Behrens R, Lang T, Muschweck H, Richter T, Hofbeck M
University Children's Hospital Erlangen-Nürnberg, Germany.
J Pediatr Gastroenterol Nutr. 1997 Nov;25(5):487-91. doi: 10.1097/00005176-199711000-00001.
Long-term nasogastric tube feeding is often associated with irritation of the hypopharynx or dislocation of the tube. These pitfalls may be circumvented by percutaneous endoscopic gastrostomy. Although frequently used in adults, there is limited experience with the procedure in children.
A series of 139 patients (aged 3 weeks to 36.5 years, mean age, 4.4 years; weight 3.1-60 kg, mean weight, 15 kg) underwent placement of a percutaneous endoscopic gastrostomy because of central dysphagia (n = 103); general dystrophy caused by chronic renal failure, congenital heart disease, neoplasms, or cystic fibrosis (n = 26); requirement for special diets (n = 7); malnutrition related to respiratory insufficiency (n = 2); and gastric volvulus (n = 1).
The percutaneous endoscopic gastrostomy was placed either in the stomach (n = 122) or in the duodenum (n = 15). In two patients a direct percutaneous endoscopic jejunostomy was performed, because duodenal placement proved impossible. Percutaneous endoscopic gastrostomies were placed using intravenous sedation (midazolam, etomidate, or diazepam). None of the patients required general or inhalation anesthesia. We observed 19 complications including: dislocation of the duodenal part into the stomach (n = 5); inflammation at the insertion site (n = 3); perforation of the stomach (n = 2), which healed under conservative treatment; disconnection of the retention disk (n = 4); occlusion of the tube (n = 4), and chronic vomiting (n = 1). Mean lifetime of a percutaneous endoscopic gastrostomy was more than 1 year.
Percutaneous endoscopic gastrostomy provides a major improvement for children requiring long-term tube feeding. High efficacy and low rates of complication suggest that percutaneous endoscopic gastrostomy should be considered more often, even in infants.
长期鼻胃管喂养常伴有下咽刺激或管道移位。经皮内镜下胃造口术可避免这些问题。虽然该手术在成人中常用，但在儿童中的经验有限。
139例患者（年龄3周至36.5岁，平均年龄4.4岁；体重3.1 - 60 kg，平均体重15 kg）因中枢性吞咽困难（n = 103）；慢性肾功能衰竭、先天性心脏病、肿瘤或囊性纤维化导致的全身营养不良（n = 26）；特殊饮食需求（n = 7）；呼吸功能不全相关的营养不良（n = 2）；以及胃扭转（n = 1）接受了经皮内镜下胃造口术。
经皮内镜下胃造口术置于胃内（n = 122）或十二指肠内（n = 15）。2例患者因无法将造口管置于十二指肠而进行了直接经皮内镜下空肠造口术。经皮内镜下胃造口术采用静脉镇静（咪达唑仑、依托咪酯或地西泮）进行。所有患者均无需全身麻醉或吸入麻醉。我们观察到19例并发症，包括：十二指肠段移位至胃内（n = 5）；插入部位炎症（n = 3）；胃穿孔（n = 2），经保守治疗愈合；固定盘断开（n = 4）；管道堵塞（n = 4）；以及慢性呕吐（n = 1）。经皮内镜下胃造口术的平均使用时长超过1年。
经皮内镜下胃造口术为需要长期管饲的儿童带来了重大改善。高疗效和低并发症发生率表明，即使在婴儿中，也应更频繁地考虑经皮内镜下胃造口术。
