腹腔鏡下噴門形成術におけるanterior wrappingとposterior wrapping治療成績の検討  [in Japanese] Comparison of Outcomes of Anterior Wrapping and Posterior Wrapping in Laparoscopic Fundoplication  [in Japanese]

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Author(s)

    • 坂井 宏平 Sakai Kohei
    • 京都府立医科大学小児外科学 Department of Pediatric Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
    • 古川 泰三 Furukawa Taizo
    • 京都府立医科大学小児外科学 Department of Pediatric Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
    • 木村 修 [他] Kimura Osamu
    • 京都府立医科大学小児外科学 Department of Pediatric Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
    • 東 真弓 Higashi Mayumi
    • 京都府立医科大学小児外科学 Department of Pediatric Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
    • 文野 誠久 Fumino Shigehisa
    • 京都府立医科大学小児外科学 Department of Pediatric Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
    • 青井 重善 Aoi Shigeyoshi
    • 京都府立医科大学小児外科学 Department of Pediatric Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
    • 田尻 達郎 Tajiri Tatsuro
    • 京都府立医科大学小児外科学 Department of Pediatric Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine

Abstract

【目的】胃食道逆流症(GERD)に対する噴門形成術の術式はDor 法などのanterior wrapping(AW)とToupet 法,Nissen 法などのposterior wrapping(PW)に大別される.当科では2002 年より腹腔鏡下手術を導入し,2010 年まで主にAW を施行し,2011 年からPW を第一選択としている.今回その治療成績に関して検討した.<br>【方法】2002 年から2013 年までに経験した腹腔鏡下噴門形成術施行例全33 例を対象とし,後方視的に比較検討した.施行された術式はAW が18 例,PW が15 例であった.PW のうち9 例はNissen 法,6 例はToupet 法であった.<br>【結果】基礎疾患は重症心身障害児例24 例,先天性食道裂孔ヘルニア6 例,食道閉鎖術後3 例であった.年齢中央値は4 歳(0~39 歳)であり,男児26 例,女児7 例であった.AW 群とPW 群では手術時間,出血量ではPW の方が有意に減少していた(手術時間:p<0.05,出血量:p<0.05).再発率に関してはAW 群で18 例中3 例(16.7%),PW 群で15 例中1 例(6.7%)であり有意にPW で減少していた(p<0.05).また,Nissen 法とToupet 法では有意差を認めなかった.PW の再発例は重症心身障害児例であり,Toupet 法で施行されていた.<br>【結論】当科における腹腔鏡下噴門形成術ではPW がAW よりも手術時間,術中出血量は少なく,再発率に差を認めなかった.PW の術式の選択は患児の基礎疾患を加味して判断することが重要であり,特に重症心身障害児ではNissen 法が有用であると考えられた.

<i>Purpose:</i> The operative method of fundoplication for gastroesophageal reflux disease (GERD) is divided into anterior wrapping (AW), such as Dor fundoplication, and posterior wrapping (PW), such as Toupet and Nissen fundoplications. Our institute introduced laparoscopic fundoplication in 2002. AW was performed until 2010, and PW has been performed since 2011. We examined the outcomes of AW and PW.<br><i>Methods:</i> We examined 33 cases that we encountered from 2002 to 2013 and compared them retrospectively. The median age was 4 years (0-39 years), 26 patients were boys, and 7 were girls.<br><i>Results:</i> Twenty-four patients showed severe motor and intellectual disabilities, six had congenital hiatal hernia, and three showed postoperative esophageal atresia. AW (Dor) was performed in 18 patients, and PW (Nissen fundoplication for 9 patients, Toupet fundoplication for 6 patients) was performed in 15 patients. Compared with AW (<i>p</i> < 0.05), PW is associated with significantly reduced blood loss and operation time. Recurrence was observed in three patients subjected to AW (16.7%) and in 1 patient subjected to PW (6.7%). The recurrence rate was significantly reduced in the PW group. There was no significant difference between Nissen and Toupet fundoplications in terms of recurrence. For the 3 patients who showed recurrence in the AW group, 1 underwent reoperation and 2 were treated conservatively. One patient who underwent Toupet fundoplication showed recurrence.<br><i>Conclusions:</i> In our institute, PW was found to be associated with significantly less operation time and intraoperative blood loss than AW. PW is a better procedure than AW for GERD. It was considered important to determine the condition of the patient in the selection of PW as the operative method. In particular, Nissen fundoplication is useful for patients with severe motor and intellectual disabilities.

Journal

  • Journal of the Japanese Society of Pediatric Surgeons

    Journal of the Japanese Society of Pediatric Surgeons 52(1), 78-82, 2016

    The Japanese Society of Pediatric Surgeons

Codes

  • NII Article ID (NAID)
    130005126799
  • NII NACSIS-CAT ID (NCID)
    AN00192281
  • Text Lang
    JPN
  • ISSN
    0288-609X
  • NDL Article ID
    027188584
  • NDL Call No.
    Z19-244
  • Data Source
    NDL  J-STAGE 
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