对于神经功能受损的儿童，预防性胃底折叠术有必要吗？

Is prophylactic fundoplication necessary in neurologically impaired children?

作者信息

Viswanath N, Wong D, Channappa D, Kukkady A, Brown S, Samarakkody U

机构信息

Waikato Hospital, Department of Paediatric Surgery, Hamilton, New Zealand.

出版信息

Eur J Pediatr Surg. 2010 Jul;20(4):226-9. doi: 10.1055/s-0030-1249677. Epub 2010 May 21.

DOI:10.1055/s-0030-1249677

PMID:20496317

Abstract

BACKGROUND

Previously, concomitant antireflux surgery was performed in all neurologically impaired children undergoing gastrostomy tube placement in our department. This fundoplication procedure, not necessarily performed for symptomatic gastroesophageal reflux, increased the postoperative complications. This practice was changed and fundoplication was offered to only those children who had clear surgical indications for an antireflux procedure on follow-up after a feeding gastrostomy.

METHODS

In the period from 1996 to 2007, all children who underwent gastrostomy with fundoplication were compared with those in whom feeding gastrostomy alone was done. The clinical symptoms, investigations and indications for gastrostomy and fundoplication were recorded. The children who underwent gastrostomy were followed up for symptoms of gastroesophageal reflux and the need for subsequent fundoplication was studied. The complications directly related to surgery were also studied and statistically analyzed.

RESULTS

A total of 137 children had gastrostomy insertion, 60 of whom underwent fundoplication. Of these 60 children, 45 had concomitant fundoplication and gastrostomy. In the patients who had gastrostomy alone, a subsequent fundoplication procedure was required only in 17.1% (14 of 82). The complication rate as well as the severity of complications directly related to surgery was found to be higher in the gastrostomy+fundoplication group (18 of 60) compared with those who had only gastrostomy (12 of 82) (p=0.036).

CONCLUSION

Prophylactic fundoplication may not be necessary in neurologically impaired children undergoing gastrostomy for feeding purposes. It increases the postoperative morbidity compared to gastrostomy alone in this group of children. It should be offered selectively to children continuing to have reflux-related complications after gastrostomy. The technical difficulties with a pre-existing gastrostomy can be overcome in the hands of experienced laparoscopic surgeons.

摘要

背景

此前，在我们科室，所有接受胃造口管置入术的神经功能受损儿童均同时接受抗反流手术。这种胃底折叠术并不一定是为有症状的胃食管反流而进行的，却增加了术后并发症。这种做法随后发生了改变，仅对那些在喂养性胃造口术后随访中有明确抗反流手术指征的儿童施行胃底折叠术。

方法

在1996年至2007年期间，将所有接受胃造口术并同时行胃底折叠术的儿童与仅接受喂养性胃造口术的儿童进行比较。记录临床症状、检查以及胃造口术和胃底折叠术的指征。对接受胃造口术的儿童进行随访，观察胃食管反流症状，并研究后续行胃底折叠术的必要性。还对与手术直接相关的并发症进行了研究和统计学分析。

结果

共有137名儿童接受了胃造口术置入，其中60名接受了胃底折叠术。在这60名儿童中，45名同时接受了胃底折叠术和胃造口术。在仅接受胃造口术的患者中，仅17.1%（82名中的14名）需要后续行胃底折叠术。与仅接受胃造口术的患者（82名中的12名）相比，胃造口术+胃底折叠术组（60名中的18名）与手术直接相关的并发症发生率和并发症严重程度更高（p=0.036）。