Petrosyan Mikael, Hunter Catherine, Estrada Joaquin, Guner Yigit, Qureshi Faisal, Stein James, Ford Henri R, Wang Kasper, Nguyen Nam
Department of Pediatric Surgery, Childrens Hospital Los Angeles, Los Angeles, California 90027, USA.
J Laparoendosc Adv Surg Tech A. 2010 Mar;20(2):207-9. doi: 10.1089/lap.2009.0064.
The placement of gastrostomy tubes (GTs) in infants and children to provide enteral access over the past decade has shifted toward a minimally invasive, safer direction with the development of various new techniques. We have developed a modified technique, utilizing subcutaneous (S.C.) tunneling stay sutures to prevent complications, such as GT dislodgment and wound infection. The aim of this study was to identify and describe complications of the modified procedure and compare it with the standard laparoscopic GT placement.
A retrospective 4-year review of 153 patients who underwent laparoscopic GT placement was conducted. Eighty-nine patients underwent the modified S.C. tunneled technique, and 64 patients had standard U-stitch with temporary fixation.
The overall complication rate was significantly higher with the temporary fixation group (20%) versus the modified technique group (2.5%). Six patients from the temporary group and 2 patients from the modified group developed cellulitis. Seven patients underwent reoperation secondary to GT dislodgment in the temporary group. No patients were identified with tube-related pressure necrosis or procedure-related deaths.
S.C. placement of stay sutures in the modified technique is associated with a lower complication rate than temporary fixation. The modified technique should be the preferred approach when performing laparoscopic GT insertion.
在过去十年中，随着各种新技术的发展，婴儿和儿童胃造口管（GT）置入以提供肠内通路的方式已朝着微创、更安全的方向转变。我们开发了一种改良技术，利用皮下（S.C.）隧道式固定缝线来预防诸如GT移位和伤口感染等并发症。本研究的目的是识别并描述改良手术的并发症，并将其与标准腹腔镜GT置入术进行比较。
对153例行腹腔镜GT置入术的患者进行了为期4年的回顾性研究。89例患者采用改良的S.C.隧道技术，64例患者采用标准U形缝线临时固定。
临时固定组的总体并发症发生率（20%）显著高于改良技术组（2.5%）。临时固定组有6例患者、改良技术组有2例患者发生蜂窝织炎。临时固定组有7例患者因GT移位而接受再次手术。未发现与导管相关的压迫性坏死或与手术相关的死亡病例。
改良技术中S.C.放置固定缝线的并发症发生率低于临时固定。改良技术应是进行腹腔镜GT插入时首选的方法。
