Fox K A, Mularski R A, Sarfati M R, Brooks M E, Warneke J A, Hunter G C, Rappaport W D
Department of Surgery, University of Arizona Health Sciences Center, Tucson, USA.
Am J Surg. 1995 Dec;170(6):564-6; discussion 566-7. doi: 10.1016/s0002-9610(99)80016-6.
The enteral route is preferred in surgical patients requiring nutritional support; however, controversy surrounds the choice of location of feeding tube placement. Although jejunostomy has been commonly accepted as superior to gastrostomy for long-term nutritional support because of an assumed lower risk of aspiration pneumonia, recent studies suggest that reevaluation of common practices of surgical tube placement is warranted.
We conducted a retrospective chart review of gastrostomy and jejunostomy procedures from 1986 to 1993. Demographic information and complications related to the procedure were reviewed. Aspiration pneumonia was defined as respiratory symptoms, leukocytosis, and infiltrate on chest radiograph.
Sixty-nine gastrostomies and 86 jejunostomies were performed during the study period. Six patients were diagnosed with aspiration pneumonia; 2 cases of which occurred with jejunostomy and 4 cases occurred with gastrostomy (P = not significant).
There was no difference in rates of pulmonary aspiration or other complications between gastrostomy and jejunostomy. We suggest that when a surgically placed feeding tube is required, the determination of appropriate procedure be based on clinical factors such as the technical difficulty of the operation or long-term feeding goals.
对于需要营养支持的外科患者，肠内途径是首选；然而，喂养管放置位置的选择存在争议。尽管空肠造口术因被认为发生误吸性肺炎的风险较低，已被普遍接受为优于胃造口术的长期营养支持方法，但最近的研究表明有必要重新评估外科置管的常规做法。
我们对1986年至1993年期间的胃造口术和空肠造口术进行了回顾性病历审查。审查了人口统计学信息和与手术相关的并发症。误吸性肺炎的定义为呼吸道症状、白细胞增多和胸部X光片上的浸润影。
在研究期间共进行了69例胃造口术和86例空肠造口术。6例患者被诊断为误吸性肺炎；其中2例发生于空肠造口术，4例发生于胃造口术（P值无统计学意义）。
胃造口术和空肠造口术在肺部误吸发生率或其他并发症方面没有差异。我们建议，当需要通过手术放置喂养管时，合适手术方式的确定应基于临床因素，如手术的技术难度或长期喂养目标。
