Murayama K M, Johnson T J, Thompson J S
Department of Surgery, University of Nebraska Medical Center, Omaha 68198-3280, USA.
Am J Surg. 1996 Nov;172(5):591-4; discussion 594-5. doi: 10.1016/s0002-9610(96)00246-2.
Laparoscopic gastrostomy (lap g-tube) and jejunostomy (lap j-tube) are relatively new procedures that do not require laparotomy. Our aim was to determine the role of laparoscopic feeding tube placement for enteral access and the safety of these techniques.
We reviewed our experience with attempted laparoscopic placement of 93 enteral tubes in 81 patients over a 3-year period. Patients received either a lap g-tube (n = 64), lap j-tube (n = 5), or both lap g/j-tube (n = 12). When enteral access was needed for nutritional support, the choice of lap g-tube or lap j-tube was based on risk of gastroesophageal reflux.
The most common underlying conditions requiring tube placement were head and neck cancer (49%), neurologic disorders (19%), and trauma (11%). Mean operative times (minutes) were as follows (mean +/- SD): lap g-tube (39 +/- 7), lap j-tube (63 +/- 10), and lap g/j-tube (85 +/- 13). Lap g-tube placement was successful in 73 (96%) of 76 patients and lap j-tube in all 17 patients. The major complication rate for all tubes was 8% (7 of 93) and included gastrointestinal bleeding, wound infection, and failed placement. Five patients died in the 30-day period following surgery, but none of the deaths was procedure related.
Laparoscopic tube placement should be considered for patients in whom endoscopy is not feasible or undesirable or who are undergoing other operative procedures. Lap g-tube and lap j-tube are safe procedures that avoid the potential risk of a laparotomy, and they can be done with a high success rate. This is a valuable approach for patients with head and neck cancer or neurologic disorders and for trauma patients with multiple disease processes.
腹腔镜胃造口术（lap g - 管）和空肠造口术（lap j - 管）是相对较新的手术，无需开腹。我们的目的是确定腹腔镜放置喂养管用于肠内通路的作用以及这些技术的安全性。
我们回顾了在3年期间对81例患者尝试进行93根肠内管腹腔镜放置的经验。患者接受lap g - 管（n = 64）、lap j - 管（n = 5）或lap g/j - 管（n = 12）。当需要肠内通路进行营养支持时，lap g - 管或lap j - 管的选择基于胃食管反流的风险。
需要放置管子的最常见基础疾病是头颈癌（49%）、神经系统疾病（19%）和创伤（11%）。平均手术时间（分钟）如下（均值±标准差）：lap g - 管（39 ± 7）、lap j - 管（63 ± 10）和lap g/j - 管（85 ± 13）。76例患者中有73例（96%）lap g - 管放置成功，17例患者中lap j - 管全部放置成功。所有管子的主要并发症发生率为8%（93例中的7例），包括胃肠道出血、伤口感染和放置失败。5例患者在术后30天内死亡，但无一例死亡与手术相关。
对于内镜检查不可行或不理想或正在接受其他手术的患者，应考虑腹腔镜置管。lap g - 管和lap j - 管是安全的手术，可避免开腹的潜在风险，且成功率高。对于头颈癌或神经系统疾病患者以及患有多种疾病的创伤患者，这是一种有价值的方法。
