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Meðfædd vélindalokun á Íslandi 1963-2002

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Authors
Anna Gunnarsdóttir
Guðmundur Bjarnason
Ásgeir Haraldsson
Issue Date
2004-09-01

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Other Titles
Oesophageal atresia in Iceland 1963-2002
Citation
Læknablaðið 2004;90(9):629-33
Abstract
Objective: Oesophageal atresia is an congenital anomali with incidence of 1/3000-1/4500 live births. The results of reconstructive surgery has improved greatly, to 80-92% survival reported in the last two decades. The aim of this study was to determine the incidence of oesophageal atresia in Iceland and to evaluate the results of operations at the Department of Pediatric surgery at The Children¿s Hospital, Landspítal-inn - University Hospital in Iceland. Material and methods: This retrospective study included all children diagnosed with oesophageal atresia in Iceland between 1963 and 2002. Information was gathered from hospital records, including birth-weight, gestational age, the type of atresia and the presence of other congenital anomalies. The results of operation were determined including post operative complications. Information on life births in Iceland for the same period was gathered from the Icelandic National Register. Results: Thirtyseven children were diagnosed with oesophageal atresia in these 40 years. The average birth-weight was 2626g, including 14 children (38%) with low birth-weight (<2500g). Fifteen children (41%) were prematurely born (<38 weeks). Thirtyfour children (92%) had the most common type of oesophageal atresia with proximal blind loop and distal tracheooesophageal fistula.Thirtyfourchildrenwereoperatedon,includingone in Denmark. Nine children died within 60 days after surgery. The most common cause of death was lung inflammation(n=7,78%).ThesurvivalaftersurgeryinIceland was 73% in the study period. Other congenital defects were common in this patient group with congenital heart defects as the most common ones (n=12, 32%). The incidence decresead in the study period from 1/3737 in the firsttenyearsto1/10639inthelastdecade, this did not reach statistical signifiquance. Conclusion: It is interesting to see this decrease in incidence in the study period and this is the lowest incidence known to us. The survival has improved from previous study but is however still lower compared to our neighbouring countries. Other congenital anomalies are common in this patient group.
Inngangur: Meðfædd lokun á vélinda er sjaldgæfur galli með nýgengi um 1/3000-1/4500 fæddra barna. Meðferð gallans er skurðaðgerð. Árangur aðgerða fer batnandi og er lifun 80-92% síðustu tvo áratugi. Tilgangur þessarar rannsóknar var að kanna nýgengi vélindalokunar á Íslandi og meta árangur aðgerða. Efniviður og aðferðir: Rannsóknin var afturvirk og upp­lýsingar fengnar úr sjúkraskrám þeirra sem greind­­ust með meðfædda vélindalokun á Barnaspít­ala Hringsins 1963-2002. Fengnar voru upplýsingar með­al annars um meðgöngulengd, fæðingarþyngd, teg­­und galla og hvort aðrir fæðingargallar væru til staðar. Einnig var lagt mat á árangur aðgerða. Upp­lýsingar um fjölda lifandi fæddra á tímabilinu fengust frá Hagstofu Íslands. Niðurstöður: 37 börn greindust með meðfædda vél­inda­lokun á tímabilinu. Meðalfæðingarþyngd var 2626 grömm, þar af voru 14 börn (38%) léttburar (<2500 grömm). Fimmtán börn (41%) voru fyrirburar (<38 vikur). Þrjá­tíu og fjögur börn (92%) höfðu algengustu tegund vélindalokunar með blindan nærenda á vélinda og fistil milli fjærenda og barka. Þrjátíu og fjögur börn gengust undir aðgerð með lokun á fistli og sammynningu á vélinda, þar af eitt erlendis. Níu börn létust eft­ir vélindaaðgerð. Algengasta dánaror­sök var lungna­bólga (n=7, 78%). Lifun eftir aðgerð hérlendis var 73% á tímabilinu. Aðrir meðfæddir gallar voru al­geng­ir þar sem hjartagallar reyndust algengastir (n=12, 32%). Nýgengi sjúkdómsins fór lækkandi á tíma­bilinu, frá 1/3737 á fyrstu tíu árunum í 1/10639 á síðasta áratug sem er þó án tölfræðilegrar marktækni. Ályktanir: Athyglisvert er hversu nýgengi sjúkdómsins virðist hafa lækkað síðasta áratug og eru þetta lægstu tölur sem okkur er kunnugt um. Árangur aðgerða hefur batnað frá fyrri rannsókn en er þó heldur lakari en í nágrannalöndum okkar. Aðrir fæðingar­gallar eru algengir hjá þessum sjúklingahópi.
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