Mortalite, Morbidite ve Prognostik Faktörler
Özet
Konjenital Diyafram Hernisi' nin (KDH) yüksek mortalite ve ciddi morbiditesinin ana nedenleri, herniye olan organların akciğerleri sıkıştırması sonucu oluşan pulmoner hipoplazi ve anormal vaskülarizasyondan kaynaklanan pulmoner hipertansiyondur (PH). Bochdalek hernisinde genel mortalite %40-60 arası değişim gösterebilir. Mortalite ve morbiditeyi etkileyen faktörler arasında; hastanın takip ve tedavisinin yapıldığı merkezin deneyimi, hastalığın prenatal tanı alma durumu, Fötal Akciğer-Baş Çevresi Oranı (LHR)/Gözlenen-Beklenen LHR ile karaciğer/mide herniasyonunun hastada varlığı, majör konjenital kalp hastalığı/sendromlar ve prematür doğum bulunur. Postop dönemde KDH hastalarında hayat boyu sürebilecek multi sistem patolojileri görülebilir. Bunlar arasında uzun süreli PH, kronik akciğer patolojileri, tekrarlayan solunum yolu enfeksiyonları, nörogelişimsel gecikmeler, motor beceri sorunları, işitme kaybı, gastrointestinal patolojiler (Yüksek oranda gastroözofajial reflü, beslenme sorunları ve malrotasyon durumları) mevcuttur. Hastanın oksijenasyon indeksi ve PH' un tedaviye direnci, ekstrakorporeal membran oksijenasyonu (ECMO) ihtiyacı ve prognozu belirlemede kritik rol oynar. Morgagni hernilerinde prognoz, herninin şiddetinden ziyade hastalığın tanı zamanı ve hastada akut komplikasyon (inkarserasyon/strangülasyon) varlığı ile belirlenir. KDH hastalığı ciddi mortalite riski olan, tedavi aşamasında multidisipliner yaklaşım ve başarılı bir cerrahi işlemlerden sonra bile bazen yaşam boyu sürecek takip gerektiren bir patolojidir. Mortalite ve morbiditenin azaltılması için PH’ un daha etkili tedavisi önem arz eder.
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