Stevens S D, Picus D, Hicks M E, Darcy M D, Vesely T M, Kleinhoffer M A
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110.
J Vasc Interv Radiol. 1992 Nov;3(4):679-83. doi: 10.1016/s1051-0443(92)72923-6.
The authors reviewed their experience with percutaneous gastrostomy and gastrojejunostomy in 30 consecutive patients who had undergone prior gastric surgery consisting of either partial resections (n = 24) or alteration of normal gastric anatomy (n = 6). Parameters evaluated included indications for the procedure, procedural modifications, type of prior gastric surgery, major and minor procedural complications, tube efficacy, and follow-up data. Gastrostomy tubes were placed in 27 patients for enteral feeding and in three for decompression. The success rate (100%), as well as the prevalence of major (0%) and minor (23%) morbidity--transient fever, skin infection, and high gastric residuals--were similar to those reported in patients who had not undergone prior gastric surgery. Thirty-day mortality was 13% (four patients); no deaths were related to the gastrostomy tube placement. Minor procedural modifications such as an extra-long needle, a peel-away sheath, or additional rotational fluoroscopy were necessary in 18 patients (60%). Knowledge of the postsurgical gastric anatomy is crucial in this subset of patients. Prior gastric surgery is no longer a contraindication to percutaneous gastrostomy or gastrojejunostomy tube placement.
作者回顾了他们对30例曾接受过胃部手术患者进行经皮胃造口术和胃空肠造口术的经验，这些患者之前接受的胃部手术包括部分切除术（n = 24）或正常胃解剖结构改变（n = 6）。评估的参数包括手术指征、手术改良、既往胃部手术类型、主要和次要手术并发症、置管效果及随访数据。27例患者置入胃造口管用于肠内营养，3例用于减压。成功率（100%）以及主要（0%）和次要（23%）并发症发生率——短暂发热、皮肤感染和高胃残余量——与未接受过胃部手术患者的报道相似。30天死亡率为13%（4例患者）；无死亡与胃造口管置入相关。18例患者（60%）需要进行一些小的手术改良，如使用超长针、可剥离鞘或增加旋转透视。了解术后胃解剖结构对这部分患者至关重要。既往胃部手术不再是经皮胃造口术或胃空肠造口管置入的禁忌证。
