Zambaiti Elisa, Virgone Calogero, Bisoffi Silvia, Stefanizzi Roberta, Fascetti Leon Francesco, Gamba Piergiorgio
Division of Pediatric Surgery, Department Women's and Children's Health, University Hospital of Padua, 35121 Padua, Italy.
Division of Pediatrics, Department Women's and Children's Health, University Hospital of Padua, 35121 Padua, Italy.
Children (Basel). 2021 Jan 4;8(1):22. doi: 10.3390/children8010022.
Gastrostomy placement is crucial in neurologically impaired (NI) children to ensure an adequate food intake and a safe route for drugs administration and to reduce the risk of primary aspiration. NI patents are more prone to gastroesophageal reflux. The association with fundoplication is deemed to reduce reflux-related respiratory complications. However, long-term benefits of this approach are not clear. We therefore aimed to compare long-term reflux-related respiratory complications of gastrostomy only (GO) to gastrostomy with fundoplication (GF). We retrospectively reviewed 145 consecutive NI children managed from 2008 to 2018. As long-term outcomes, we analyzed number and length of hospital admissions (Reflux-Related-Hospitalization, RRH) and emergency department accesses (Reflux-Related-Accesses, RRA) due to respiratory problems. Results were analyzed with appropriate statistical method. Median age at referral and at gastrostomy placement were 2.2 and 3.4 years (SD 5.6), respectively. Median follow-up was four years (range 1-12). Anti-reflux procedures were performed in 26/145 patients (18%); tracheotomy in 23/145 (16%). RRH following surgery showed lower number of admissions/year (0.32 vs. 1 for GO vs. GF, < 0.005) and days hospitalization/year (3 vs. 13, = 0.08) in GO compared to GF; RRA was similar (0.60 vs. 0.65, = 0.43). Gastrostomy placement alone appeared not to be inferior to gastrostomy plus fundoplication with respect to long-term respiratory-related outcomes for NI children in our center.
胃造口术对于神经功能受损（NI）儿童至关重要，可确保足够的食物摄入以及安全的给药途径，并降低原发性误吸风险。NI患儿更容易发生胃食管反流。胃底折叠术被认为可减少反流相关的呼吸系统并发症。然而，这种方法的长期益处尚不清楚。因此，我们旨在比较单纯胃造口术（GO）与胃造口术联合胃底折叠术（GF）的长期反流相关呼吸系统并发症。我们回顾性分析了2008年至2018年期间连续治疗的145例NI儿童。作为长期结果，我们分析了因呼吸问题导致的住院次数和住院时长（反流相关住院，RRH）以及急诊科就诊次数（反流相关就诊，RRA）。结果采用适当的统计方法进行分析。转诊时和胃造口术时的中位年龄分别为2.2岁和3.4岁（标准差5.6）。中位随访时间为4年（范围1 - 12年）。145例患者中有26例（18%）接受了抗反流手术；145例中有23例（16%）进行了气管切开术。与GF相比，GO术后RRH显示每年的住院次数较少（GO组为0.32次，GF组为1次，<0.005），每年的住院天数较少（3天对13天，=0.08）；RRA相似（0.60对0.65，=0.43）。在我们中心，就NI儿童的长期呼吸相关结局而言，单纯胃造口术似乎并不逊色于胃造口术加胃底折叠术。
