González Ruiz Y, Corona Bellostas C, Fernández Atuán R, Bragagnini Rodríguez P, Siles Hinojosa A, Ruiz de Temiño Bravo M, Elías Pollina J
Servicio de Cirugía Pediátrica. Hospital Universitario Miguel Servet. Zaragoza.
Cir Pediatr. 2019 Apr 22;32(2):69-73.
To compare the outcomes and complications between laparoscopic gastrostomies (LG) and percutaneous endoscopic gastrostomies (PEG).
Retrospective review of 79 patients who had their gastrostomies inserted in our hospital (2010-2017). We compared surgical techniques, minor and major complications.
A total of 24 LG (14 males) and 55 PEG (29 males) were performed. The mean age was 4.77 [0.15-15.56] years for LG and 5.37 [0.12-16.58] years for PEG. The median time of presentation of complications was 59 [2-975] days. No statistical differences were found in minor complications between both techniques; however, minor complications were more frequent in LG (54.16% in LG versus 34.55% in PEG), mainly, overgranulation and peristomal leakage. A statistically significant association was found between patients with oncological comorbidity and minor complications (p<0.05).A statistically significant association was found between major complications and PEG (4.17% in LG versus 21.82% in PEG), p=0.045. The major complications were one tube dislodgement in the LG group, and 9 Buried-Bumper syndrome, one colon interposition without perforation, one colon perforation, one omentum interposition, two tube dislodgements and one small bowel perforation in PEG group.
Given the statistically significant association between major complications and the PEG group, being the higher frequency and severity of these complications with this technique evident; we consider the LG a safer technique. However, studies with larger number of patients and multicentric are necessary.
比较腹腔镜胃造口术（LG）和经皮内镜胃造口术（PEG）的治疗效果及并发症。
回顾性分析2010年至2017年在我院接受胃造口术的79例患者。比较手术技术、轻微和严重并发症。
共进行了24例LG（14例男性）和55例PEG（29例男性）。LG组的平均年龄为4.77[0.15 - 15.56]岁，PEG组为5.37[0.12 - 16.58]岁。并发症出现的中位时间为59[2 - 975]天。两种技术在轻微并发症方面未发现统计学差异；然而，LG的轻微并发症更常见（LG为54.16%，PEG为34.55%），主要是过度肉芽组织形成和造口周围渗漏。肿瘤合并症患者与轻微并发症之间存在统计学显著关联（p<0.05）。严重并发症与PEG之间存在统计学显著关联（LG为4.17%，PEG为21.82%），p = 0.045。严重并发症在LG组为1例导管移位，PEG组为9例埋入式撞针综合征、1例无穿孔的结肠置入、1例结肠穿孔、1例大网膜置入、2例导管移位和1例小肠穿孔。
鉴于严重并发症与PEG组之间存在统计学显著关联，且该技术的这些并发症频率和严重程度更高；我们认为LG是一种更安全的技术。然而，需要进行更多患者数量和多中心的研究。
