気管ならびに食道の先天性疾患と外科治療

Abstract

Among various anomalies related to the trachea and esophagus, atretic and stenotic lesions are the most common and challenging objects in pediatric surgery. Tracheoplasty with the costal cartilage grafts is the treatment of choice for the extensive congenital stenosis of the thoracic trachea. We treated 4 cases of tracheal stenosis with this technique. Observation for following 2 years suggests that this technique is useful for such extensive lesions as an end-to-end anastomosis is not indicated.One hundred and thirty seven cases of esophageal atresia were treated at our institute with an overall mortality rate of 38%. Primary or staged end-to-end esophageal anastomosis was performed on 94 patients with a 20% mortality rate, whereas jejunal or colonic interposition was indicated for 13 patients with a mortality rate of 30%.The cause of stenosis of the esophagus was fibromuscular hypertrophy in 20, bronchial remnants in the esophageal wall in 7 and the ectopic gastric mucosa in 2 of our series of patients. Esophagoesophageal anastomosis was a possible procedure when the length of resection of the esophagus was limited to within 2.5cm. Intestinal interposition was, however, required when the esophagus was resected 3.5cm and more.