日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Pediatric Cardiology and Cardiac Surgery 31(4): 192-198 (2015)
doi:10.9794/jspccs.31.192

原著Original

当センターにおける消化管閉鎖合併の先天性心疾患の現状と今後の課題Congenital Heart Diseases Associated with Congenital Anomalies of the Gastrointestinal Tract

北海道立子ども総合医療・療育センター循環器病センターCardiovascular Center, Hokkaido Medical Center for Child Health and Rehabilitation ◇ 〒006-0041 北海道札幌市手稲区金山一条1丁目240番6号1-240-6 Kanayama-1, Teine-ku, Sapporo-shi, Hokkaido 006-0041, Japan

受付日:2015年2月20日Received: February 20, 2015
受理日:2015年6月3日Accepted: June 3, 2015
発行日:2015年7月1日Published: July 1, 2015
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背景:消化管閉鎖に先天性心疾患(CHD)を合併する場合には,先行手術,術式の選択など外科的治療戦略が重要になる.当センターにおける消化管閉鎖合併の先天性心疾患の現状と今後の課題を明らかにするために,自験例を後方視的に検討した.

方法:1979年1月から2011年12月までの32年間に当センターに入院し,治療を受けた消化管閉鎖442例を対象とし,消化管閉鎖合併のCHDを検討した.

結果:CHDを合併したのは76例であり,食道閉鎖,十二指腸閉鎖,重複合併疾患で合併率は高い傾向にあった.また,CHD合併群は非合併群より死亡率が高かった.CHD合併群に対する外科的治療戦略として,心臓手術よりも消化管手術を先行する例が多かった.食道閉鎖にCHDを合併した場合は,低出生体重児や18トリソミーの合併が多く,現在も予後不良であった.

結語:CHDを合併した消化管閉鎖の治療成績は向上しているが,食道閉鎖のCHD合併例は現在も予後不良である.

Background: Determining the surgical strategy for patients with congenital heart disease (CHD) who have associated anomalies of the gastrointestinal tract can be difficult; this includes the selection of the initial surgery and its timing. The aim of this study was to retrospectively evaluate our previous surgical strategies and the results of these surgeries.

Methods: We reviewed the treatment results for 442 patients with associated anomalies of the gastrointestinal tract that were treated over the past 32 years from January 1979 to December 2011, and investigated those with CHD.

Results: Seventy-six patients had co-existing CHD. Esophageal atresia, duodenal atresia, and overlapping anomalies were frequently associated with CHD. The mortality rate of patients with CHD was higher than in patients without CHD. Among patients with CHD, the rate of initial surgeries for non-cardiac disorders was higher than the rate of initial surgeries for CHD. In patients with esophageal atresia and CHD, low birth weight and trisomy 18 were risk factors for poor outcomes.

Conclusion: The outcomes for patients with CHD who have associated gastrointestinal tract anomalies have improved. However, the outcomes for patients with esophageal atresia and CHD remain the same.

Key words: surgical management strategies; congenital heart disease; congenital anomalies of the gastrointestinal tract; esophageal atresia; low birth weight infants

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This page was last modified on 2015-08-13T16:55:40.122+09:00


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