Castle Shannon L, Speer Allison L, Torres Manuel B, Anselmo Dean M, Nguyen Nam X
Children's Hospital Los Angeles, Los Angeles, California, USA.
J Laparoendosc Adv Surg Tech A. 2013 Feb;23(2):170-3. doi: 10.1089/lap.2012.0243. Epub 2013 Jan 17.
Placement of a primary gastrojejunal tube (GJT) can be technically challenging and often requires an open procedure to negotiate the tube past the duodenal sweep into the jejunum. The alternative approach is to first place a gastrostomy tube (GT), which is then changed to a GJT under endoscopic or fluoroscopic guidance after waiting 6-8 weeks to allow the stoma to mature. We report a case series of primary GJT placement using a combined laparoscopic-endoscopic approach.
We retrospectively reviewed patients who underwent a combined laparoscopic-endoscopic primary GJT placement. Patients' demographics and relevant clinical information were analyzed.
Six patients (4 male, 2 female) were identified. The median age at the time of operation was 30.2 months (range, 28 days-10 years). Five GJTs were successfully placed laparoscopically/endoscopically, and one procedure was converted to open. The mean operative time was 84 minutes (range, 63-102 minutes). Postoperative abdominal radiography confirmed post-pyloric tube position in all patients. Feedings were initiated on the first postoperative day. One intraoperative complication required conversion to an open procedure. No patients developed postoperative complications.
Laparoscopic-endoscopic primary GJT placement is technically feasible and an excellent alternative in patients who require transpyloric feeding access.
放置原发性胃空肠管（GJT）在技术上具有挑战性，通常需要通过开放手术将管子穿过十二指肠曲进入空肠。另一种方法是先放置胃造瘘管（GT），等待6 - 8周使造口成熟后，再在内镜或透视引导下将其更换为GJT。我们报告一系列采用腹腔镜 - 内镜联合方法进行原发性GJT放置的病例。
我们回顾性分析了接受腹腔镜 - 内镜联合原发性GJT放置的患者。分析了患者的人口统计学和相关临床信息。
共纳入6例患者（4例男性，2例女性）。手术时的中位年龄为30.2个月（范围：28天至10岁）。5例GJT通过腹腔镜/内镜成功放置，1例手术转为开放手术。平均手术时间为84分钟（范围：63 - 102分钟）。术后腹部X线检查证实所有患者的幽门后管位置正确。术后第一天开始喂养。1例术中并发症需要转为开放手术。无患者发生术后并发症。
腹腔镜 - 内镜原发性GJT放置在技术上是可行的，对于需要经幽门喂养通路的患者是一种很好的替代方法。
