Stylianos S, Flanigan L M
Division of Pediatric Surgery, Babies and Children's Hospital of New York, Columbia University College of Physicians & Surgeons, NY 10032, USA.
J Pediatr Surg. 1995 Feb;30(2):219-20. doi: 10.1016/0022-3468(95)90563-4.
Button gastrostomy (BG) insertion has been a secondary procedure after initial open Stamm or percutaneous endoscopic tube gastrostomy. Previous attempts at primary open BG have been limited by the difficulty in bringing the BG "wings" through the abdominal wall. We employed an innovative technique for primary BG, which eliminates many of the disadvantages inherent in tube gastrostomy.
From June 1993 to April 1994, primary BG insertion was performed in 34 children, using a silicon BG in a tapered peel-away sheath. Seventeen children had percutaneous endoscopic insertion of the BG. Six (35%) weighed less than 10 kg. Simultaneous laparoscopic guidance was used for percutaneous BG insertion in two children who had had multiple previous abdominal procedures. Open BG was performed during concomitant abdominal procedures in 15 patients and after unsuccessful percutaneous BG in two patients. Twelve patients (71%) weighed less than 10 kg. The standard Stamm technique was used for open BG insertion, and the tapered peel-away sheath was readily brought out through a remote incision in the abdominal wall.
The mean operative time for percutaneous primary BG was 12 minutes from needle insertion (range, 10 to 22 minutes). The mean time until BG feeding was 18 hours after insertion (range, 12 to 48 hours). No serious complications occurred in any of the 34 patients. Follow-up (1 to 10 months) has shown minor tissue reaction, minor leakage, and enthusiastic patient and parent satisfaction.
This innovative technique has proven safe and effective and allows for insertion of a skin-level, nonrefluxing, nonreactive, self-retaining feeding device, which eliminates the need for initial open or percutaneous tube gastrostomy and the associated complications. Potential cost savings may result through elimination of secondary button insertion procedures and the radiological studies often used to confirm proper button placement.
纽扣式胃造口术（BG）置入一直是在初次开放式 Stamm 胃造口术或经皮内镜下胃造口术后的一种二次手术。以往初次开放式 BG 的尝试因将 BG“翼”穿过腹壁困难而受限。我们采用了一种用于初次 BG 的创新技术，该技术消除了胃造口术固有的许多缺点。
1993 年 6 月至 1994 年 4 月，对 34 名儿童进行了初次 BG 置入，使用置于锥形可剥离鞘内的硅制 BG。17 名儿童经皮内镜下置入 BG。6 名（35%）体重不足 10 千克。两名曾接受过多次腹部手术的儿童在经皮 BG 置入时采用了同步腹腔镜引导。15 例患者在同期腹部手术期间进行了开放式 BG 置入，2 例患者经皮 BG 置入失败后进行了开放式 BG 置入。12 例患者（71%）体重不足 10 千克。开放式 BG 置入采用标准的 Stamm 技术，锥形可剥离鞘很容易通过腹壁的一个远处切口引出。
经皮初次 BG 的平均手术时间从进针开始为 12 分钟（范围 10 至 22 分钟）。开始经 BG 喂养的平均时间为置入后 18 小时（范围 12 至 48 小时）。34 例患者中无一发生严重并发症。随访（1 至 10 个月）显示有轻微组织反应、轻微渗漏，患者及家长满意度高。
这种创新技术已被证明安全有效，可置入一种皮肤平面、无反流、无反应、自固定的喂养装置，无需初次开放式或经皮胃造口术及其相关并发症。通过省去二次纽扣置入手术以及常用于确认纽扣正确放置的放射学检查，可能会节省潜在成本。
