摘要
目的分析经皮内镜引导下胃造瘘术（PEG）在儿科应用的疗效。方法选择2011年10月至2014年10月在广州市妇女儿童医疗中心小儿消化内科行PEG及经皮内镜下胃造瘘空肠置管术（JET-PEG）的患儿为研究对象，记录手术成功率，操作时间，比较患儿术前及术后6个月体重、肠内营养热量及肺炎发作频率的变化，随访至2014年10月，随访内容包括近期及远期并发症，造瘘管留置时间、换管或拔管情况，吞咽功能或原发病的转归。结果13例患儿中，男10例，女3例，平均年龄2岁（1．8个月～9岁），12例行PEG的患儿有6例因先天性口咽发育异常致喂养困难、呛咳、反复肺炎，另外6例因神经系统疾病致吞咽困难，1例行JET-PEG的患儿因慢性假性肠梗阻致呕吐及腹胀。13例均1次穿刺置管成功，PEG操作时间平均（25±3）min，JET-PEG为60min，手术相关的近期并发症I例，为造瘘口周围皮肤感染，无远期并发症。至术后6个月，全部患儿体重均增长[（3．0～30．0）比（5．5～30．5）kg]，12例肠内营养热量增加[（209～502）比（272～543）kJ／（kg·d）]。术前存在反复肺炎的患儿，术后6个月内肺炎发作频率降低[（0～1．5）比（0～0．16）次／月]。随访至2014年10月，13例患儿的造瘘管平均留置时间为17．8个月（4～36个月）；4例患儿能完全自主进食后拔管，其余继续经胃造瘘管或空肠营养管喂养的9例患儿中，3例更换了球囊型胃造瘘管。13例中2例腭裂患儿，分别于术后6个月及15个月行腭裂修补术。结论在儿科中应用PEG和JET-PEG进行肠内营养治疗是安全和有效的，手术创伤小，术后恢复快，并发症少，造口美观、护理简单，可显著改善患儿的营养状况及生活质量。
Objective To analyze the efficacy of percutaneous endoscopic gastrostomy （PEG） in pediatric patients. Method From October 2011 to October 2014, children in the gastrointestinal ward of Guangzhou Women and Children＇s Medical Center received PEG or jejunal tube PEG （JET-PEG）. The success rate, operation time were recorded. The changes of their weight, enteral nutrition calories and the incidence of pneumonia before and after the first 6 months of operation were compared. Follow-up was conducted until October 2014, the recent and long term complications, the length of indwelling time, the replacement or removal of the tube were recorded, the patients swallowing function or the primary disease＇s outcomes were observed. Result Of the 13 cases, 10 were male, 3 were female, their average age was 2 years （ range 1.8 months - 9 years ） . We performed PEG for 12 of the patients who had congenital craniofacial problems that led to feeding difficulties or recurrent cough and pneumonia （6/12）, or neurological disorders （6/12） with inability to swallow, and in one case JET-PEG was performed, this child suffered from chronic intestinal pseudo-obstruction with vomiting and abdominal distension. The gastrostomy was successful in all the patients through one operation, the average operation time of PEG was （ 25 ± 3 ） minutes, JET-PEG was 60 minutes. One local skin infection was noted, no long-term complication occurred.In the first 6 months after operation, all the patients gained weight （ （ 5.5 - 30. 5 ） kg postoperation vs. （3.0-30. 0） kg preoperation）, and 12 cases＇ enteral nutrition calories increased （from （209 -502） to （272-543） kJ/（kg · d））, the incidence of pneumonia decreased in the children who had recurrent pneumonia before the operation （from （0 - 1.5） to （0 - 0. 16） per month）. Until October 2014, their average length of gastric tube indwelling time was 17. 8 months （range 4 - 36 months）. In 4 cases PEG tube was removed when they could eat completely independently, the other 9 needed enteral vein nutrition via PEG tube or jejunal tube,in 3 of them balloon type gastric fistula tube was applied. Two of the 13 cases who had cleft palate received stomatological operations when their weight grew to meet the standard. Conclusion PEG and JET-PEG are safe and effective method for enteric nutrition feeding in pediatrics, the technique causes minimal trauma and has rapid postoperative recovery, few complications, good aesthetic appearances and simole nursing, it can significantly imorove their nutritional status and quality of life.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2016年第2期145-149,共5页
Chinese Journal of Pediatrics
关键词
胃
自然腔道内镜手术
儿童
Stomach
Natural orifice endoscopic surgery
Child
