Andrassy R J, Mahour G H, Harrison M R, Muenchow S K, Mishalany H G, Woolley M M
J Pediatr Surg. 1979 Jun;14(3):381-5. doi: 10.1016/s0022-3468(79)80504-7.
The authors report their experience with early postoperative feedings in a variety of pediatric surgical patients utilizing a needle catheter jejunostomy. A small caliber catheter, similar to that used for antecubital central venous cannulation, is inserted in the antimesenteric border of the jejunum providing a subserosal tunnel. A purse-string suture is placed around the catheter and then it is secured to the abdominal wall, and the catheter is brought out through the abdominal wall via a needle puncture wound. Our experience with 27 insertions in 25 patients ranging in age from 1 day to 17 yr, has demonstrated the ease of placement and feasibility of immediate postoperative feeding. Patients were generally started on a dilute elemental diet through the jejunostomy within 12 hr of the operative procedure. Patients were administered between one and 3.5 g of protein kg/day and between 45 and 100 cal/kg/day depending on age and weight. Duration of treatment with enteral nutrition ranged from 10 to 150 days. There was no catheter-related complications utilizing the technique described. Technical details of catheter placement and protocol for administration of early postoperative feedings are discussed. The ability to provide nutritional support via the gut has obviated the need for total parenteral nutrition in the majority of these patients.
作者报告了他们在各类小儿外科手术患者中使用针导管空肠造口术进行术后早期喂养的经验。将一根小口径导管，类似于用于肘前中心静脉插管的导管，插入空肠的系膜对侧缘，形成一个浆膜下隧道。在导管周围放置荷包缝线，然后将其固定于腹壁，导管通过针刺伤口引出腹壁。我们对年龄从1天至17岁的25例患者进行了27次插管操作，结果表明该操作易于放置且术后立即喂养可行。患者通常在手术操作后12小时内通过空肠造口开始给予稀释的要素饮食。根据年龄和体重，患者每天给予1至3.5克蛋白质/千克以及45至100千卡/千克。肠内营养治疗持续时间为10至150天。采用所述技术未出现与导管相关的并发症。文中讨论了导管放置的技术细节以及术后早期喂养的给药方案。通过肠道提供营养支持的能力使得这些患者中的大多数无需进行全胃肠外营养。
