外科的治療を施行した気管無形成の 1 例

概要

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This full-term male newborn with maternal history of polyhydroamnios was intubated just after birth because of severe respiratory distress. The tube was recognized to be situated in the esophagus. Further examination revealed that the trachea was absent and both main bronchi originated from the lower part of the esophagus, heading upward. On the second day, he underwent gastrostomy and banding of the esophagus at the esophagocardiac junction. The tip of the endoesophageal tube was placed at the tracheoesophageal fistula and positive pressure ventilation was continued. However, maintenance of the adequate airway was difficult due to collapse of the fistula at the esophageal orifice. After struggling of 23 days, the patient died of severe pulmonary emphysema and subsequent right heart failure. Autopsy disclosed multiple anomalies; congenital heart disease, skeletal anomalies, etc. Sixty-five cases of tracheal agenesis were collected. Eight of them underwent surgical intervention in order to create an airway, to prevent aspiration of saliva, to prevent regurgitation of gastric contents, and to provide a route for feeding. There was no long-term survivor and it is still a challenging clinical problem to establish a stable airway for tracheal agenesis.
日本小児外科学会の論文
1990-12-20