Rosenberg Jodine, Amaral Joao G, Sklar Cindy M, Connolly Bairbre L, Temple Michael J, John Philip, Chait Peter G
Department of Diagnostic Imaging, Division of Image Guided Therapy, the Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada.
Radiology. 2008 Jul;248(1):247-53. doi: 10.1148/radiol.2481061193. Epub 2008 May 5.
To retrospectively evaluate the technical success, safety, and outcomes of radiologically guided retrograde percutaneous gastrostomy and gastrojejunostomy tube placements in terms of weight gain and growth in children with gastroschisis, omphalocele, and/or congenital diaphragmatic hernia (CDH).
Research ethics board approval, with waived informed patient consent, was obtained for review of the data of 37 children (17 male, 20 female; age range, 1-20 months; mean age, 4.3 months) in whom gastrostomy or gastrojejunostomy tubes were inserted between 1995 and 2004. Twenty-two patients had CDH, eight had gastroschisis, five had omphalocele, and two had both CDH and omphalocele. The technical success and complications of the procedures were recorded. Tube maintenance problems were analyzed separately from postprocedural complications. Initial and final patient growth percentiles were compared by using a one-sided paired Student t test.
Thirty-six of the 38 procedures performed in the 37 patients were successful. There were three intraprocedural complications (two cases of access difficulty, one case of bleeding) and three major complications (one skin and prosthetic material infection, one track loss during tube replacement, one delayed gastrostomy track closure necessitating surgery). Sixteen patients had at least one minor complication (cellulitis, feeding intolerance, skin-site bleeding, intussusception). Twenty-two patients had at least one tube maintenance problem. All patients gained weight (mean weight gain, 4.7 kg) after the procedure, with a significant increase in growth percentile (average increase, 6.5%; P = .029).
Radiologically guided percutaneous gastrostomy and gastrojejunostomy tube placements in children with gastroschisis, omphalocele, and/or CDH are associated with high success rates and low major complication rates. Although tube maintenance problems and minor complications are common, use of gastrostomy and gastrojejunostomy tubes effectively improves nutritional support.
回顾性评估在患有腹裂、脐膨出和/或先天性膈疝（CDH）的儿童中，经放射学引导逆行经皮胃造口术和胃空肠造口术置管在体重增加和生长方面的技术成功率、安全性及结果。
研究获得伦理委员会批准，无需患者知情同意，对1995年至2004年间37例（男17例，女20例；年龄范围1 - 20个月；平均年龄4.3个月）接受胃造口术或胃空肠造口术置管的儿童数据进行回顾。22例患者患有CDH，8例患有腹裂，5例患有脐膨出，2例同时患有CDH和脐膨出。记录手术的技术成功率和并发症情况。将管道维护问题与术后并发症分别进行分析。采用单侧配对学生t检验比较患者初始和最终的生长百分位数。
37例患者实施的38例手术中有36例成功。术中出现3例并发症（2例穿刺困难，1例出血）和3例主要并发症（1例皮肤及假体材料感染，1例更换管道时通道丢失，1例胃造口通道延迟闭合需手术治疗）。16例患者至少出现1例轻微并发症（蜂窝织炎、喂养不耐受、皮肤穿刺部位出血、肠套叠）。22例患者至少出现1例管道维护问题。所有患者术后体重均增加（平均体重增加4.7 kg），生长百分位数显著提高（平均增加6.5%；P = 0.029）。
在患有腹裂、脐膨出和/或CDH的儿童中，经放射学引导的经皮胃造口术和胃空肠造口术置管成功率高，主要并发症发生率低。尽管管道维护问题和轻微并发症较为常见，但使用胃造口术和胃空肠造口术置管能有效改善营养支持。
