摘要
目的:评估逆行经皮路径影像导引下放置儿童胃造瘘管(G)及胃空肠吻合管(GJ)的术后并发症。方法:随机选择加拿大多伦多儿童医院4年间(1995-1999)行介入法治疗的G或GL手术的患者共208例进行回顾性分析。并发症分为重度(包括皮下脓肿、腹膜炎、败血症、胃肠道出血及死亡)和轻度两类。结果:共有253个导管(208个用于G手术、41个用于GL手术、4个用于同时行G和GL手术)置入208例患者。中位数年龄15 月(7d-18岁),大多数患者的诊断是神经性疾病(47%)。插管的主要指征为发育不正常(57%)及异物吸入危险(47%)。5%的患者发生了重度并发症,其中腹膜炎占3%,因插管致死亡1例(0.4%),73%的患者发生了轻度并发症,包括插管移位(37%)、渗漏(25%)、G手术插管部位皮肤感染(25%)。GJ手术较G手术而言,发生率更高的为导管梗阻、易位、移动、渗漏及套叠,而局部感染、胃食管反流及穿刺部位出血则较少见。结论:影像引导下放置胃造瘘管及胃空肠吻合管的术后有许多并发症,但大部分为轻度,多与导管的维持有关,但重度并发症,包括死亡,也可以发生。
Objective. To evaluate the complications associated with the image-guided insertion of gastrostomy (G) and gastro-jejunoslomy (GJ) tubes in children, performed by the retrograde percutaneous route. Methods. A convenience sample of 208 charts of 840 patients recorded as having G and/or GJ tubes placed by the interventional radiology service in a 4 - year period (1995 - 1999) at the Hospital for Sick Children in Toronto, Canada, were selected for review. Complications were categorized as major (including subcutaneous abscess, peritonitis, septicemia, gastrointestinal bleeding, and death) or minor. Results. In total, 253 tubes (208 G tubes, 41 GJ tubes, 4 G and GJ tubes) were placed in the 208 patients reviewed. The median age at the time of insertion was 15 months (range: 7 days - 18 years) . The most common diagnostic category was neurologic disease (47% ) . The main indications for tube insertion were recorded as failure to thrive (57% ) and risk of aspiration (47% ) . Major complications were seen in 5% of patients. Peritonitis was noted in 3%, and there was 1 death related to tube insertion (0. 4% ) . Minor complica- tions were found in 73% of patients, including tube dis-lodgement (37%), tube leakage (25%), and G-tube site skin infection (25% ) . GJ tubes had a higher rate than G tubes of obstruction, migration, dislodgement, leakage, and intussusception. Site infection, gastroesophageal reflux, and bleeding from the site were seen less frequently in patients with GJ tubes compared with G tubes. Conclusion. G and GJ tubes placed by the image-guided retrograde percutaneous method are associated with a wide range of complications. The majority of these are minor and are predominantly related to tube maintenance, but major complications, including death, do occur.
