1 千葉県こども病院循環器内科Department of Cardiology, Chiba Children’s Hospital ◇ Chiba, Japan
2 千葉大学大学院医学研究院小児病態学Department of Pediatrics, Graduate School of Medicine, Chiba University ◇ Chiba, Japan
背景：心臓血管外科手術後の声帯麻痺はよく知られている合併症であるが，新生児期・乳児期早期での手術例における詳細な検討はなされていない．
方法：対象は2008年10月から2014年9月までの6年間に，千葉県こども病院において生後2か月未満に手術した先天性心疾患症例221例を対象に，症候化した術後声帯麻痺の合併率や危険因子，臨床像に関する単施設後ろ向き観察研究を行った．
結果：221症例中14例（6.3％）に術後声帯麻痺を合併し，単変量解析では術後挿管期間（p＝0.008），大動脈修復術（p＜0.0001），Rastelli手術（p＝0.006），心室中隔欠損閉鎖術（p＜0.0001）の4因子で有意に合併が多く，多変量解析では大動脈修復術が唯一の独立した危険因子あった（p＝0.0005, OR 76.57, 95％CI 6.62–885.25）．麻痺側は左側12例（86％），両側2例（14％）と左側に多く，声帯麻痺を合併した14例において，生存した13例中12例（92％）で臨床症状が改善した．
結論：新生児期・乳児期早期に大動脈修復術を要する症例では，術後声帯麻痺の合併は特に注意すべきである．
Background: Although vocal cord paralysis (VCP) is a well-known complication after cardiovascular surgery, there is little published information on VCP after cardiovascular surgery in neonates and early infants.
Methods: A total of 221 patients who were ＜2 months old and had undergone cardiovascular surgery at Chiba Children’s Hospital between October 2008 and September 2014 were included in this study. We retrospectively investigated the incidence, risk factors, and prognosis of VCP.
Results: Of the 221 patients, 14 (6.3％) exhibited postoperative VCP. Postoperative intubation period (p＝0.008), arch repair (p＜0.0001), Rastelli procedure (p＝0.006), and VSD closure (p＜0.0001) were identified as risk factors of VCP in univariate analysis, but arch repair was the only risk factor in multivariate analysis (p＝0.0005, OR 76.57, 95％CI 6.62–885.25). The paralyzed side was greater on the left side (left side only, 86％; bilateral, 14％), and 12 (92％) of 13 patients (1 died) demonstrated good recovery from difficulty of swallowing, stridor and/or hoarseness.
Conclusion: In neonates and early infants who have undergone arch repair treatment, postoperative VCP is one of the most important complications but is likely to improve spontaneously.
Key words: vocal cord paralysis; cardiovascular surgery; neonate; early infant; arch repair; complication
© 2018 特定非営利活動法人日本小児循環器学会© 2018 Japanese Society of Pediatric Cardiology and Cardiac Surgery
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