Amano Hizuru, Tanaka Yujiro, Kawashima Hiroshi, Deie Kyoichi, Suzuki Keisuke, Fujiogi Michimasa, Morita Kaori, Iwanaka Tadashi, Uchida Hiroo
Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan.
Department of Pediatric Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Nagoya J Med Sci. 2017 Nov;79(4):427-433. doi: 10.18999/nagjms.79.4.427.
Fundoplication is a standard treatment for gastroesophageal reflux disease (GERD) in neurologically impaired children. However, it has a high recurrence rate due to wrap herniation and disruption resulting from the failure or enlargement of the esophageal hiatus suture site. In adult patients with GERD, reinforcement of the sutured esophageal hiatus with a mesh significantly reduces the recurrence rate after surgery for esophageal hiatus hernia. In children, there are no big series of fundoplication with mesh reinforcement. Therefore, we confirmed the safety and feasibility of an expanded polytetrafluoroethylene mesh hiatal reinforcement with fundoplication as an additional procedure for neurologically impaired children. Neurologically impaired children (age, ≥5 years) who underwent laparoscopic fundoplication and gastrostomy at our institution between 2011 and 2013 were included in this study. The operative time, bleeding amount, complications, and recurrence were retrospectively evaluated. Thirteen patients were included in this study. The mean age at operation was 147.2 ± 37.8 months, and mean body weight was 18.5 ± 7.9 kg. The complication rate of epilepsy and scoliosis was 100% and 84.6%, respectively. The operative time was 265.1 ± 38.1 minutes, and mean blood loss was 26.5 ± 34.7 mL. There were no peri- or postoperative complications. None of the patients showed recurrent symptoms such as repeated vomiting and aspiration pneumonia during the mean follow-up period of 2.5 ± 0.6 years. The mesh hiatal reinforcement with fundoplication for neurologically impaired children is safe and feasible.
胃底折叠术是神经功能受损儿童胃食管反流病（GERD）的标准治疗方法。然而，由于食管裂孔缝合部位的失败或扩大导致包绕疝形成和破裂，其复发率较高。在成年GERD患者中，用补片加强缝合的食管裂孔可显著降低食管裂孔疝手术后的复发率。在儿童中，尚无大量使用补片加强的胃底折叠术系列报道。因此，我们证实了使用膨体聚四氟乙烯补片加强食管裂孔并附加胃底折叠术对神经功能受损儿童的安全性和可行性。本研究纳入了2011年至2013年在我院接受腹腔镜胃底折叠术和胃造口术的神经功能受损儿童（年龄≥5岁）。对手术时间、出血量、并发症和复发情况进行了回顾性评估。本研究共纳入13例患者。手术时的平均年龄为147.2±37.8个月，平均体重为18.5±7.9 kg。癫痫和脊柱侧凸的发生率分别为100%和84.6%。手术时间为265.1±38.1分钟，平均失血量为26.5±34.7 mL。围手术期和术后均无并发症。在平均2.5±0.6年的随访期内，所有患者均未出现反复呕吐和吸入性肺炎等复发症状。对神经功能受损儿童采用补片加强食管裂孔并附加胃底折叠术是安全可行的。
