腹腔镜下胃造瘘术

Laparoscopic gastrostomy

胃造瘘术是不能经口饮食或者需要长期肠内营养治疗患者的主要营养方式。开放手术下胃造瘘术应用已有一百余年历史，已被证实安全有效，但手术创伤相对较大。随着内镜、腹腔镜技术的推广应用，多种微创胃造瘘术已经用于临床。经皮内镜下胃造瘘手术具有操作简单、创伤小、恢复快、并发症少的优势，而且仅需要局部麻醉，已逐渐取代了外科手术，成为胃造瘘的首选方法。但内镜下胃造瘘术的应用也有明显局限性，对于因咽、食管不通畅，不能进行上消化道内镜检查的患者，外科手术仍然是必须的。腹腔镜下胃造瘘术比传统开放手术微创优势明显，常见手术方式有多种，本文述评各种常用术式的特点，并介绍笔者所在医疗机构应用的腹腔镜下管型通道成形胃造瘘术的经验。管型通道成形胃造瘘术是利用胃壁制备管型通道作为瘘管，可以避免胃前壁向腹壁的过度悬吊牵拉；由于瘘道内有黏膜衬附，更换营养管简单方便，可以随时取出营养管，经管型通道送入口服药物，也不需要特殊造营养管瘘管，只需要使用普通球囊导尿管，既可用于营养液灌注，也可用于封堵瘘道。

Gastrostomy is a main enteral nutrition access for patients who needed long term tube feeding,or who cannot swallowing.Open surgical procedure of gastrostomy had been used for more than100years and had been proved safe and effective,but resulting in large trauma.With the wide application of endoscopic and laparoscopic technique,many minimally invasive gastrostomy technique had been used in clinical.Percutaneous endoscopic gastrostomy operation had almost replaced the surgical procedure,because of its simple steps,small trauma,fast recovery,rare complications,and also avoidable of general anesthesia.But for those patients with throat or oesophageal obstruction or patients are unable to tolerate gastrointestinal endoscopy,surgical operation is necessary.Laparoscopic gastrostomy has advantages of minimally invasive surgery than traditional open surgery.Here we evaluated the common used minimally invasive gastrostomy operations and introduced our experience on the laparoscopic gastrostomy.We prefered the janeway procedure when making a gastrostomy.The fistula tube was made by the anterior wall along the large curvature of gastric body.With a bridge of the fistula tube between the anterior gastric wall and the abdominal wall,the gastric body dose not need to be stretched up with tension which could be symptomatic.With normal mucosal lining in the fistula tube,the feeding catheter could be changed easily,or be easily put away in occasion of taking in oral pills or capsules through the fistula tube.A foley’s urine catheter was competent for feeding and also for securing the fistula tube when the balloon was inflated.