Department of Radiology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Slot 105, 1 Children's Way, Little Rock, 72202, AR, USA.
Department of Radiology, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA.
Pediatr Radiol. 2024 Jun;54(7):1137-1143. doi: 10.1007/s00247-024-05936-2. Epub 2024 May 2.
Reports of technical success, adverse events, and long-term outcome of percutaneous cecostomy in children are limited.
To characterize technical success, 30-day severe adverse events, and long-term outcome of percutaneous cecostomy at two centers.
A retrospective review of hospital course and long-term follow-up (through May 2022) of percutaneous cecostomy tubes placed May 1997 to August 2011 at two children's hospitals was used. Outcomes assessed included technical success (defined as successful tube placement into the colon allowing antegrade colonic enemas), length of stay, 30-day severe adverse events, surgery consults, surgical repair, VP shunt infection, ongoing flushes, tube removal, duration between maintenance tube exchanges, and deaths.
A total of 215 procedures were performed in 208 patients (90 institution A, 125 institution B). Tubes were placed for neurogenic bowel (72.1%, n = 155) and functional constipation (27.9%, n = 60). Technical success was 98.1% (211/215) and did not differ between centers (p = 0.74). Surgical repair was required for bowel leakage in 5.1% (11/215) and VP shunt infection was managed in 2.1% (2/95). Compared to functional constipation, patients with neurogenic bowel had higher % tube remaining (65.3% [96/147] versus 25.9% [15/58], p < 0.001) and higher ongoing flushes at follow-up (42.2% [62/147] versus 12.1% [7/58], p < 0.001). Tube removal for dissatisfaction occurred in 15.6% [32/205] and did not differ between groups (p = 0.98). Eight deaths due to co-morbidity occurred after a median of 7.4 years (IQR 9.3) of tube access.
Percutaneous cecostomy is technically successful in the vast majority of patients and provided durable access in most. Bowel leakage and VP shunt infection are uncommon, severe adverse events.
经皮乙状结肠造口术在儿童中的技术成功率、不良事件和长期结果的报告有限。
描述两家中心的经皮乙状结肠造口术的技术成功率、30 天内严重不良事件和长期结果。
对 1997 年 5 月至 2011 年 8 月期间在两家儿童医院进行的经皮乙状结肠造口管放置的住院过程和长期随访（截至 2022 年 5 月）进行回顾性分析。评估的结果包括技术成功率（定义为成功将造口管插入结肠，允许逆行结肠灌洗）、住院时间、30 天内严重不良事件、手术咨询、手术修复、脑室-腹腔分流感染、持续冲洗、造口管移除、维持性造口管更换之间的时间、以及死亡。
共对 208 例患者（90 例来自机构 A，125 例来自机构 B）进行了 215 次操作。造口管的放置指征为神经源性肠道（72.1%，n=155）和功能性便秘（27.9%，n=60）。技术成功率为 98.1%（211/215），两个中心之间无差异（p=0.74）。5.1%（11/215）的患者发生肠漏，需要手术修复，2.1%（2/95）的脑室-腹腔分流感染需要治疗。与功能性便秘相比，神经源性肠道的患者剩余造口管的比例更高（65.3%[96/147]与 25.9%[15/58]，p<0.001），随访时持续冲洗的比例更高（42.2%[62/147]与 12.1%[7/58]，p<0.001）。因不满意而拔除造口管的发生率为 15.6%（32/205），两组之间无差异（p=0.98）。8 例死亡是由于合并症，发生在造口管使用后中位数为 7.4 年（IQR 9.3）。
经皮乙状结肠造口术在绝大多数患者中技术上是成功的，并为大多数患者提供了持久的通道。肠漏和脑室-腹腔分流感染是罕见的严重不良事件。
