Aziz Dalal, Chait Peter, Kreichman Felix, Langer Jacob C
Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.
J Pediatr Surg. 2004 Nov;39(11):1648-50. doi: 10.1016/j.jpedsurg.2004.07.004.
Neonates with esophageal atresia may require a gastrostomy before definitive repair. Most surgeons do this procedure using the Stamm technique through a laparotomy. The authors describe a new technique for percutaneous placement of a gastrostomy in these infants and report their preliminary results.
For children with esophageal atresia and a tracheoesophageal fistula (TEF), the air-filled stomach is localized fluoroscopically and accessed using a standard percutaneous technique. For those with pure esophageal atresia, a transhepatic needle is used to instil air into the stomach. Once the stomach is distended, the gastrostomy tube is inserted under fluoroscopy.
Fourteen neonates with esophageal atresia had a percutaneous gastrostomy tube placed. Eleven had esophageal atresia and a TEF, and 3 had pure esophageal atresia with a gasless abdomen requiring the transhepatic approach. There were no intraoperative or major postoperative complications, but there were 5 minor early postoperative complications and 2 minor late postoperative complications.
Percutaneous gastrostomy insertion is a safe technique for neonates with esophageal atresia and can be used even in children with pure esophageal atresia who have a gasless abdomen. This technique does not require laparotomy and appears to be associated with a low rate of complications.
食管闭锁的新生儿在进行确定性修复之前可能需要进行胃造口术。大多数外科医生通过剖腹术采用斯坦姆技术进行此手术。作者描述了一种在这些婴儿中经皮放置胃造口术的新技术，并报告了他们的初步结果。
对于患有食管闭锁和气管食管瘘（TEF）的儿童，通过荧光透视定位充满空气的胃，并使用标准经皮技术进入。对于单纯食管闭锁的患儿，使用经肝穿刺针向胃内注入空气。一旦胃扩张，在荧光透视下插入胃造口管。
14例食管闭锁的新生儿接受了经皮胃造口管置入术。11例患有食管闭锁和TEF，3例患有单纯食管闭锁且腹部无气，需要采用经肝途径。没有术中或重大术后并发症，但有5例轻微早期术后并发症和2例轻微晚期术后并发症。
经皮胃造口术置入对食管闭锁的新生儿是一种安全的技术，甚至可用于腹部无气的单纯食管闭锁患儿。该技术不需要剖腹术，且似乎并发症发生率较低。
