疝钩针法腹腔镜下胃造口术在婴幼儿中的应用分析  

Hernia hook needle assisted laparoscopic gastrostomy in infants

作　　者：曾信豪 何秋明 王哲 颜斌 谢晓丽 侯龙龙 钟微 余家康 Zeng Xinhao;He Qiuming;Wang Zhe;Yan Bin;Xie Xiaoli;Hou Longlong;Zhong Wei;Yu Jiakang(Department of Pediatric Surgery,Affiliated Hospital,Southwest Medical University,Sichuan Clinical Research Center for Birth Defects,Luzhou 646000,China;Department of Neonatal Surgery,Municipal Women&Children's Medical Center,Guangzhou 510630,China)

机构地区：[1]西南医科大学附属医院儿外科,四川省出生缺陷临床医学研究中心,泸州646000 [2]广州市妇女儿童医疗中心新生儿外科,广州510630

出　　处：《中华小儿外科杂志》2023年第2期102-107,共6页Chinese Journal of Pediatric Surgery

基　　金：西南医科大学自然科学项目(2020ZRQNB005)。

摘　　要：目的总结疝钩针法腹腔镜下胃造口术在婴幼儿中的应用经验,评估其临床应用价值、安全性及效果。方法收集2018年1月至2021年1月在广州市妇女儿童医疗中心新生儿外科应用疝钩针法腹腔镜下胃造口术的12例婴幼儿临床资料,其中男9例,女3例,中位年龄为113 d,年龄范围为22~337 d,体重(4973±1978)g,收集其手术时间、术后并发症等相关指标。采用描述性统计分析。结果12例婴幼儿手术时间为(58.8±11.7)min,均放置双腔硅胶球囊管;术后开奶时间为(4.0±1.4)d,达到全奶量时间为(12.3±4.0)d。术后随访10~26个月,2例造口周围皮肤出现皮疹,予以药物处理后恢复;1例因造口管松脱出现球囊堵塞幽门造成胃出口梗阻,予以更换纽扣式造口胃饲管后恢复;共6例将双腔硅胶管更换为纽扣式造口胃饲管;8例已拔除胃造口管,术口自行愈合、无需手术关闭;余4例胃造口管均固定良好,可完全依赖胃造口管进行肠内营养,均无胃造口相关并发症。结论疝钩针法腹腔镜下胃造口术在婴幼儿中的应用操作简单、创伤小,术后瘢痕小,更安全、美观,值得推广。Objective To summarize the application of hernia hook needle assisted laparoscopic gastrostomy in infants and to evaluate its clinical safety and efficacy.Methods From January 2018 to January 2021,clinical data were retrospectively reviewed for 12 children(9 boys and 3 girls)undergoing laparoscopic gastrostomy with hernia repair needle.Median age was 113(22-337)days and median body weight(4973±1978)g.Descriptive statistical analysis was utilized for processing the relevant data of age,body weight,operative duration and postoperative complications.Results Foley catheter was inserted in all cases.Median operative duration was(58.8±11.7)min,median postoperative initiating time of enteral feeding(4.0±1.4)days and median full enteral feeding time(12.3±4.0)days.During a postoperative follow-up period of(10-26)months,two children with rash around stoma improved after external application of stoma powder.One child developed gastric outlet obstruction from balloon blockage of pylorus due to tube shifting and the problem was resolved by replacing a gastric feeding tube.In 6 cases,Foley catheter was replaced by low-profile gastrostomy tube.And gastrostomy tube was removed in 8 cases and operative incision healed without surgical repair.The remaining 4 cases were all properly fixed and could rely on gastrostomy tube for enteral nutrition.There was no complications related to gastrostomy.Conclusions Hernia hook needle assisted laparoscopic gastrostomy is a simple and safe technique.With better cosmetics due to minimal scar,it is worth a wider popularization.

关 键 词：胃造口术 腹腔镜 婴幼儿 疝钩针 

分 类 号：R726.5[医药卫生—儿科]