Bratu Ioana, Bharmal Aamir
Pediatric General Surgery, Department of Surgery, Stollery Children's Hospital, University of Alberta, 2C3.56 WMC, 8440-112 Street, Edmonton, Alberta, Canada T6G 2B7.
ISRN Gastroenterol. 2011;2011:686803. doi: 10.5402/2011/686803. Epub 2010 Dec 1.
Background/Purpose. To determine the incidence, predictors, and outcomes of repair of gastrocutaneous fistulae (GCF) in pediatric patients. Methods. Patients were identified through a medical records search of all gastrostomy insertions performed from 1997-2007. Results. Of 1083 gastrostomies, 49 had GCF closure. Gastrostomy indications were reflux/aspiration (30/43 [70%]) and feeding intolerance/failure to thrive (7/43 [16%]). Gastrostomies were performed as open surgical procedures (84%) with fundoplication (66% of all cases) at an age of 0.5 ± 0.57 (median ± inter-quartile range) years. Gastrostomies were removed in outpatient settings when no longer used and were present for 2.3 ± 2.2 years, and GCF persisted for 2.0 ± 3.0 months. GCF were closed by laparotomy and stapling. GCF closure length of stay was 2.0 ± 3.3 days. Complications occurred in 6/49 patients and included infection/fever (4/6) and localized skin redness/breakdown (2/6). Conclusions. From our collected data, GCFs occur at a frequency of 4.5% and persist for 2.0 ± 3.0 months until closed. Given the complicated medical histories of patients and relatively high rate of postoperative infection/reaction (12.2%), GCF closure is not a benign, "uncomplicated" procedure. Further information describing factors determining which patients develop GCF requiring closure is needed.
背景/目的。确定小儿患者胃皮肤瘘（GCF）修复的发生率、预测因素及结果。方法。通过检索1997年至2007年期间所有胃造口术的病历识别患者。结果。在1083例胃造口术中，49例GCF得以闭合。胃造口术的指征为反流/误吸（30/43 [70%]）和喂养不耐受/生长发育不良（7/43 [16%]）。胃造口术采用开放手术方式（84%），并在0.5±0.57（中位数±四分位间距）岁时进行胃底折叠术（占所有病例的66%）。不再使用时在门诊取出胃造口管，胃造口管留置时间为2.3±2.2年，GCF持续存在2.0±3.0个月。通过剖腹手术和吻合器闭合GCF。GCF闭合后的住院时间为2.0±3.3天。49例患者中有6例发生并发症，包括感染/发热（4/6）和局部皮肤发红/破溃（2/6）。结论。根据我们收集的数据，GCF的发生率为4.5%，持续存在2.0±3.0个月直至闭合。鉴于患者复杂的病史以及术后感染/反应的相对高发生率（12.2%），GCF闭合并非一种简单的“无并发症”手术。需要更多关于确定哪些患者会发生需要闭合的GCF的因素的信息。
