Kirurško liječenje nekrotizirajuće pneumonije u djece

master's thesis

• Title (english): Surgical treatment of necrotizing pneumonia in children
• Author: Luka Kelčec
• Mentor: Tomislav Luetić (mentor)
• Committee member: Anko Antabak (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Tomislav Luetić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2023-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Nekrotizirajuća pneumonija (NP) u djece je teška i po život potencijalno opasna komplikacija izvanbolnički stečenih pneumonija. Obilježava ju razgrađivanje zahvaćenog plućnog parenhima sa nastankom kaviteta uz često prateći empijem i bronhopleuralne fistule. Bolest nastaje zbog čimbenika virulencije uzročnika ili čimbenika sklonosti domaćina. Najčešći izolirani uzročnik u djece je Streptococcus pneumoniae, a incidencija joj je u zadnjih dva desetljeća višestruko porasla. Nekrotizirajuća pneumonija se obično razvije u prethodno zdrave djece mlađe od 5 godina. Njena klinička prezentacija ne razlikuje se bitno od nekomplicirane upale pluća. Karakteristično je perzistiranje i pogoršavanje simptoma unatoč antimikrobnom liječenju. Dijagnoza se postavlja slikovnim pretragama prsišta, od kojih se CT pokazao najosjetljivijim.

Iako liječenje NP prvenstveno uključuje terapiju antibioticima, u bolesnika sa kontinuiranim pogoršanjem bolesti uz razvoj parenhimskih komplikacija i neuspjehom konzervativnog liječenja indicirano je kirurško liječenje. Najčešće se koriste resekcije pluća različitog opsega ( lobektomije, klinaste resekcije ) i dekortikacije pluća uz debridman otečenog parenhima. U tijeku bolesti s razvojem pleuralnog izljeva, empijema, piopneumotoraksa i apscesa često se izvodi drenaža.

Porastom incidencije NP pažnja liječnika usmjerena je na indikacije, vrijeme, vrstu, opsežnost te ishode kirurškog liječenja. Naše spoznaje o liječenju ograničene su izvještajima i rezultatima liječenja individualnih prikaza bolesnika ili manjih grupa bolesnika. Cilj ovog rada je pregled spoznaja o nekrotizirajućoj pneumoniji u djece posebno onoj koja zahtijevaju kirurško liječenje.

Abstract (english)

Necrotizing pneumonia (NP) in children is a severe and potentially life-threatening complication of community-acquired pneumonia. It is characterized by the breakdown of the affected lung parenchyma with the formation of cavities, often accompanied by empyema and bronchopleural fistulas. The disease is caused by the virulence factor of the causative agent or the host's susceptibility factor. The most common isolated causative agent in children is Streptococcus pneumoniae, and its incidence has increased manyfold in the last two decades. Necrotizing pneumonia usually develops in previously healthy children under the age of 5. Its clinical presentation does not differ significantly from uncomplicated pneumonia. Persistence and worsening of symptoms despite antimicrobial treatment is characteristic for NP. The diagnosis is made by imaging tests of the chest, of which CT has proven to be the most accurate.

Although the treatment of NP primarily includes antibiotic therapy, in patients with continuous worsening of the disease with the development of parenchymal complications and failure of conservative treatment, surgical treatment is indicated. Lung resections of various extents (lobectomies, wedge resections) and lung decortications with debridement of the swollen parenchyma are most often used. In disease progression with the development of pleural effusion, empyema, pyopneumothorax and abscess, drainage is often performed.

With the increase in the incidence of NP, the focus of experts is on the indications, time, type, extent and outcomes of surgical treatment. Our knowledge about the treatment is limited by the results of individual case reports and researches on small groups of patients. The aim of this paper is to review knowledge about necrotizing pneumonia in children, especially those that require surgical treatment.

• Keywords: Nekrotizirajuća pneumonija u djece; Infekcije stečene u zajednici - liječenje; Kirurško liječenje komplikacija pneumonije u djece
• Keywords (english): Necrotizing pneumonia in children; community-aquired infections; treatment; surgical treatment; complication of pneumonia in children
• Language: croatian
• URN:NBN: urn:nbn:hr:105:232543
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-10-25 09:56:35