1 東京大学医学部附属病院 小児科Department of Pediatrics, University of Tokyo Hospital ◇ Tokyo, Japan
2 東京大学医学部附属病院 心臓外科Department of Cardiac Surgery, University of Tokyo Hospital ◇ Tokyo, Japan
心外膜リードを用いた小児のペースメーカ植込み術ではgenerator本体は上腹部に植込まれることが多い．術後の腹腔内へのgenerator migrationは重篤な病態に発展しうる重要な合併症である．皮膚の潰瘍形成・generator露出リスク低減の観点から，generatorは上腹部の腹直筋筋層上（皮膚直下）ではなく筋層下に植込まれることがあるが，筋層下に植込んだ場合には腹膜を隔てた腹腔内へmigrationしやすくなる．今回，上腹部・腹直筋筋層下に留置したgeneratorが腹腔内へmigrationし，6か月間の経過観察後に抜去術を行った1歳女児例を経験したので報告する．抜去術時にはリードが大網と絡み合って強く癒着している術中所見を認めた．この癒着は腸管を巻き込み，腸閉塞や腸管穿孔といった重大な合併症をその後に引き起こす危険性があり，migration状態での待機期間が長期間にわたるリスクを示唆する重要な所見と考えた．
In most pediatric cases of epicardial pacemaker implantation, generators are generally placed in the upper abdomen. Postoperative generator migration into the abdominal cavity is a serious complication that could lead to severe clinical conditions. Although generator placement in the rectus abdominis submuscular layer is sometimes preferred over placement in the supramuscular layer for infection prevention, it could increase the risk of intraperitoneal migration. We report the case of a 1-year-old girl who had a generator implanted in the upper abdomen, specifically in the rectus abdominis submuscular layer, that migrated into the abdominal cavity. The implant was removed after 6 months of follow-up. Intraoperative findings during implant removal showed that the lead was entangled with the large mesh and strongly adhered to it. This adhesion entrapped the intestinal tract and could lead to serious complications, including intestinal obstruction or perforation.
Key words: pacemaker implantation; generator migration; epicardial pacing; submuscular implantation
© 2025 特定非営利活動法人日本小児循環器学会© 2025 Japanese Society of Pediatric Cardiology and Cardiac Surgery
This page was created on 2025-10-22T11:46:35.947+09:00
This page was last modified on 2025-11-14T14:08:56.000+09:00
このサイトは（株）国際文献社によって運用されています。
