Sydnor Ryan H, Schriber Stacey M, Kim Charles Yoon
Division of Vascular and Interventional Radiology, Duke University Medical Center, Durham, NC, USA.
Gut Liver. 2014 Sep;8(5):495-9. doi: 10.5009/gnl13204. Epub 2014 Feb 24.
BACKGROUND/AIMS: To determine the prevalence and time-course of t-fastener migration after gastropexy deployment.
We reviewed our procedural database for all percutaneous gastrostomy and gastrojejunostomy tube insertions performed over a 14-month period using a widely accepted t-fastener kit for gastropexy (Kimberly-Clark). Of 201 patients, 71 (41 males, 30 females; mean age, 56 years) underwent subsequent abdominal computed tomography (CT) imaging. The location and associated findings of each t-fastener were retrospectively recorded for each CT scan performed after the tube insertion.
A total of 153 t-fasteners were deployed during 71 procedures with subsequent CT follow-up. In the short term (within 4 weeks after deployment), 5.1% of the t-fasteners had detached and were no longer present; 59.5% were intraluminal or within the gastric wall; and 35.5% were within the anterior abdominal wall musculature or subcutaneous. In the long term (>3 months), 48.6% of the t-fasteners had detached and were no longer present, 25.0% were intraluminal or within the gastric wall, and 26.4% were within the anterior abdominal wall musculature or subcutaneous. No t-fastener-related complications, such as abscesses, fluid collections, or fistulae, were identified.
Following gastropexy for percutaneous transgastric feeding tube placement, t-fastener migration into the abdominal wall frequently occurred soon after the tube insertion. Therefore, recent t-fastener deployment does not guarantee an intact gastropexy.
背景/目的：确定胃固定术后T型钉移位的发生率和时间进程。
我们回顾了在14个月期间使用广泛接受的用于胃固定术的T型钉套件（金佰利公司）进行的所有经皮胃造口术和胃空肠造口管插入术的手术数据库。在201例患者中，71例（41例男性，30例女性；平均年龄56岁）接受了后续腹部计算机断层扫描（CT）成像。对置管后进行的每次CT扫描，回顾性记录每个T型钉的位置及相关发现。
在71例接受后续CT随访的手术中，共置入了153个T型钉。短期内（置入后4周内），5.1%的T型钉已脱落且不再存在；59.5%位于管腔内或胃壁内；35.5%位于前腹壁肌肉组织或皮下。长期内（>3个月），48.6%的T型钉已脱落且不再存在，25.0%位于管腔内或胃壁内，26.4%位于前腹壁肌肉组织或皮下。未发现与T型钉相关的并发症，如脓肿、积液或瘘管。
在经皮经胃喂养管置入术行胃固定术后，T型钉在置管后不久经常迁移至腹壁。因此，近期置入T型钉并不能保证胃固定术完整无缺。
