Richter M, Plank C, Lang T, Behrens R, Carbon R T, Dötsch J, Köhler H
Kinder- und Jugendklinik, Universitätsklinikum, Erlangen.
Z Gastroenterol. 2010 Jun;48(6):673-7. doi: 10.1055/s-0028-1109931. Epub 2010 Jun 1.
Nutrition of children with end-stage renal disease and peritoneal dialysis (PD) is often difficult. Tube feeding via a gastrostoma is discussed controversially, and some authors consider this as a contraindication because of the risk of peritonitis.
In our centre 16 infants and children with end-stage renal disease were treated with PD and tube feeding over a gastrostoma in the last 12 years. The patients showed dystrophy (mean BMI -1.73 SDS) and were too small (mean body length -4.56 SDS). Seven of them (median age 11 months) received a gastrostoma before insertion of a Tenkhoff-catheter and start of PD. Nine children (median age 5 months) had PD primarily before insertion of the gastrostoma and start of tube feeding.
Patients with start of PD while a gastrostoma was already inserted had 15 events with peritonitis in the observation time of 91 months (1.98 per patient year). Patients with primary start of PD had 12 events with peritonitis in a total time of 43 month (3.34 per patient year), after insertion while PD was already running the number of events fell significantly to 25 peritonitis events in a total of 271 months (1.11 per patient year, p < 0.01). The children had a benefit from tube feeding via a gastrostoma in regard of body weight (BMI + 1.61 SDS, p < 0.01) as well as growth (body height + 2.29 SDS, p < 0.05).
Tube feeding via a gastrostoma is a good and safe option for alimentation, even under peritoneal dialysis. A decrease of PD-associated peritonitis under tube feeding was observed while physical development was positively influenced.
终末期肾病及腹膜透析（PD）患儿的营养问题常常较为棘手。经胃造口管饲法存在争议，一些作者认为由于存在腹膜炎风险，这属于禁忌证。
在过去12年中，我们中心有16例终末期肾病婴幼儿及儿童接受了PD治疗并通过胃造口进行管饲。这些患者存在营养不良（平均BMI -1.73 SDS）且身材矮小（平均身长 -4.56 SDS）。其中7例（中位年龄11个月）在插入Tenkhoff导管并开始PD之前接受了胃造口术。9例儿童（中位年龄5个月）主要在插入胃造口管并开始管饲之前先进行了PD。
在已插入胃造口管的情况下开始PD治疗的患者，在91个月的观察期内发生了15次腹膜炎事件（每位患者每年1.98次）。最初开始PD治疗的患者在总计43个月的时间内发生了12次腹膜炎事件（每位患者每年3.34次），在插入胃造口管且PD已开始进行后，腹膜炎事件数量显著下降，在总计271个月内发生了25次腹膜炎事件（每位患者每年1.11次，p < 0.01）。这些儿童通过胃造口管饲在体重（BMI + 1.61 SDS，p < 0.01）以及生长（身长 + 2.29 SDS，p < 0.05）方面均有所获益。
即使在腹膜透析情况下，经胃造口管饲也是一种良好且安全的营养供给方式。观察到在管饲情况下与PD相关的腹膜炎有所减少，同时身体发育受到积极影响。
