Viktorsdóttir Margrét Brands, Óskarsson Kristján, Gunnarsdóttir Anna, Sigurdsson Luther
1 Department of Surgery, Landspitali University Hospital , Reykjavík, Iceland .
J Laparoendosc Adv Surg Tech A. 2015 Mar;25(3):248-51. doi: 10.1089/lap.2014.0296. Epub 2015 Feb 5.
The aim of this study was to review the indications and the results of percutaneous endoscopic gastrostomy (PEG) procedures in Icelandic children.
A retrospective review of all pediatric PEG procedures performed in Iceland in 1999-2010 was conducted. Diagnosis, demographics, complications, and body mass index were recorded.
Ninety-eight children (51 girls) were included. Median age was 2 years (range, 1 month-17 years). The most common diagnosis was neurological disease (56%). Median length of stay was 4 days (range, 1-189 days). Extended length of stay was not related to PEG. Before surgery, median body mass index (BMI) was 14.5 kg/m(2) (range, 9.8-20.8 kg/m(2)), and the median BMI-for-age z-score was -1.4 (range, -5.9 to 3.0). One year after surgery, median BMI was 15.3 kg/m(2) (range, 11.2-22.1 kg/m(2)), and median BMI-for-age z-score was -0.5 (range, -5.1 to 3.8). The median weight increased significantly in 1 year by 1.0 standard deviation (P<.0001; 95% confidence interval, -1.4820 to -0.7387). One hundred sixty-six complications were recorded in 65 children; 96% were minor, with the most common being granuloma formation (19%) and superficial skin infection (25%). The rate of infection was not statistically different between those who received preoperative antibiotics versus no antibiotics (P=.296). Major complications were peritonitis (n=3), esophageal tear (n=1), buried bumper (n=1), and malposition of the gastrostomy tube (n=1). Median follow-up was 47 months (range, 1-152 months). Fourteen children died (at 1 month to 3 years), but no deaths were related to PEG insertion. Twenty-seven children were without gastrostomy at follow-up. Twelve children (14%) underwent fundoplication later; 11 of them were neurologically impaired.
PEG is a safe technique with a high complication rate, but the majority of complications are minor and easily treatable. Gastrostomy is sometimes temporary. Enteral feeding results in significant weight gain in 1 year.
本研究旨在回顾冰岛儿童经皮内镜下胃造口术（PEG）的适应症及手术结果。
对1999年至2010年在冰岛进行的所有儿科PEG手术进行回顾性研究。记录诊断结果、人口统计学资料、并发症及体重指数。
纳入98名儿童（51名女孩）。中位年龄为2岁（范围1个月至17岁）。最常见的诊断为神经疾病（56%）。中位住院时间为4天（范围1至189天）。住院时间延长与PEG无关。手术前，中位体重指数（BMI）为14.5kg/m²（范围9.8至20.8kg/m²），中位年龄别BMI z评分-1.4（范围-5.9至3.0）。手术后1年，中位BMI为15.3kg/m²（范围11.2至22.1kg/m²），中位年龄别BMI z评分为-0.5（范围-5.1至3.8）。1年内体重中位数显著增加1.0个标准差（P<0.0001；95%置信区间-1.4820至-0.7387）。65名儿童记录到166例并发症；96%为轻微并发症，最常见的是肉芽肿形成（19%）和浅表皮肤感染（25%）。术前接受抗生素治疗与未接受抗生素治疗的患者感染率无统计学差异（P=0.296）。主要并发症为腹膜炎（n=3）、食管撕裂（n=1）、埋入式固定片问题（n=1）和胃造口管位置异常（n=1）。中位随访时间为47个月（范围1至152个月）。14名儿童死亡（1个月至3岁），但无死亡与PEG插入有关。27名儿童随访时无胃造口。12名儿童（14%）后来接受了胃底折叠术；其中11名有神经功能障碍。
PEG是一种安全的技术，并发症发生率高，但大多数并发症轻微且易于治疗。胃造口术有时是临时性的。肠内喂养可使体重在1年内显著增加。
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