Transcript
Page 1: Vol. 36, pp. 235 - Marianna Uigakukai.marianna-u.ac.jp/idaishi/www/363/03-36-5Hiroaki Kitagawa.pdf · Vol. 36, pp. 235 243, 2008 25 643 ˘ ˇˆ˙˝ ˘ ˇ ˘ ˆ ˙ ˇˆ ˝ ˙ ˝ ˛

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������� 15��� ��� 9889����� ����� ��� 30����������� !"#$%&�� '()���*�)+,$-./� 012�3456789�:;<=>?$-.@��>?AB$�*��C��DE��� 1� FG

HIJ Esophageal atresia: KLMFGHIJNOP��Q� 2�RHI�STJ Bowel atresia�steno-sis: KLM�UM����UMRHI�STJ� 3�VWSTJ Hypertrophic pyloric stenosis: �: 30�������XYZMVWSTJ� 4� R[\]^J Malrotation �of the intestine�: _R`a\�bcdRHefg/h�ijkl$mJ��n��5�Hirschsprung �5o�Ep*� Hirschsprung’s

disease and allied disorders� 6� qrstM*�Meconium-related obstruction: qrMRHeJ�qruJvC.w�qr�xU��RHeJ� 7�yRzW{| Anorectal anomalies: } ~���{|$��NOP�Iz�Q� 8� �����Bowel perforation: 3mM������MR�.w�xU�������M���� 9� ��]^JAbdominal wall defects: ��ijkl����������.w� 10����ijkl Diaphragmatichernia: KLM���ijkl �Bochdalek ijkl� ��������J$�� 10 *�5�� o��$ 11����� *�C: ¡¢M£¤MRHe���¥G*�� 12�¦§¨*�C: �¦§ijkl� ©ª«¬� ­M®�J.w� 13� ¯J°±J:

Table 1. Clinical Data of Neonates with Surgical Disorders

²³´µ ¶·¸¹ º236

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�������� ������ 14���� 15���� � ������� 16� �������17� ���: ����������� � !�"#��$%&� 25 '�()'* 1 '�� �

�� 5'�1982�86, 1987�91, 1992�96, 1997�2001,2002�2006 ���+)'� !�"�,-.#��/�01234�56�7 *�+"#�89:;<'��=>?�&@A�B?��Ryan �� *�C� P�0.05�D*�=�"#�

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1� E: 25 ' FG"#�H�I5/& 643�JK� 1�4 : 1�LMN� (O/�H�/� 6�5� P�"� ' 25�26LM.# �Table 1�� O/�H(E&�+)'� QR ST"#� "U"�H�I5/�VWXYZ&� �0� 7.5�U[�\ 5'� 6.0�]�^_"# �Fig 1��2� �`a: �H�I5/���� 50� *VWX321 b�� 0 � 176 �27.4��b�� 1�6 �46 �7.2��b�� 7�13 �3MXC&�"�100 �15.6��&�� 14 ��Fc"��3"d�ef�-.#� g5hA� &� 2500 g ���ij/b 68.6�*VWXk�� l�g5hA ��1500g����g5hA��1000 g�/m 9.8� nop#�o#qrsE 37 s��b 75� *VW� 36 s !& 25�LM.#� �"�� tC��u��.#

500v 85� 17�b#ho#&r/�w[U�$x �N%yz{|*}~#� ���L& 1986 &�W�r/��&?+ �N�H���bg5����p#� �� 118bg5����p��N� 1991 &��'b 15� -.#� ���mg5���&ST"� �\ 5'���'&(� 40.6� LM.#� �� 2003 &� 55�bg5����p# �Table 1��3� ���E: I5/�H�$ 10 ��vL&��)����b 79��m@�� ��*+��b 57 L�p Q�� �D,��-+�� 36� Hirschsprung .���/��� 35� �0)� 32 � �11�� 30 � ��2�:��29� 34�� 27�5��:���18� 3467�9 �� ��  ¡ 18 �¢L� Z% 360 LM.# �Fig 2�� �p[�/&�$��*A8"���X��b@�� "#b.��$��£�E&392 ���A8��E 32 ;�)���� 11 ���*+�� 9� �11�� 6� ��  ¡6�LM.#��$ 10�����¤¥L ������¦��97 �9:&� ;<§=*�¨ ¦©��)ª��«�ef�-.#kc�¬>��)ª§­�0®?���­¯@1b 95*VW� °0�����A��b8 1LM.#� �±²�:��� ³�´B� CDµ�-¶�±²E��·& 41LM.#� ���.F 43�9:&� ¸F¹�

