vol. 36, pp. 235 - marianna uigakukai.marianna-u.ac.jp/idaishi/www/363/03-36-5hiroaki...

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臛腪腫腦腭腧腲腼臱膇膳膹 Vol. 36, pp. 235243, 2008 腗腎腖腄腀腁腆腑腓腏腉腇腅腐腚腒腕 25 腘腊腄腋腍腂腃 643 腛腅腙腔腌腈 腋腕 腊腨 腞腧 腄腋 腄腈 腕腎 腔腋 腣腓 腨腋 腐腉 腡腚 腖腉 腋腡 腤腑 腕腉 腅腑 腉腨 腠腐腈 腟腒 腈腉 腗腦 腞腧 腙腠 腘腢 腕腎 腌腨 腜腥 腠腋 腉腨 腍腖 腟腠 腙腉 腏腆 腓腎 : 20 6 24 1982 腅腠 2006 腜腔腙 25 膌腘膶臟腔膚膝腌腏 643 腙膅腼臔臚膺腙膼臙臞腥 腌腏臹膭臯臏腕腗腑腏臔臚膺腚臨臊膺膅腼腴膊膺腙 6.5腘自致臉1.4 : 1 腀腑腏50腚臅臚腅腎腴腜腏腚臎腌57腆臔臚膺膏腎膀 30 臁臆腥臂腉腏臔臚膺膅腼臀10 膾膊臵腔腚膔膲臎腆膯臭腔臻臸膂腰膎膙腆腊 腣腘膻腁腔臭腅腑腏643 腙腂腐臈膁腴臵腙膷62 腥腺 96ῒ῏腔腀腑腏5 腙臹膭膏膌腥腺臈腙 20 腅腠臻膖 5 膌腙 56 腜腔腰腘臼腸腌腏p0.05臔臚膺膏臁臆腘腒腁腓腚5 膌腙膷腥腺 12.6臻膖 5 膌腙 8.6腜腔 臦膟腌腏膾膊腥腺腵膆腩腬腨腦44.8ῒ῏腆膯腝膨腈腮腸臌腹膋臣膤27.7ῒ῏腚腡腱臑臎19.5ῒ῏腊腟膮臎18.8ῒ῏腙臇腔膨腅腑腏腜腏臅臚臮臄 1,500 g 腫腪膺腙膷 腥腺1500 g 腮臐膺腘腰腘膨腅腑腏 31.7vs 3.6,P0.001膶臟腘腄腉腢膅腼 臔臚膺腙膡腚 5 腙臹膭膏膌腠腅腘膂臥腋腣腏腆膾膊腘腚腵膆腩腬腨腦腱臑腄腟腛臌腹膋臣膤腙膷腥腺腆腯臧膨腈腎腙腳腚膅腼臔臚膺腘腄腉腢膕臺臼臅臚 臮臄膺腙臫腻腞臢臒臮腱臑腞臄臎膎膙腙膪腋腠腘腚臅臚臤臖至腋腣腏臄臎腙臫腻腗腖 腆膍腌腏腕膧腃腠腣腏腍腇腘腌 臔臚膺膅腼膾膊臙臞臔臚膺膅腼臰膺膼腄腁腅腃 腤腆膬腙臊膺膅腼腲膻臗膃臱臡膡腘腶 腅腠腗膐臆腆腉腏腋腣腏腊腕腘腟腡1960 腘膸腡腟腂腞腈腔腂腙臶腌腆膠腣腏1964 腎腧臊膺膅腼膇膀腆臟腋腣1982 腘腚膇膀 膽腙臊膺膅腼腲腄腟腛臖膶臟腙腐腀腥臟腕腈腘臊膺膅腼腲腆腅腅腤腢臔臚膺腆腈腀 腊 腉腕腑腒腎腙膒腬腺膣臐腥膵腌腓腇腏腊腙臘 腘臬腡膠膰腔腚臨膬腔 220 腐腀膶臟腆臔臚膺 膅腼臖膄腌腓腁腢腊腙腏腛臈腟腡腐腀 膶臟腕腌腓膈腌腓腇腏臛腪腫腦腭腧腲腼臱膇腮腸膶臟臊膺膅腼腙腽膓 25 腘腤腏腢膅腼 臔臚膺腙臖膿臞腥腌腏腙腔膫腍 腓腐腂腖腗 1982 4 膛腅腠 2006 3 膛腜腔腙 25 膌腘臛腪腫腦腭腧腲腼臱膇 膅腼膇臊膺膅腼 235 37

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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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Page 2: 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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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

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38

Page 3: 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 ˝ ˙ ˝ ˛

�������� ������ 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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39

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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

41

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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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42

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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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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

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