重症中枢神経障害児における胃食道逆流現象(第2報) : 外科治療の意義について

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Nissen-Hill fundoplication with gastrostomy has been carried out in 13 neurologically impaired children at our institutions over the past three and a half years. Six of the 13 patients has previously failed a trial of nonsurgical management with prokinetic drugs. No patients showed persistent vomiting and/or hematoemesis postoperatively. The surgical treatments were effective for stridor in four patients (33%), repeated pneumonia in 5 patients (83%), cough attack in 1 patients (50%) and apnea in 2 patients (100%), Enteral nutrition became possible after the operation in 3 patients who had been previously managed only by parenteral nutrition. Marked nutritional improvement was noted in most cases with significant increases in weight for age and elevated levels of Hb and serum Fe. The gastric bleeding in 2 patients, wound infection in 1 patient, intestinal perforation following small bowel obstrution in 1 patient, pulmonary atelectasis in 1 patient and dumping syndrome in 1 patient. The incidence of late postoperative complications was 31%, which included gas bloat syndrome in 3 patients and small bowel obstruction in 1 patients. Two of the children have died, none from causes related to the surgical procedure. Clinical follow-up evaluations of all survivors did not show a persistence or recurrence of gastroesophageal reflux during a mean follow-up period of 21 months. Nissen-Hill fundoplication with gastrostomy appears to be safe and beneficial with the disappearance of vomiting/hematoemesis, a significant weight gain and a satisfactory decrease of pulmonary disease in neurologically impaired children. Further research should be undertaken to improve the effects of surgical treatment.
日本小児外科学会の論文
1992-08-20

重症中枢神経障害児における胃食道逆流現象(第2報) : 外科治療の意義について

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