Fig. 1. Case number of neonates and total inpatients per 5-year study period.

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2 �� ��� 6 �� ��������� 16 �� ��� 11��� �� ���� 1990����������� ��� ������������� 38� �� !"#��#����4���$%�&'(�)�����3��� !"#������*+ ,-�./'�4���$%� 01#�2� 345��6� 782��16 ��9:;<�� ()������ =��� >?�@�A>BC,D 21� E?�� ��#F��������G<�HF'IJ��F9 31�� ��� KLMA�?�&'NO'�� 6P����Q�R S�TU ,-���� ��'�� 18 �� ��� �V�W� ��?� 15��� �F��� �X� !"#H4'� Y�Z[�\��� ���]^� _`H�� a>b_�� W�cD���M���?�'�� ���4� d�`efg: 6h� 56�5� �, 363���` i?d�`e 435 j�fg9kB<��Table 1�� lm�` in,�oj�fg�� JpqfgIreJstu�g9 40v �� V�$% &�?�=���V<w< in,fg9 32v:;<�� x�y�z`{cfg|o in,d�`{cfg�}>� 5�9��435�7390 v�� ���5� M~�: {ctd�`� 581 �A��?�9

�jKL� 62 �9��?� ���� 9.6��62�643�� �� �Table 1�� ;�d�`efg�`����� 9�9��36�363�� ��� {ctd�`6h�������t��A��ey� �,D� ��� 20.0��25�125�%�s�ey� 11.0��13�118�;�� n� � �Q?��p0.05�� G� ��ey! �����s 8.3��10�120�� 4.3��6�138�D�Q?�9� �� 5�y� 5.6��8�142�DII��?�� x< "?� d�`efg�`���ey!��������� ��9 12.6� � ��G� ��ey! ����A�?�@��� ������%�� �Fig 3��=������������ ��������

44.8�� �/�� � 22.2�� #$¡¢'� 22.2��%£����27.8�; #$&'11.1��� ¤¥8¦§(¨'� 18.2� 9©ª� '�o�J%��«(¨�*+'����� 8.9�� �«)*���3.5�D�%��� x�¬­������������� ®����ey� 50�%�� ��ey! �s 42.9�� 42.9�� 37.5�� D�Qn,��A����9� «(¨�*+'¤¥8�«)*�� "¯,D¤©�� ���p0.01� Fig 4���� 62��¬­� fg°+�� 17��27�4��� ��� ?%?x<� 17�����` ¤-±@��� ²,,³�� g�%�´gµ¶6P·³n

Fig. 2. Distribution of major neonatal surgical disorders.

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40

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���� ��������3��� �����3��� � �������4��� ��������������� !"�#$��6 ��%&'(� )*+,-�%.� /-��01(234$�DIC 56789:;�'(:� <�=>?@A�$B"0C'?D(� EF5G89H0I(2(4JK%.L�MN:OP5QR?D( �Table 2��S(��T5.� ������89H:UVGW�37.5��� �����. 25.8�� 1500�2500 g �. 15.9� %&X� 2500 g Y@

��Z��89H. 3.6�FI�[?��'(� =���� �� 1500 g \]����^.�1500 g Y@^F_`=7Fa�.I�[?�#%&'( �p�0.01; Fig 5��

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b��cdJK�<�.efg�%&X� LRh:ijklm5no7K��8p�qr0�=1��stu�cdvw. 1965x�� 2003xS% 5xy5cdzb���{m�|0}~2?I(� U��

Fig. 3. Mortality rates for surgical neonates per 5-year study period.

