Osei Hector, Munoz-Abraham Armando Salim, Kim Jin Sun, Kazmi Sakina, Myint Janine, Chatoorgoon Kaveer, Greenspon Jose, Fitzpatrick Colleen, Villalona Gustavo A
Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri.
Department of Surgery, Division of Pediatric Surgery, Saint Louis University School of Medicine, St. Louis, Missouri.
J Laparoendosc Adv Surg Tech A. 2019 Oct;29(10):1259-1263. doi: 10.1089/lap.2019.0316. Epub 2019 Sep 25.
Although rare, major complications after gastrostomy tube placement are a significant source of morbidity in children. The purpose of this study was to identify predictors of major complications in pediatric patients undergoing gastrostomy placement. Retrospective review of surgically placed gastrostomy tubes from 2010 to 2017 was performed. Data collected included demographics, outcomes, and major complications. We divided the patients into no complications (Group 1) and major complications (Group 2). Excluded were minor complications and percutaneous endoscopic gastrostomy procedures. Of 123 patients, 51.5% were males and 52% infants. Group 1 had 112 patients (91%), whereas Group 2 had 11 patients (9%). Of Group 2 patients, 3 required prolonged nil per os/total parenteral nutrition and 8 surgical reinterventions. Laparoscopy in 110 patients (89%), open surgery in 10 patients (8%), and 3 conversions to open. There were no significant differences in demographics or preoperative characteristics (albumin and comorbidities). We identified surgical approach (open: 6.3% versus 27.3%, = .014), operative time (58 versus 85 minutes, = .04), and use of preoperative antibiotics (63% versus 92%, = .004) as predictors of outcomes. However, on multivariate analysis lack of preoperative antibiotics (adjusted odds ratio [aOR], 14.82 [confidence interval: 2.60-84.34], = .002), and open procedure (aOR, 6.14 [1.01-37.24], = .049) were independent predictors of major complications. Most patients with major complications after gastrostomy tube placement require surgical reintervention. Lack of preoperative antibiotics and open procedures are independent predictive factors for major complication in patients undergoing gastrostomy tube placement.
尽管罕见，但，胃造口术置管后的严重并发症是儿童发病的重要原因。本研究的目的是确定接受造口术置管的儿科患者发生严重并发症的预测因素。对2010年至2017年手术放置的造口术管进行了回顾性分析。收集的数据包括人口统计学、结局和严重并发症。我们将患者分为无并发症组（第1组）和严重并发症组（第2组）。排除轻微并发症和经皮内镜下胃造口术。123例患者中，51.5%为男性，52%为婴儿。第1组有112例患者（91%），而第2组有11例患者（9%）。第2组患者中，3例需要长时间禁食/全胃肠外营养，8例需要手术再次干预。110例患者（89%）采用腹腔镜手术，10例患者（8%）采用开放手术，3例转为开放手术。人口统计学或术前特征（白蛋白和合并症）无显著差异。我们确定手术方式（开放手术：6.3%对27.3%，P = 0.014）、手术时间（58对85分钟，P = 0.04）和术前抗生素的使用（63%对92%，P = 0.004）作为结局的预测因素。然而，多因素分析显示，术前未使用抗生素（调整后的优势比[aOR]，14.82[置信区间：2.60 - 84.34]，P = 0.002）和开放手术（aOR，6.14[1.01 - 37.24]，P = 0.049）是严重并发症的独立预测因素。大多数造口术置管后发生严重并发症的患者需要手术再次干预。术前未使用抗生素和开放手术是造口术置管患者发生严重并发症的独立预测因素。
