Gauderer Michael W L
Division of Pediatric Surgery, Children's Hospital, Greenville Hospital System University Medical Center, Greenville, SC 29605-4253, USA.
J Pediatr Surg. 2008 Dec;43(12):2178-81. doi: 10.1016/j.jpedsurg.2008.08.043.
This communication is an analysis of the experience with a new type of gastrostomy. It was developed for patients with pronounced epigastric anatomical abnormalities, such as dense adhesions, in whom the conventional "open" gastrostomy could prove difficult and the percutaneous endoscopic, the imaging-guided, and the laparoscopically assisted methods would be unsafe.
A large, soft rubber catheter is inserted in the child's mouth and advanced into the stomach. A small epigastric incision is made. With the help of the catheter, the anterior gastric wall is identified and the stoma site chosen. One of the curved needles of a double-armed monofilament suture is passed through the gastric wall and through the catheter. The needle is then cut off. The other needle is passed through the abdominal wall, from the inside out at the most suitable skin stoma site. When the catheter (with the embedded suture) is withdrawn from the mouth, a tract is established. The suture is replaced by a guide wire, which allows a percutaneous endoscopic gastrostomy-type catheter to be placed by the percutaneous endoscopic gastrostomy "pull" technique.
This approach was used in 15 patients (14 children-ages 1 month to 7 years and one 19 years old) with: status post (s/p) necrotizing enterocolitis and bowel loss (n = 4); s/p gastroschisis and short-gut syndrome (n = 3); cerebral palsy, s/p ventriculo-peritoneal shunt infections (n = 2); s/p complex omphalocele; dwarfism; morphologic abnormalities; repaired prune-belly syndrome; s/p duodenal atresia with malrotation; severe scoliosis with s/p multiple shunt infections (one each). There were no complications. The technique also proved useful in several other children in whom a laparotomy incision for unrelated conditions was remote from the gastrostomy site.
Using a very small incision, this hybrid method permits safe and precise gastric and abdominal wall site selection and gastrostomy catheter placement. Gastrotomy as well as purse-string and peritoneal fixation sutures are not needed, and the danger of accidental catheter dislodgement is minimized.
本交流内容是对一种新型胃造口术经验的分析。该胃造口术是为患有明显上腹部解剖结构异常（如致密粘连）的患者开发的，对于这些患者，传统的“开放”胃造口术可能很困难，而经皮内镜、影像引导和腹腔镜辅助方法又不安全。
将一根大的软橡胶导管插入儿童口腔并推进至胃内。在上腹部做一个小切口。借助导管识别胃前壁并选择造口部位。将双臂单丝缝线的一根弯针穿过胃壁和导管。然后将针切断。另一根针从腹腔内穿出腹壁，在最合适的皮肤造口部位由内向外穿出。当导管（带有嵌入的缝线）从口腔抽出时，形成一条通道。将缝线换成导丝，通过经皮内镜胃造口术“牵拉”技术放置经皮内镜胃造口术式导管。
该方法用于15例患者（14名儿童，年龄1个月至7岁，1名19岁），这些患者的情况如下：坏死性小肠结肠炎和肠丢失术后（n = 4）；腹裂和短肠综合征术后（n = 3）；脑瘫，脑室 - 腹腔分流感染术后（n = 2）；复杂脐膨出术后；侏儒症；形态异常；修复后的梅干腹综合征；十二指肠闭锁伴旋转不良术后；严重脊柱侧弯伴多次分流感染术后（各1例）。无并发症发生。该技术在其他几名因无关病症进行剖腹手术切口远离胃造口部位的儿童中也证明是有用的。
这种混合方法使用非常小的切口，允许安全、精确地选择胃和腹壁部位并放置胃造口术导管。不需要胃切开术以及荷包缝合和腹膜固定缝线，并且意外导管移位的风险降至最低。