Fig. 4. Mortality rates for neonates with major surgical disorders.

b��cd{m 25x������ 239

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�������� 1964��� ��������������� ������� � 60�!"����2�� ���#$%&'(�)�*+�%�,-.� ��/01234��567.�89:;%�&'<�����=��� >?@ABCD?EF�GHI�JK+L6����.�MNO=�D�9 2P����9� Q2�RSTUAGHI� VWXYZ[\� ]^EFI� Hirschsprung _�J6`�� a�bc+�&

'<:;%�� ���de.fghc343�M� ij���kl� 2003 ��.�&'<:;%mn��opq�� 6 10�0rs��3�� ����� tu�&'<:;%�� vw�� ,-hc��%�;x�y Quality of life �QOL��z{|Dz8+c329�}~�������"�� m7����� VWXYZ[\��� 6������ ��<�fg�z)��L��� VWXYZ[\��"�����

Table 2. Causes of Death of Neonates with High Mortality Rate

Fig. 5. Comparison of mortality for surgical neonates according to birth weight.

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���� �������������� ���������������� �Table 2�4��������� 1980�� ����������� !���"#���� $%&'� ()�*+,-� ����./� ���01�2���3���./� ��4�� 5��./�6� � �����"#���5��9�� !"� � �����/�78� #$%&%'(9����%) �:*��+���� ;� ��%,-<=./�>�6�?0����<�� ��12%@��3�4���� $��� AB15����C�D�E'6) ���&'� 7�%F8&G=�����9H��6�� �<�IJ�% � ���%7��F8����K78��� L%� � ��%<�M���01:N���8� AB��G �;�%15%O%@�<�� 1P�%<=�Q>?8@R���%%� A��ST./����B �C��%UV�DW�9H�� $�"�VE��9H��10�11�� I��X� C�D�YFZG��B �C�A������������VEH�I%3C�JT��������12�13��[\%]^&'�_I"#� A��M`./K3a1bc�dL����%e�f�8� M`6A��MC�����NOg:h7�%F8gP��7[�8�����J���14�� A��%K./8� QR1iS�� 3a1Tj�� U�QRkV4��� 3QRlm��nW��� oKBc1�pq�6�X�� ���8� Yr6Zst%[J��aV\9Hq�� �aV\R]q#^����� ()�*+,-� u_vD�2�� ;D`abc� bc�2�� de*+,-%w� �aV\9Hq� 65�gxh�y�dLH7z��� Kfst{��8� |}78�B �C��9B �C�����g�6!���"#��� h~�12�i������15�� iKt�C� 1500 g��%A��7z��� ������ g�6��t�?0��==z�� ��� 1500 g jk�78� j�lS6��gmn����g+��o�7z�� Lp8C�9Hg+�<�st�!���� ! q�K�r��;} 5��%VE�%VTg�sI��� At159sts��;tVT&G=����8���<7z��� ;�u6%�����6st%� ZG�vw7z��� �

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EXIT 6�� 8) � 20�g®ª���� ��<����%7�F88�������� !§7�� �����%) �� ()�*+,-� ��4��68 ��%���¤¯�¤������ "�"��SH�+����� ��� "���7�S�?0���g��� B�����7� °����%�SHgB±������������ � ��<�� ²��¤³���C%15g���#B`�� M`6��gf#��M`�� ��%15g���#A���%´��� Ud6���#]�6���µ¶��������� [�����´`%��%·��[�7z��

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1� Kramer MS, Liu S, Luo Z, Yuan H, Platt RWand Joseph KS. Analysis of perinatal mortality

and its components: time for a change? Am J

Epidemiol 2002; 156: 493�497.2� ����M`�¸�t�n�£��s¹º¸����%A��M`%µ� 2003�A��M`M�]^� ��M¸» 2004; 40: 919�943.

