| 特集名 | 知っておくべき疾患 --食道 | |
|---|---|---|
| 題名 | 先天性食道閉鎖，食道狭窄 | |
| 発刊年月 | 1998年 04月 | |
| 著者 | 大澤 仁 | 帝京大学医学部内科 |
| 【 要旨 】 | 先天性食道狭窄，食道閉鎖は食道欠損の長さ，部位が異なったり，気管痩の有無等によりその病態，症状，治療および予後が異なってくる．また心奇形等の合併奇形の存在や誤嚥性肺炎等の合併症の発生が，治療や予後を大きく左右する． 本症の90%以上が下部食道と気管が瘻を形成するVogt分類3b型であることは，本症の早期診断に，胃胞の大量貯留像や継続する大量唾液排出などのヒントを与えるとともに，胃液の気管内逆流等からの誤嚥性肺炎や無気肺等の危険な合併症を発生しやすい． 特異な病態とX線や超音波を使用しての出生前早期診断が本症の根本的治療である外科手術の成否を大きく左右する． |
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| Theme | Digestive Diseases to Know -- Esophagus | |
|---|---|---|
| Title | Congenital Esophageal Atresia | |
| Author | Hitoshi Ohsawa | Department of Medicine, Teikyo University School of Medicine |
| [ Summary ] | Congenital esophageal atresia is an embryological defect occurring during the fifth to eighth week of intrauterine life. Many types are observed morphologically and may be accompanied by tracheo-esophageal fistula, or other types of anomalies. The earliest symptome of this anomalie is polyhydramnios in the pregnant mother. So, we can have early diagnosis of this anomaly by arising abdominal ultra-sonography, abdominal CT or MRI. We may find intragastric gas or another accompanied anomalies. Directly after delivery in these cases, we may find a great deal of salivary fluid in the subject's mouth, frequent vomiting of milk, cyanosios, dyspnea and pulmonary complications, such as pneumonia caused by swallowing difficulties and pulmonary atelectasis. Pulmonary complications are very important, because they are the main cause of death before and after operations. Radical treatment of this anomaly is through surgical means. Various types of operations were performed to treat this anomaly depending on the types involved. Some analysis of these results and the proguosis after operations shows that the most important points concerning successful treatment are early diagnosis before delivery, if possible, pre-operative and post operative management of pulmonary complications and electrolyte imbalance, full exchange of the information about the case between the attending physician and an experienced pert surgeon, and finally, early transportion of the patient to a qualified surgeon. |
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