Church Joseph T, Speck Karen E, Jarboe Marcus D
Section of Pediatric Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
J Pediatr Surg. 2017 Jul;52(7):1210-1214. doi: 10.1016/j.jpedsurg.2017.03.061. Epub 2017 Apr 2.
Gastrostomy tubes (G-tubes) can be placed utilizing a variety of techniques. Here we present a case series to demonstrate feasibility of a novel method, ultrasound-guided G-tube placement (USGTP).
All cases of USGTP at our institution from September 2015-August 2016 were reviewed. Data included demographics, operative time, complications, time to first feeding, and 30-day readmissions. All steps of the procedure were carried out using ultrasound guidance, resulting in placement of a low-profile G-tube.
Twelve patients underwent USGTP. Median age at operation was 2.6years (IQR 0.9-5.3) and median weight 9.9kg (IQR 7.2-18.4). Median operative time was 27min. (IQR 20-44). First feeding occurred 8.8±2.9h after the procedure. The second patient in the series experienced the only operative complication. In this case, a linear probe was used with insufficient gastric distension, resulting in placement of the tube through a fold in the stomach wall. This was recognized and remedied intraoperatively. This prompted successful technique modification for future USGTPs. Only one patient was readmitted within 30days, and this was related to urinary retention, an underlying problem.
US-guided G-tube placement appears initially to be safe, efficient and effective. Advantages include good anatomical delineation, a single incision, initial placement of a low-profile G-tube, and avoidance of endoscopy, laparoscopy, and radiation. This report illustrates feasibility of USGTP paving the way for further investigation and comparison to other existing gastrostomy insertion methods.
IV.
胃造口管（G管）可通过多种技术放置。在此，我们展示一组病例以证明一种新方法——超声引导下胃造口管置入术（USGTP）的可行性。
回顾了2015年9月至2016年8月在本机构进行的所有USGTP病例。数据包括人口统计学资料、手术时间、并发症、首次喂养时间和30天再入院情况。该操作的所有步骤均在超声引导下进行，最终放置了一根低轮廓G管。
12例患者接受了USGTP。手术时的中位年龄为2.6岁（四分位间距0.9 - 5.3），中位体重为9.9千克（四分位间距7.2 - 18.4）。中位手术时间为27分钟（四分位间距20 - 44）。术后8.8±2.9小时开始首次喂养。该系列中的第二例患者出现了唯一的手术并发症。在此病例中，使用线性探头时胃扩张不足，导致胃管通过胃壁褶皱处置入。术中发现并纠正了这一情况。这促使对未来的USGTP进行了成功的技术改进。30天内只有1例患者再次入院，这与尿潴留这一基础问题有关。
超声引导下胃造口管置入术初步看来是安全、高效且有效的。优点包括良好的解剖结构显示、单一切口、初始放置低轮廓G管以及避免内镜检查、腹腔镜检查和辐射。本报告说明了USGTP的可行性，为进一步研究以及与其他现有胃造口置入方法的比较铺平了道路。
IV级。
