Weltz C R, Morris J B, Mullen J L
Division of Gastrointestinal Surgery, University of Pennsylvania School of Medicine, Philadelphia.
Ann Surg. 1992 Feb;215(2):140-5. doi: 10.1097/00000658-199202000-00008.
One hundred patients underwent laparotomy for independent jejunal feeding tube placement. Neurologic disease was present in 50%, and obtundation (28) and oropharyngeal dysmotility (25) were the most common indications for enteral feeding. The post-pyloric route was chosen because of aspiration risk in almost all (94%) patients. Postoperative (30-day) mortality rate was 21%, because of cardiopulmonary failure in most (18). One death resulted directly from aspiration of tube feeds. Two surgical complications required reoperation: one wound dehiscence and one small bowel obstruction. Four wound infections occurred. Two patients underwent reoperation after tube removal, and four tubes required fluoroscopically guided reinsertion for peritubular drainage (2), removal (1), and occlusion (1). Aspiration pneumonia was present in 18 patients preoperatively and in eight postoperatively. None of the patients with feeding-related preoperative aspiration pneumonia (13) had a recurrence while fed by jejunostomy. Three patients developed postoperative aspiration pneumonia before initiation of jejunostomy feedings. Jejunostomy may be performed with low morbidity rate and substantial reduction of feeding-related aspiration pneumonia, and is the feeding route of choice in aspiration risk patients.
100例患者接受了剖腹手术以独立放置空肠喂养管。50%的患者存在神经系统疾病，意识障碍（28例）和口咽运动障碍（25例）是肠内喂养最常见的指征。由于几乎所有（94%）患者存在误吸风险，因此选择了幽门后途径。术后（30天）死亡率为21%，多数（18例）死于心肺衰竭。1例死亡直接由管饲误吸导致。2例手术并发症需要再次手术：1例伤口裂开和1例小肠梗阻。发生了4例伤口感染。2例患者在拔管后接受了再次手术，4根喂养管需要在透视引导下重新插入以进行管周引流（2例）、拔管（1例）和堵塞处理（1例）。术前18例患者存在误吸性肺炎，术后8例存在。术前与喂养相关的误吸性肺炎患者（13例）在通过空肠造口喂养时均未复发。3例患者在开始空肠造口喂养前发生了术后误吸性肺炎。空肠造口术的发病率可能较低，且与喂养相关的误吸性肺炎大幅减少，是空肠造口术的发病率可能较低，且与喂养相关的误吸性肺炎大幅减少，是存在误吸风险患者的首选喂养途径。
