El-Rifai N, Michaud L, Mention K, Guimber D, Caldari D, Turck D, Gottrand F
Department of Pediatric Gastroenterology, Hepatology and Nutrition, Lille University Children's Hospital and Faculty of Medicine, Lille, France.
Endoscopy. 2004 Aug;36(8):700-4. doi: 10.1055/s-2004-825662.
The aims of this study were to determine the prevalence of gastrocutaneous fistula after removal of gastrostomy tubes in children and to identify associated risk factors.
The records of children who had undergone removal of gastrostomy tubes between January 1992 and December 2002 were reviewed retrospectively. Persistent gastrocutaneous fistula was defined as the absence of closure of the gastrostomy 1 month after tube removal. Factors that might influence spontaneous closure of the gastrostomy were studied, including age, underlying disease, nutritional status, type of gastrostomy, replacement of the gastrostomy tube by a button, abdominal wall thickness, duration of gastrostomy tube or button placement, and complications related to the presence of the gastrostomy (infection, granulation tissue).
A total of 44 patients were included in the study (mean age 20 months, range 1 day to 14 years). Of these, 28 had undergone percutaneous endoscopic gastrostomy and 16 surgical gastrostomy. The mean time to spontaneous closure was 6 +/- 7 days. Persistent gastrocutaneous fistula developed in 11 patients (25 %) and in seven of these patients this required surgical closure (16 %). The mean duration of gastrostomy placement was significantly longer in patients who went on to develop a gastrocutaneous fistula than in patients who did not develop a fistula (39 +/- 19 months vs. 22 +/- 23 months, respectively, P < 0.03). No other significant association was found between the time required for spontaneous closure and the characteristics of patients or the type of gastrostomy.
Persistent gastrocutaneous fistula is common after removal of gastrostomy tubes in children. Surgical closure should be considered when a gastrostomy has not closed spontaneously 1 month after removal of the gastrostomy tube.
本研究旨在确定儿童胃造口管拔除后胃皮肤瘘的发生率，并识别相关危险因素。
回顾性分析1992年1月至2002年12月期间接受胃造口管拔除术的儿童的病历。持续性胃皮肤瘘定义为拔除胃造口管1个月后胃造口仍未闭合。研究了可能影响胃造口自发闭合的因素，包括年龄、基础疾病、营养状况、胃造口类型、用纽扣式胃造口器替代胃造口管、腹壁厚度、胃造口管或纽扣式胃造口器留置时间以及与胃造口相关的并发症（感染、肉芽组织）。
本研究共纳入44例患者（平均年龄20个月，范围1天至14岁）。其中，28例行经皮内镜下胃造口术，16例行外科胃造口术。自发闭合的平均时间为6±7天。11例患者（25%）发生了持续性胃皮肤瘘，其中7例患者需要手术闭合（16%）。发生胃皮肤瘘的患者胃造口留置的平均时间显著长于未发生瘘的患者（分别为39±19个月和22±23个月，P<0.03）。在自发闭合所需时间与患者特征或胃造口类型之间未发现其他显著关联。
儿童胃造口管拔除后持续性胃皮肤瘘很常见。胃造口管拔除1个月后胃造口仍未自发闭合时，应考虑手术闭合。
