Hotokezaka M, Adams R B, Miller A D, McCallum R W, Schirmer B D
Department of Surgery, University of Virginia Health Sciences Center, Charlottesville, VA 22908, USA.
Surg Endosc. 1996 Oct;10(10):1008-11. doi: 10.1007/s004649900225.
Patients suffering from upper gastrointestinal pathology may require jejunal feeding for adequate nutrition. A laparoscopically guided percutaneous jejunostomy offers a minimally invasive means of obtaining such feeding access.
Laparoscopic jejunostomy was performed in 32 patients. The most common indications were gastroparesis (n = 16), neurological deficits (n = 7), and proximal obstruction (n = 5). The proximal jejunum was affixed to the abdominal wall using intracorporeal and extracorporeal transabdominal sutures, allowing safe insertion of an 18-Fr Silastic dual-lumen tube.
Laparoscopic jejunostomy was successfully completed for 28 patients; the procedure was converted to an open operation in four cases. Three of these four were among 14 patients undergoing the procedure who had a history of previous abdominal surgery. Major complications were observed in seven patients, including one reoperation and one death from aspiration pneumonia. Tube feeding was accomplished in all patients; progression to full enteral feeding proceeded without interruption in 20 patients.
Laparoscopic jejunostomy can be performed with relative safety. Morbidity, though high, is usually related to preexisting disease. Previous abdominal surgery is not necessarily a contraindication to laparoscopic jejunostomy.
患有上消化道疾病的患者可能需要空肠喂养以获得充足营养。腹腔镜引导下经皮空肠造口术提供了一种获取此类喂养途径的微创方法。
对32例患者实施了腹腔镜空肠造口术。最常见的适应证为胃轻瘫（n = 16）、神经功能缺损（n = 7）和近端梗阻（n = 5）。使用体内和体外经腹缝线将空肠近端固定于腹壁，以便安全插入一根18F的硅橡胶双腔管。
28例患者成功完成腹腔镜空肠造口术；4例手术中转开腹。这4例中的3例是在14例有腹部手术史的患者中。7例患者出现主要并发症，包括1例再次手术和1例因吸入性肺炎死亡。所有患者均完成管饲；20例患者顺利过渡到完全肠内喂养且未中断。
腹腔镜空肠造口术可相对安全地实施。发病率虽高，但通常与既往疾病有关。既往腹部手术不一定是腹腔镜空肠造口术的禁忌证。
