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
Pediatric Cardiology and Cardiac Surgery 35(4): 271-276 (2019)
doi:10.9794/jspccs.35.271

原著Original

先天性心疾患を有する18トリソミー児に対する姑息術が在宅移行へ与える効果Effects of Palliative Surgery on Children with Congenital Heart Disease Due to Trisomy 18 to Promote Transition to the Home Environment

1岐阜県総合医療センター小児循環器内科Department of Pediatric Cardiology, Gifu Prefectural General Medical Center ◇ Gifu, Japan

2岐阜県総合医療センター小児心臓外科Department of Pediatric Cardiac Surgery, Gifu Prefectural General Medical Center ◇ Gifu, Japan

受付日:2019年3月29日Received: March 29, 2019
受理日:2019年7月12日Accepted: July 12, 2019
発行日:2019年11月1日Published: November 1, 2019
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背景:18トリソミー児の先天性心疾患に対しては現時点で明確な治療指針が定まっていない.当施設では,手術介入が在宅移行にあたって不可欠で両親の介入希望がある場合のみ姑息術に限って行う方針としている.

方法:2010年1月~2016年9月に当科で診察した17例を対象として,姑息術の有無が在宅移行へ与える効果について後方視的に検討した.在宅移行にあたり手術介入を行った例(I群=5例)と行わなかった例(N群=12例)に分類し,2群間で比較した.

結果:2017年8月末時点で,生存日数の中央値はI群427日,N群255日であった(p=0.1168).院内死亡例はI群1例,N群5例で,在宅期間(=死亡日齢−退院日齢)の中央値はI群647日,N群72日であった(p=0.0495).

結論:在宅移行に向け姑息術を行うことで生存日数および在宅期間を延長し,児と家族が一緒に過ごせる期間を長くできる可能性がある.

Background: For children with congenital heart disease (CHD) resulting from trisomy 18, we do not perform intracardiac repair; instead, we opt for palliative surgery when their parents wish to proceed with surgical intervention.

Methods: From hospital medical records, we retrospectively identified 17 patients whose attending physicians had consulted our department between January 2010 and September 2016. We classified patients into two groups: those who required surgical intervention for CHD to promote transition to the home environment and who underwent surgery with parental consent (Group I: 5 patients), and those who did not require surgical intervention for CHD and did not undergo surgery (Group N: 12 patients). We compared the ease of transition to life in the patient’s own home between Group I and Group N.

Results: The median survival of the patients was 427 days in Group I and 173.5 days in Group N (p=0.0534). The median number of days spent in the patients’ own homes was 647 days in Group I and 72 days in Group N (p=0.0495).

Conclusion: Palliative surgery for CHD in patients with trisomy 18 extended the period of time that patients and their families could spend together in the home environment following hospital discharge.

Key words: trisomy 18; congenital heart disease; cardiac surgery; hospital discharge; prognosis

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This page was last modified on 2019-12-16T15:02:43.000+09:00


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