重症心身障害児の胃食道逆流現象 : 逆流防止手術の効果から考えた手術適応の意義

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Thirteen children who had both severe mental and severe physical retardation, underwent Nissen fundoplication for gastroesophageal reflux. Most patients suffered from intractable vomiting, hematemesis and failure to thrive. Diagnostic study revealed large hiatus hernia by barium swallow, severe reflux esophagitis by endoscopy, and high pH score in 24-hour esophageal pH monitoring. Candidates for surgery were suggested by pediatric neurologists from medicosocial viewpoints. After surgery, the symptoms of GER disappeared and nutritive state was improved in all patients except one in whom GER recurred six months after surgery and was repaired again. Relaparotomy for postoperative intestinal obstruction was perfromed on three children. Three children have died at the time of mean duration of 2.5 years after surgery, none from causes related to the surgical procedure. Follow-up study of ranged from one to nine years after surgery was revealed that eight patients stay home with their families in good condition, one patient is admitted in an institution for severely retarded children, and another one lost to follow-up. Our standard technique of antireflux surgery for severely retarded children consists of complete fundoplication, crural repair, posterior gastropexy, pyloroplasty and gastrostomy for feeding purpose. Posterior gastropexy was performed with anchoring of the fundoplicated distal esophagus to the median arcuate ligament because this procedure seems necessary to prevent recurrent hernia. Quality of their individual life improved after surgery.
特定非営利活動法人日本小児外科学会の論文
1991-04-20

重症心身障害児の胃食道逆流現象 : 逆流防止手術の効果から考えた手術適応の意義

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