DeCou J M, Shorter N A, Karl S R
Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756.
J Pediatr Surg. 1993 Oct;28(10):1276-9; discussion 1279-80. doi: 10.1016/s0022-3468(05)80312-4.
Feeding problems are legion in severely neurologically impaired children. Many patients do well with a gastrostomy with or without fundoplication. Unfortunately, fundoplication is not without complication, emphasizing the need for other options in the management of these difficult patients. Since 1990 six patients (age range, 2 months to 6 years) have been treated by the creation of a permanent Roux-en-Y end-jejunostomy and a gastrostomy. The Roux limb is closed tightly around a mushroom catheter. The gastrostomy is left for gastric decompression, and the jejunostomy tube is used for all nutrition and most medications. One patient died in the postoperative period. All the others have done well, without significant complication and with a high level of parent satisfaction (average follow-up, 12 months). Previously four other patients were treated with a Roux-en-Y jejunostomy in which, rather than closing the Roux limb around the catheter, it was brought out as a catheterizable stoma. Frequent leakage and prolapse make this approach less desirable.
严重神经功能受损儿童的喂养问题极为常见。许多患者通过胃造口术（无论是否行胃底折叠术）情况良好。不幸的是，胃底折叠术并非没有并发症，这凸显了在管理这些棘手患者时需要其他选择的必要性。自1990年以来，有6名患者（年龄范围为2个月至6岁）接受了永久性Roux-en-Y空肠造口术和胃造口术治疗。Roux袢围绕蘑菇状导管紧密闭合。胃造口用于胃减压，空肠造口管用于所有营养供给和大多数药物给药。1例患者在术后死亡。其他所有患者情况良好，无明显并发症，家长满意度高（平均随访12个月）。此前，另外4例患者接受了Roux-en-Y空肠造口术，在该手术中，Roux袢不是围绕导管闭合，而是作为可插管造口引出。频繁渗漏和脱垂使这种方法不太可取。
