Graham Christopher D, Rodriguez Leonel, Flores Alejandro, Nurko Samuel, Buchmiller Terry L
Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Division of Gastroenterology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA; Colorectal Program, Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital.
J Pediatr Surg. 2019 Mar;54(3):486-490. doi: 10.1016/j.jpedsurg.2018.09.013. Epub 2018 Oct 2.
Children failing medical management for severe constipation and/or fecal incontinence may undergo surgical intervention for antegrade enema administration. We present a modification of the laparoscopic-assisted percutaneous endoscopic cecostomy (LAPEC) procedure that allows primary placement of a skin-level device.
A single-institution retrospective review was performed from 2009 to 2015. In the modified technique the colonoscope is advanced to the cecum, cecal suspension sutures are placed under laparoscopic visualization, and percutaneous needle puncture of the cecum is performed under direct laparoscopic and endoscopic visualization. A skin-level cecostomy tube is then placed over a guide wire. Patient characteristics and 30-day results were analyzed by Fisher's exact test.
Fifty-two patients underwent attempted LAPEC. Successful LAPEC using both laparoscopic and endoscopic guidance was achieved in 46 (88.5%). A MIC-KEY device was placed in 38. Corflo PEG tube placement was necessary in 14 due to high BMI (mean 28.4). Colonoscopy failed to reach the cecum in 6 and laparoscopy alone was utilized to achieve successful tube placement. Cecostomy site infections occurred in 3 (5.8%), only in those undergoing PEG placement using a pull technique (p < 0.05).
Primary placement of a skin-level device was successful in the majority of patients undergoing cecostomy tube placement for bowel management utilizing antegrade colonic enemas. This technique avoids a second anesthesia for tube conversion. Visualization via colonoscopy with the use of cecal suspension sutures is recommended. High BMI necessitates initial placement of a PEG tube and complications exclusively occurred in this group.
Clinical.
IV Case series study.
因严重便秘和/或大便失禁而药物治疗失败的儿童可能需要接受手术干预以进行顺行灌肠。我们介绍了一种改良的腹腔镜辅助经皮内镜下盲肠造口术（LAPEC），该手术允许直接放置皮肤水平装置。
对2009年至2015年在单一机构进行的回顾性研究。在改良技术中，将结肠镜推进至盲肠，在腹腔镜直视下放置盲肠悬吊缝线，并在腹腔镜和内镜直视下对盲肠进行经皮穿刺。然后通过导丝放置皮肤水平盲肠造口管。采用Fisher精确检验分析患者特征和30天结果。
52例患者尝试进行LAPEC。46例（88.5%）在腹腔镜和内镜引导下成功完成LAPEC。38例放置了MIC-KEY装置。由于BMI较高（平均28.4），14例需要放置Corflo PEG管。6例结肠镜未能到达盲肠，仅通过腹腔镜完成了成功的置管。3例（5.8%）发生盲肠造口部位感染，仅发生在采用牵拉技术放置PEG管的患者中（p<0.05）。
对于大多数接受盲肠造口管置入术以利用顺行结肠灌肠进行肠道管理的患者，直接放置皮肤水平装置是成功的。该技术避免了为更换造口管而进行的二次麻醉。建议使用盲肠悬吊缝线通过结肠镜进行可视化操作。BMI较高需要初始放置PEG管，且并发症仅发生在该组患者中。
临床研究。
IV级病例系列研究。
