儿童和青年患者经皮内镜胃造口术的治疗效果。

Outcome after percutaneous endoscopic gastrostomy in children and young adults.

机构信息

Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

出版信息

J Pediatr Gastroenterol Nutr. 2010 Apr;50(4):390-3. doi: 10.1097/MPG.0b013e3181aed6f1.

DOI:10.1097/MPG.0b013e3181aed6f1

PMID:20179645

Abstract

BACKGROUND AND OBJECTIVES

Factors predicting outcome after percutaneous endoscopic gastrostomy (PEG) in large pediatric cohorts are not well defined. We hypothesized that definable preoperative clinical factors predict the need for further intervention to provide enteral access after PEG. Our aim was to identify factors associated with PEG outcome.

MATERIALS AND METHODS

A retrospective review of 760 (407 boys and 353 girls) patients was performed after PEG at the Johns Hopkins Children's Center from 1994 to 2005. Logistic or multiple linear regression was used to analyze indication; diagnosis; age; prematurity; neurological impairment; weight-for-age z scores; modified barium swallow; postoperative complications; need for fundoplication (FP), gastrojejunal tube, or jejunostomy; and length of hospital stay.

RESULTS

The median age was 1 year (range 0-26 years). The most common indications given for PEG were failure to thrive (n = 373) and dysphagia (n = 27). Postoperative FP, gastrojejunal tube, or jejunostomy were performed in 66 (10%), 24 (4%), and 9 (1%) patients, respectively. Preoperative report indicated that dysphagia and direct aspiration on modified barium swallow was strongly associated with patients undergoing FP after PEG, 10.6% of patients (P = 0.008, odds ratio 2.4) and 11.2% of patients (P = 0.013, odds ratio 2.8), respectively. Younger preoperative age was also associated with the need for FP (P = 0.0006; median age of 5.8 vs 14 months). Patients with preoperative dysphagia had a longer median length of hospital stay: 8 versus 3 days (P < 0.00001). Patients with neurological impairment demonstrated greater weight gain than neurologically normal patients after PEG (P = 0.04). Minor postoperative complications (most commonly wound infection) were observed in 4% (27/747) of children before hospital discharge from PEG and in 20% of children (138/682) after discharge. There were only 2 major complications (gastric separation and gastrocolonic fistula.). There were no fatalities.

CONCLUSIONS

Preoperative diagnosis, indication, prematurity, and neurological impairment did not influence postoperative complications.

摘要

背景与目的

经皮内镜下胃造口术（PEG）后，影响患儿预后的相关因素尚未明确。我们假设，术前可明确的临床因素可以预测 PEG 后需要进一步干预以建立肠内营养通道。本研究旨在确定与 PEG 结局相关的因素。

材料与方法

回顾性分析 1994 年至 2005 年期间，760 例（男 407 例，女 353 例）于约翰霍普金斯儿童中心行 PEG 术的患儿资料。采用逻辑或多元线性回归分析，评估 PEG 术的适应证、诊断、年龄、早产、神经功能障碍、体重-年龄 Z 评分、改良钡剂吞咽检查、术后并发症、是否需要行胃底折叠术（FP）、胃空肠管或空肠造口术、住院时间。

结果

中位年龄为 1 岁（0-26 岁）。PEG 术的主要适应证为生长发育不良（n=373）和吞咽困难（n=27）。66 例（10%）、24 例（4%）和 9 例（1%）患儿术后分别行 FP、胃空肠管和空肠造口术。改良钡剂吞咽检查显示，术前有吞咽困难和直接吸入的患儿行 FP 的比例较高，分别为 10.6%（P=0.008，比值比 2.4）和 11.2%（P=0.013，比值比 2.8）。术前年龄较小也与 FP 需求相关（P=0.0006；中位年龄为 5.8 个月 vs. 14 个月）。术前有吞咽困难的患儿住院时间较长：8 天 vs. 3 天（P<0.00001）。行 PEG 术后，神经功能障碍患儿的体重增加优于神经功能正常患儿（P=0.04）。4%（27/747）的患儿在 PEG 术后出院前和 20%（138/682）的患儿在出院后出现轻微术后并发症（最常见的是伤口感染）。仅 2 例出现严重并发症（胃分离和胃结肠瘘）。无死亡病例。