先天性腸閉鎖・狭窄症の治療法の変遷と成績の推移

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  • MANAGEMENT AND CONSEQUENCES OF INTESTINAL ATRESIA AND STENOSIS

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Fifty-four children with congenital intestinal atresia and stenosis have been managed at our department between 1968 and 1988. The location of obstruction was the duodenum in 22, jejunum in 16, ileum in 14, and colon in one. There was one neonate with duodenal atresias and colonic atresia. The children were divided into group I (n=17, 1968 to 1974), group II (n=17, 1975 to 1981) and group III (n=20, 1982 to 1988). High risk neonates according to modification of Waterston's criteria represented 17% in group I, 6% in group II and 76% in group III. The incidence of high risk neonates has significantly increased in group III (p<0.01). The mortality was 29% in group I, 35% in group II and 5% in group III. Although high risk neonates increased, the mortality was significantly (p<0.05) reduced during group II and group III. The improved survival in the third 7 year of the series appears to be related to improved neonatal intensive care and operative management, and more frequent use of total parenteral nutrition. Associated anomalies and prematurity do not appear to be the primary determinants of mortality at the present time.

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