign bodies in children and adults: 20 years of experience]. Ulus Travma Acil Cerrahi Derg. 2013;19(3):229-34. [Crossref]  [PubMed] 
  12. Metin B, Öncel M, Yıldırım Ş, Tözüm H. Çocuklarda özefagus yabancı cisimleri [Esophageal foreign bodies in children]. Arşiv Kaynak Tarama Dergisi. 2014;23(2):186-96. [Link] 
  13. Tiryaki HT, Akbıyık F, Şenel E, Mambet E, Livanelioğlu Z, Atayurt HF. Çocukluk çağında yabancı cisim yutulması [Foreign body ingestion in childhood]. Turkish J Pediatr Dis. 2010;4(2):94-9. [Link] 
  14. Lee JH. Foreign body ingestion in children. Clin Endosc. 2018;51(2):129-36. [Crossref]  [PubMed]  [PMC] 
  15. Kramer RE, Lerner DG, Lin T, Manfredi M, Shah M, Stephen TC, et al; North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Endoscopy Committee. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr. 2015;60(4):562-74. [Crossref]  [PubMed] 
  16. Dereci S, Koca T, Serdaroğlu F, Akçam M. Çocukluk çağında yabancı cisim yutulması [Foreign body ingestion in childhood]. Turk Pediatri Ars. 2015;50:234-40. [Crossref]  [PubMed]  [PMC] 
  17. Erginel B, Karlı G, Soysal FG, Keskin E, Özbey H, Çelik A, et al. Çocukluk çağında yabancı cisim yutma [Foreign body ingestion in childhood]. İst Tıp Fak Derg. 2016;79:1. [Link] 
  18. Chirica M, Kelly MD, Siboni S, Aiolfi A, Riva CG, Asti E, et al. Esophageal emergencies: WSES guidelines. World J Emerg Surg. 2019;14:26. [Crossref]  [PubMed]  [PMC] 
  19. Tartar T, Bakal U, Saraç M, Eroğlu Y, Kazez A. Bir çocuk hastada foley sonda ile özofagustan yabancı cisim çıkarılmasının nadir bir komplikasyonu: özofagus rüptürü [A rare complication of foreign body removal from the esophagus with a Foley catheter in a pediatric patient: Esophageal rupture]. KSU Medical Journal. 2021;16(3):454-7. [Crossref] 
  20. Doğan M, Esen F, Doğan Y, Öztürk S, Demir ÖF, Öztürk MA. Çocukluk çağındaki trakeobronşiyal yabancı cisim aspirasyonları [Tracheobronchial foreign body aspirations in childhood]. Bakırköy Tıp Dergisi. 2019;15:126-30. [Crossref] 
  21. Temiz A. Bronkoskopi endikasyonları ve teknik [Bronchoscopy indications and technique]. Çocuk Cerrahisi Dergisi. 2016;30(Ek Sayı 3):226-35.
  22. Özsoylu S, Akyıldız B, Dursun A. Yabancı cisim aspirasyonu: 6 yıllık deneyimlerimiz [Foreign body aspiration: our experience of 6 years]. Bozok Med J. 2011;7(3):43-6. [Link] 
  23. Doğan D, Çetinkaya E. Acil bronkoskopi [Emergency bronchoscopy]. Güncel Göğüs Hastalıkları Serisi. 2018;6(2):188-95. [Link] 
  24. Kiyan G, Gocmen B, Tugtepe H, Karakoc F, Dagli E, Dagli TE. Foreign body aspiration in children: the value of diagnostic criteria. Int J Pediatr Otorhinolaryngol. 2009;73(7):963-7. [Crossref]  [PubMed] 
  25. Cohen S, Avital A, Godfrey S, Gross M, Kerem E, Springer C. Suspected foreign body inhalation in children: what are the indications for bronchoscopy? J Pediatr. 2009;155(2):276-80. [Crossref]  [PubMed] 
  26. Sağıroğlu G. Rijit bronkoskopi uygulanan 54 olgunun retrospektif analizi [Retrospective analysis of 54 cases performed rigid bronchoscopy]. Fırat Tıp Dergisi. 2011;16(2):67-70. [Link] 
  27. Pekcan S. Bronkoskopi [Bronchoscopy]. Erişim tarihi: 04.05.23 [Link] 
  28. Hasdiraz L, Oguzkaya F, Bilgin M, Bicer C. Complications of bronchoscopy for foreign body removal: experience in 1,035 cases. Ann Saudi Med. 2006;26(4):283-7. [Crossref]  [PubMed]  [PMC] 

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