重症中枢神経障害患児における胃食道逆流現象の検討

概要

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During the past 2-year period, January 1988 to December 1989, Nissen fundoplication was performed on eleven neurologically impaired children. Preoperative symptoms and esophageal functions in these patients are discussed in this reports. All patients showed free reflux on barium esophagograms and positive acid reflux on intraesophageal 24-h pH monitoring. Manometric study revealed that basal lower esophageal sphincter (LES) tone was in inverse correlation with the age of the patients. In these patients, the antireflux function of the LES was decreased by various specific factors, i, e, kyphoscoliosis, extensor spasms and long-term supine position. Furth-ermore, an abrupt elevation of intragastric pressure associated with convulsions may become a promoting factor for a "vicious cycle" of GER in these patients. As regards indications for surgery in GER in neurologically impaired children, it is important to note that antireflux functions tend to get worse during the clinical course.
特定非営利活動法人日本小児外科学会の論文
1991-06-20