3� �� ¼� A��M`��%µ��¡¢ A��M`��12%µ�� �M¸» 2007; 108:313�317.

4� Lakhoo K. Fetal councelling for congenital

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malformations. Pediatr Surg Int 2007; 23: 509�519.

5� ����� ���� ���� ������� � 3�� ����� ��� 1995� 42�48.

6� ����� ������ !"#$%���� &�'( 2007; 108: 318�324.

7� Murph FL, Mazlan TA, Tarheen F, CorballyMT and Puri P. Gastroschisis and exomphalos

in Ireland 1998�2004. Does antenatal diagnosisimpact on outcome? Pediatr Surg Int 2007; 23:

1059�1063.8� �)*+� ,�-�� .&/0� 1�23456789:;<=>?�@ 3�� &��'(2006; 42: 801�805�

9� AB C� DBEF� DGH�� � I� JK�L� D,MN� O�MP� 1�2QRS��2TUVW�3XYZ1�[\]^_QRSTU RI ^_ `�>� &��'( 2005; 41;170�176.

10� aBbc� de f� ghi�j� DGkl�

mno�� ��pqrstuv 28� ^w�&��'( 2005; 41: 776�782.

11� xyz{� �|}~� ����� yn�-� ����� ������ !"#$% pqrst� &�'( 2007; 108: 333�338.

12� ��{�� ���-� 1978 � ��� ���� !"� ��������_����� &��'( 1979; 15: 907�915.

13� D��� 1988 ������ !"� &��'( 1990; 26: 11�25.

14� �y�+� a��� oG��� ,��� � ¡�� O�¢�� £�¤� ¥�¦§� ¨©ªbc� «�¬� <=>­®¯3-°��®¯6±²¯� ��³´#µ �¶� &��·¸¹'( 2003; 19: 394�406.

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come of low birth weight neonates with con-

genital heart disease. J Pediatr 1994; 124: 461�466.

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Abstract

RESULTS OF SURGICAL TREATMENT GIVEN TO NEONATES

IN A SINGLE INSTITUTION: A 25-year analysis of 643 patients

Hiroaki Kitagawa, Takeshi Aoba, Yasuji Seki, Munechika Wakisaka,

Yoshitaka Kim, Misao Ishikawa, Teruhiro Fujioka, Tomotake Enami,

Mikio Kuwahara, Fumio Kawaguchi, and Koonosuke Nakada.

We evaluated the results of treatment in 643 neonates with various surgical disorders experienced during

the past 25 years from April 1982 to March 2006. Of 643 neonatal patients, 321 patients �roughly 50�� werediagnosed on the first day of life, 176 �27.4�� within a week, 176 �27.4�� within 2 weeks, and 100 �15.6��more than 2 weeks after birth. Among them, 363 patients �57�� underwent surgery within 30 days after birth.Sixty-two �9.6�� patients died during the initial hospital stay. The mortality rate for the patients in the initial5-year study period was 20� which was significantly decreased to 5.6� for the patients in the most recent 5-year study period �p�0.05�. The mortality rate for patients with diaphragmatic hernia was 44.8�, whichwas the highest mortality among patients with major diseases, followed by patients with bowel perforation

�27.7��, abdominal defects �19.8��, and esophageal atresia �18.8��. The mortality rate for low-birth weight��1500 g� infants was significantly higher than for the higher-birth weight ��1500 g� infants �31.6� vs. 3.6�, p�0.001�. Thus the outcome of the surgical neonates treated in our institution improved steadilythroughout each 5-year study period. However, mortality for neonates with diaphragmatic hernia, abdomi-

nal wall defects, and bowel perforation remain high, because of recent increase of severe premature patients,

chromosomal abnormalities combined with severe anomalies, and prenatally diagnosed more severe disor-

ders.

Key Words

neonate, surgical disorders, treatment results, neonatal surgery, fetal surgery

Division of Pediatric Surgery, St. Marianna University School of Medicine Kawasaki, Japan

������� 25��� � 243

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