Hall N J, Drewett M, Wheeler R A, Griffiths D M, Kitteringham L J, Burge D M
Wessex Regional Centre for Paediatric Surgery, Southampton University Hospitals NHS Trust, Mailpoint 44, Tremona Road, Southampton, SO16 6YD, UK.
Pediatr Surg Int. 2011 Aug;27(8):851-5. doi: 10.1007/s00383-011-2896-2. Epub 2011 Apr 8.
To determine the effect of trans-anastomotic tube (TAT) feeding on outcome following repair of congenital duodenal obstruction (CDO).
Retrospective comparative study of all infants with CDO over 10 years. Data are median (range). Mann-Whitney U test and Fisher's exact test were used.
Of 55 infants with CDO (48 atresia, 7 stenosis), 17 were managed with a TAT, 38 without. Enteral feeds were commenced earlier in infants with a TAT compared to those without (TAT 2 days post-repair [1-4] vs. no-TAT 3 days post-repair [1-7]; p = 0.006). Infants with a TAT achieved full enteral feeds significantly sooner than those without (TAT 6 days post-repair [2-12] vs. no-TAT 9 days post-repair [3-36]; p = 0.005). Significantly fewer infants in the TAT group required central venous catheter (CVC) placement and parenteral nutrition (PN) than in the no-TAT group (TAT 2/17 vs. no-TAT 28/38, p < 0.0001). There were six CVC-related complications (5 infections, 1 PN extravasation) and four TATs became displaced and were removed before achieving full enteral feeds. One infant with a TAT with trisomy 21 and undiagnosed Hirschsprung disease developed an anastomotic leak and jejunal perforation requiring re-operation.
A TAT significantly shortens time to full enteral feeds in infants with CDO significantly reducing the need for central venous access and PN.
确定经吻合口管（TAT）喂养对先天性十二指肠梗阻（CDO）修复术后结局的影响。
对10年间所有CDO婴儿进行回顾性比较研究。数据为中位数（范围）。采用曼-惠特尼U检验和费舍尔精确检验。
55例CDO婴儿（48例闭锁，7例狭窄）中，17例采用TAT治疗，38例未采用。与未使用TAT的婴儿相比，使用TAT的婴儿肠内喂养开始时间更早（TAT组术后2天[1 - 4天]，未使用TAT组术后3天[1 - 7天]；p = 0.006）。使用TAT的婴儿比未使用TAT的婴儿显著更快实现完全肠内喂养（TAT组术后6天[2 - 12天]，未使用TAT组术后9天[3 - 36天]；p = 0.005）。TAT组需要放置中心静脉导管（CVC）和肠外营养（PN）的婴儿明显少于未使用TAT组（TAT组2/17，未使用TAT组28/38，p < 0.0001）。有6例CVC相关并发症（5例感染，1例PN外渗），4根TAT移位，在实现完全肠内喂养前被移除。1例患有21三体综合征且未诊断出先天性巨结肠病的使用TAT的婴儿发生吻合口漏和空肠穿孔，需要再次手术。
TAT显著缩短了CDO婴儿实现完全肠内喂养所需的时间，显著减少了中心静脉通路和PN的需求。
