Hament J M, Bax N M, van der Zee D C, De Schryver J E, Nesselaar C
Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands.
J Pediatr Surg. 2001 Sep;36(9):1412-5. doi: 10.1053/jpsu.2001.26387.
BACKGROUND/PURPOSE: A study was conducted of the complications of percutaneous endoscopic gastrostomy (PEG) with or without antireflux surgery (ARS).
A retrospective review was conducted of all patients, receiving a PEG in the period January 1993 through December 1997. Patients' characteristics including underlying disease, indications, results of preoperative screening, and complications were recorded. PEG placement was performed with the Seldinger technique and, in some cases, under laparoscopic control. In the event of a pathologic pH study during preoperative screening, laparoscopic antireflux surgery (ARS) was added.
Mean age was 5 years and 10 months. The majority of the children were mentally retarded. The main indications for PEG were vomiting, food refusal, inability to swallow, and aspiration. Fifty-nine patients had PEG without ARS. Nineteen of these patients had concomitant laparoscopy. Thirty-seven patients had PEG with ARS. One patient died postoperatively of gastric leakage. PEG-related complications occurred in 31% of the patients. There was a significant higher incidence of complications in the group of patients that underwent ARS together with PEG compared with PEG placement without ARS. Roughly half of the complications were peristomal infection related to the use of T-fasteners and the other half gastroduodenal obstruction caused by the balloon of the gastrostomy catheter, both preventable complications. Preoperative vomiting without a positive pH-study disappeared in most cases after PEG placement. Although the pH study normalized in 34 of 37 patients after concomitant ARS, vomiting persisted in 7 of 17 patients. PEG improved the nutritional status in 75% of the children.
PEG improved the nutritional status in the majority of the children. However, PEG placement can lead to a considerable amount of complications, especially when combined with ARS. ARS together with PEG is successful in treating GER but does not necessarily cure preexistent vomiting. PEG alone cures vomiting in 80% of the patients and rarely leads to vomiting. There seems no good reason for combining PEG with ARS. Only if symptoms progress after PEG, ARS should be considered. Caretakers and patients should be well informed before placement.
背景/目的：对经皮内镜下胃造口术（PEG）伴或不伴抗反流手术（ARS）的并发症进行了一项研究。
对1993年1月至1997年12月期间接受PEG的所有患者进行回顾性研究。记录患者的特征，包括基础疾病、适应证、术前筛查结果和并发症。PEG放置采用Seldinger技术，在某些情况下，在腹腔镜控制下进行。如果术前筛查进行了病理pH研究，则增加腹腔镜抗反流手术（ARS）。
平均年龄为5岁10个月。大多数儿童为智力迟钝。PEG的主要适应证为呕吐、拒食、吞咽困难和误吸。59例患者接受了PEG但未进行ARS。其中19例患者同时进行了腹腔镜检查。37例患者接受了PEG并进行了ARS。1例患者术后因胃漏死亡。31%的患者发生了与PEG相关的并发症。与单纯PEG放置相比，接受PEG并同时进行ARS的患者组并发症发生率显著更高。大约一半的并发症是与使用T形钉有关的造口周围感染，另一半是由胃造口导管球囊引起的胃十二指肠梗阻，这两种都是可预防的并发症。术前无阳性pH研究的呕吐在大多数PEG放置后消失。尽管37例患者中有34例在同时进行ARS后pH研究恢复正常，但17例患者中有7例仍持续呕吐。PEG改善了75%儿童的营养状况。
PEG改善了大多数儿童的营养状况。然而，PEG放置可导致相当数量的并发症，尤其是与ARS联合时。ARS与PEG联合成功治疗胃食管反流（GER），但不一定能治愈先前存在的呕吐。单独使用PEG可治愈80%患者的呕吐，且很少导致呕吐。似乎没有充分理由将PEG与ARS联合。只有在PEG后症状进展时，才应考虑ARS。在放置前应充分告知护理人员和患者。
