Esposito C, Alicchio F, Escolino M, Ascione G, Settimi A
Chirurgia Pediatrica Università, di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italia.
Pediatr Med Chir. 2013 May-Jun;35(3):125-9. doi: 10.4081/pmc.2013.45.
Feeding difficulties and gastroesophageal reflux (GER) are major problems in severely neurologically impaired children. Many patients are managed with a simple gastrostomy, with or without fundoplication. Unfortunately, fundoplication and gastrostomy are not devoid of complications, indicating the need for other options in the management of these patients.
Between January 2002 and June 2010, ten patients (age range, 18 months-14 years) have been treated by creating a jejunostomy with the laparoscopic-assisted procedure. The procedure was performed using 2-3 trocars. The technique consists of identifying the first jeujnal loop, grasping it 20-30 cm away from the Treitz ligament, and exteriorizing it to the trocar orifice under visual guide. The jejunostomy was created outside the abdominal cavity during open surgery. At the end of the jejunostomy, the correct position of the intestinal loops was evaluated via laparoscopy.
Surgery lasted 40 min on average, the laparoscopic portion about 10 min. Hospital stay was 3 or 7 days for all patients. At the longest follow-up (8 years), all patients had experienced a significant weight gain. One patient died 1 year after the procedure of unknown causes. As for the other complications: 4/10 patients experienced peristomal heritema, 2/10 device's dislocation and 1 patient a peristomal granuloma.
Laparoscopic-assisted jejunostomy is a safe and effective procedure to adopt in neurologically impaired children with feeding problems and GER. We advocate the use of this procedure in neurologically impaired patients with feeding problems and reflux due to its overall practicability and because there is minimal surgical trauma. The improvement in the quality of life of these children after the jejunostomy seems to be the major advantage of this procedure. However the management of jejunostomy can be difficult for parents above all in the first postoperative months.
喂养困难和胃食管反流（GER）是严重神经功能受损儿童的主要问题。许多患者通过单纯胃造口术进行治疗，可伴有或不伴有胃底折叠术。不幸的是，胃底折叠术和胃造口术并非没有并发症，这表明在这些患者的治疗中需要其他选择。
在2002年1月至2010年6月期间，10例患者（年龄范围为18个月至14岁）接受了腹腔镜辅助下空肠造口术治疗。该手术使用2 - 3个套管针进行。该技术包括识别第一个空肠袢，在距Treitz韧带20 - 30厘米处抓住它，并在视觉引导下将其引出至套管针孔处。空肠造口术在开放手术期间在腹腔外创建。在空肠造口术结束时，通过腹腔镜评估肠袢的正确位置。
手术平均持续40分钟，腹腔镜部分约10分钟。所有患者的住院时间为3天或7天。在最长随访期（8年）时，所有患者体重均显著增加。1例患者在术后1年因不明原因死亡。至于其他并发症：10例患者中有4例发生造口旁疝，10例中有2例装置移位，1例患者出现造口旁肉芽肿。
腹腔镜辅助下空肠造口术是治疗有喂养问题和GER的神经功能受损儿童的一种安全有效的手术方法。由于其整体实用性以及手术创伤极小，我们提倡在有喂养问题和反流的神经功能受损患者中使用该手术。空肠造口术后这些儿童生活质量的改善似乎是该手术的主要优势。然而，空肠造口术的管理对家长来说可能很困难，尤其是在术后的头几个月。
