Stringel G, Delgado M, Guertin L, Cook J D, Maravilla A, Worthen H
Department of Surgery, Texas Scottish Rite Hospital for Crippled Children, Dallas.
J Pediatr Surg. 1989 Oct;24(10):1044-8. doi: 10.1016/s0022-3468(89)80212-x.
We report our experience with 90 neurologically impaired children treated with gastrostomy and Nissen fundoplication. Malnutrition was the main problem, followed by aspiration, recurrent pneumonia, and vomiting. The symptomatology was caused by swallowing incoordination and gastroesophageal reflux. The diagnosis of gastroesophageal reflux was confirmed by upper gastrointestinal series and pH probe. Nissen fundoplication was performed following a standard technique with preservation of the vagus nerves and its branches, repair of the diaphragmatic crura, reconstruction of the angle of His, and a 360 degree wrap. A gastrostomy and pyloroplasty or pyloric dilatation were part of the operative procedure. There were no deaths and few complications related to the surgical procedure. Marked nutritional improvement was seen in most cases with an average weight gain of 3.2 kg/patient 3 months following surgery. There was also improvement in milestones and seizure control. The majority of parents were very satisfied and would recommend the procedure to other parents with similar problems.
我们报告了90例接受胃造口术和nissen胃底折叠术治疗的神经功能受损儿童的经验。营养不良是主要问题，其次是误吸、反复肺炎和呕吐。症状是由吞咽不协调和胃食管反流引起的。上消化道造影和pH值探头证实了胃食管反流的诊断。nissen胃底折叠术采用标准技术进行，保留迷走神经及其分支，修复膈脚，重建His角，并进行360度包绕。胃造口术和幽门成形术或幽门扩张术是手术过程的一部分。没有与手术相关的死亡病例，并发症也很少。大多数病例营养状况明显改善，术后3个月平均体重增加3.2千克/患者。发育里程碑和癫痫控制也有所改善。大多数家长非常满意，并会向其他有类似问题的家长推荐该手术。
