Liu Yu-Yin, Liao Chien-Hung, Chen Chih-Chi, Tsai Chun-Yi, Liu Keng-Hao, Wang Shang-Yu, Fu Chih-Yuan, Yeh Chun-Nan, Yeh Ta-Sen
1 Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University , Taoyuan, Taiwan .
J Laparoendosc Adv Surg Tech A. 2014 Jan;24(1):22-7. doi: 10.1089/lap.2013.0360. Epub 2013 Dec 13.
Feeding jejunostomy is an alternative enteral nutritional supplementation method for patients with functional gastrointestinal tracts. In this study, we introduced the novel, safe technique of single-incision laparoscopic-assisted jejunostomy (SIL-AJ) tube placement.
We conducted a prospective record search and a retrospective review of all patients who received surgical jejunostomy tube placement in Chang Gung Memorial Hospital, Linkou, Taiwan, from October 2011 to December 2012. SIL-AJ, multiple-incision laparoscopic jejunostomy (MIL-J), and open jejunostomy (O-J) were performed concurrently. We compared the demographic data, operative time, postoperative pain control, and postoperative complications among these groups.
Forty patients who received surgical jejunostomy in this period were enrolled in the study. There were 14 patients with SIL-AJ, 10 with MIL-J, and 16 with O-J. There were no differences in age, sex, American Society of Anesthesiologists status, body mass index, or malignancy distribution among the SIL-AJ, MIL-J, and O-J groups. The total operative times for the SIL-AJ, MIL-J, and O-J procedures were 53.3±11.5, 117.3±45.8, and 52.9±16.1 minutes, respectively; SIL-AJ and O-J had similar operative times, which were significantly shorter than the operative times in the MIL-J group (P<.001). The proportions of patients who began feeding within 24 hours in the SIL-AJ, MIL-J, and O-J groups were 100%, 70%, and 37%, respectively; the SIL-AJ group had a higher feeding rate at 24 hours than the two other groups (P=.001). The SIL-AJ and MIL-J groups had fewer postoperative complications than the O-J group (P=.011).
SIL-AJ is a feasible and safe procedure that can be performed in patients who require alternative enteral feeding. Reduced postoperative pain, acceptable incisions, and quick feeding were observed in patients with SIL-AJ. Transumbilical SIL-AJ uses cost-effective appliances, and it is a relatively simple technique to learn and in which togain proficiency.
空肠造口喂养是胃肠道功能正常患者的一种替代肠内营养补充方法。在本研究中，我们介绍了单切口腹腔镜辅助空肠造口术（SIL-AJ）置管这一新颖、安全的技术。
我们对2011年10月至2012年12月在台湾林口长庚纪念医院接受手术空肠造口置管的所有患者进行了前瞻性记录检索和回顾性分析。同时进行了SIL-AJ、多切口腹腔镜空肠造口术（MIL-J）和开放空肠造口术（O-J）。我们比较了这些组的人口统计学数据、手术时间、术后疼痛控制和术后并发症。
在此期间接受手术空肠造口术的40例患者纳入本研究。其中14例行SIL-AJ，10例行MIL-J，16例行O-J。SIL-AJ组、MIL-J组和O-J组在年龄、性别、美国麻醉医师协会分级、体重指数或恶性肿瘤分布方面无差异。SIL-AJ、MIL-J和O-J手术的总手术时间分别为53.3±11.5、117.3±45.8和52.9±16.1分钟；SIL-AJ和O-J的手术时间相似，均显著短于MIL-J组（P<0.001）。SIL-AJ组、MIL-J组和O-J组在24小时内开始喂养的患者比例分别为100%、70%和37%；SIL-AJ组在24小时时的喂养率高于其他两组（P=0.001）。SIL-AJ组和MIL-J组的术后并发症少于O-J组（P=0.011）。
SIL-AJ是一种可行且安全的手术，可用于需要替代肠内喂养的患者。SIL-AJ患者术后疼痛减轻、切口可接受且喂养迅速。经脐SIL-AJ使用成本效益高的器械，是一种相对容易学习和熟练掌握的技术。
