経口硫酸アトロピン療法が無効のため外科治療を施行した乳児肥厚性幽門狭窄症の検討  [in Japanese] A CLINICAL REVIEW OF OPERATED CASES OF INFANTILE HYPERTROPHIC PYLORIC STENOSIS WITH NO EFFECT OF ORAL ATROPINE SULFATE THERAPY  [in Japanese]

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Abstract

経口硫酸アトロピン療法無効のため,手術を施行した乳児肥厚性幽門狭窄症22例について検討した.症状の初発時期は,日齢21±10日で,診断日は34±12日であった.入院から手術までの期間は12±2.8日で,その間の硫酸アトロピンの総投与量は5.5±4.4mgであった.体重の変化は,出生時2,928±480g,入院時3,373±477g,手術時3,319±410g,退院時3,612±516gであった.入院時と手術時の検査データを比較すると, TP, Hb, Ht, pH, BE値が低下し, Cl値が上昇していた.手術所見では,幽門管長が22±3.8mm, 幽門筋層の厚さが4.7±1.3mmであった.入院期間は24±5.6日で,輸液を必要とした期間が17±4.9日であった.術後合併症に関しては, 1例のみ腸炎が認められた.経口硫酸アトロピン療法無効例では,手術時には入院時より栄養状態は低下し,体重増加も得られていなかったが,安全な手術が可能であり,乳児肥厚性幽門狭窄症に対しては,まず硫酸アトロピン療法を試みるべきであると考えられた.

We studied 22 children with hypertrophic pyloric stenosis who underwent a Ramstedt pyloromyotomy because they did not respond to oral atropine sulfate administration. The first manifestation of vomiting occurred on the mean day 21± standard error of the mean of 10 after birth and the diagnosis was made on 34±12 day after birth. The duration from admission to operation was 12±2.8 days and the total administration dose of atropine sulfate was 5.5±4.4mg. The weights were 2, 928±480g at birth, 3, 373±477g at admission, 3, 319±410g at operation, and 3, 612±516g at discharge. Serum total protein concentration, hemoglobin, hematocrit, pH and base excess decreased and serum Cl concentration was increased from admission to operation. The length of the pyloric canal was 22±3.8mm, and the thickness of pyloric muscle was 4.7±1.3mm. The hospital stay was 24±5.6 days, and the duration of fluid therapy was 17±4.9 days. There was only a case of colitis as the postoperative complication. Although the nutritional status deteriorated and a weight gain from admission to operation was not observed in these patients, we could safely perform their operation. Atropine sulfate therapy should be tried before surgery for infantile hypertrophic pyloric stenosis.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 63(6), 1346-1350, 2002-06-25

    Japan Surgical Association

References:  13

Codes

  • NII Article ID (NAID)
    10008913577
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • Article Type
    ART
  • ISSN
    13452843
  • Data Source
    CJP  J-STAGE 
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