Romero R, Martinez F L, Robinson S Y, Sullivan K M, Hart M H
Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
Gastrointest Endosc. 1996 Sep;44(3):230-4. doi: 10.1016/s0016-5107(96)70156-6.
PEG disruptions during conversions to skin-level gastrostomy devices have been described, but specific risk factors have not been reported. In this study, possible risk factors for tract disruption in a pediatric population were identified, and management of complications described.
The medical records of patients who underwent gastrostomy conversions during 1994 were reviewed. Statistical analysis was performed using two-tailed student's t test, and risk ratios with 95% confidence limits were calculated.
Gastrostomy tract disruption occurred in 6 to 30 (20%) of tube conversions. Complicated and uncomplicated cases did not differ with regard to age, sex, primary or associated diagnoses, pregastrostomy or postgastrostomy nutritional status, tract maturity, or percutaneous gastrostomy tube type. The use of an 18F obturator-type skin-level gastrostomy tube increased the risk for gastric separation 4.8-fold. Tract disruptions were managed by fluoroscopic gastrostomy tube replacement, repeat PEG, or exploratory laparotomy with open gastrostomy.
The use of obturator-type skin-level gastrostomy tubes was associated with an increased risk of tract disruption. Fluoroscopic verification of intragastric placement is warranted after initial conversions to skin-level gastrostomy tubes.
在转换为皮肤水平胃造口装置的过程中，PEG 中断的情况已有描述，但尚未报告具体的危险因素。在本研究中，确定了儿科人群中造瘘管中断的可能危险因素，并描述了并发症的处理方法。
回顾了 1994 年期间接受胃造口转换的患者的病历。使用双侧学生 t 检验进行统计分析，并计算 95%置信区间的风险比。
在 6 至 30 例（20%）造瘘管转换中发生了胃造瘘管通道中断。复杂和非复杂病例在年龄、性别、主要或相关诊断、造瘘术前或术后营养状况、通道成熟度或经皮胃造瘘管类型方面没有差异。使用 18F 闭孔型皮肤水平胃造瘘管会使胃分离的风险增加 4.8 倍。通过透视下胃造瘘管置换、重复 PEG 或剖腹探查并开放胃造瘘来处理通道中断。
使用闭孔型皮肤水平胃造瘘管会增加通道中断的风险。在最初转换为皮肤水平胃造瘘管后，有必要通过透视确认胃内放置情况。
