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題名 | Percutaneous Endoscopic Gastrostomy in Children: 15 Cases Experience=孩童的經皮內視鏡胃造瘻術 |
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作者 | 葉庭吉; 楊俊仁; 許錦城; 李宏昌; 林炫沛; 許瓊心; 李燕晉; 邱南昌; 何啟生; | 書刊名 | 臺灣兒科醫學會雜誌 |
卷期 | 44:3 民92.05-06 |
頁次 | 頁135-139+181 |
分類號 | 417.5411 |
關鍵詞 | 經皮內視鏡胃造瘻術; Percutaneous endoscopic gastrostomy; PEG; |
語文 | 英文(English) |
中文摘要 | 引言:封砂患有慢性疾病的孩童,長期鼻胃管鰓食是很常見的。但是亦會有合講症出現,在 1980年,Garderer這位學者發表了新的胃造瘘技术:经皮内视镜胃造瘘術。這種技術比傳統胃造瘘手術花費較少,時間也較少,同時術後也較早進食。方法:從2000年7月2002年9月,我們收集15位病例,平均為8.2歲。這些病例中有粘多醣症第二型,粒腺體疾病,和其他神經疾患。在術前至少禁食8小時,至少一劑,預防性的抗生素。所有過程皆在手術室進行。使用的是Ponsky's pull-through方法,以及20號BARD公司的胃造瘘管,我們評估其術後之併發症及預後。結果:所有病例至少術後禁食24小時。待确定有腸蠕動音以及局部無感染象徵方能進食。使用胃造瘘管進食并無任何困難,或因并發症造成餵食中斷。併發症方面,其中一位有傷口感染,但用抗生素後病情得以控制。有一位則是發生皮膚和胃的瘘管,後來將胃造瘘管移除後,並用抗生素控制感染,其病情才獲得控制。有兩位發生胃食道逆流,必須使用藥物控制。結綸:經皮內視鏡胃瘘術,對於進食困難的孩童是一種簡單且可靠的方法,可以提供長期營養補充,而且照顧上也較為方便。雖然偶有併發症,但大多是可以用藥物控制的。 |
英文摘要 | For long-term tube feeding in children, percutaneous endoscopic gastrostomy (PEG) has the advantages of a short surgical time, early feeding following surgery, and lower rate of complications. From July 2000 to September 2002, we enrolled fifteen children (mean age: 8.2 years old) who underwent PEG placement for long-term nutritional support. Their underlying diseases included mucopolysaccharidosis (MPS) type II severe form, mitochondrial disease, Ehlers-Danlos syndrome associated with Robin sequence, spinal muscular atrophy (SMA) type II, nesidioblastosis, neurofibro mat osis and other neurological disorders. We assessed the complications and outcome in these patients after PEG placement. There were no difficulties in PEG tube-feeding after procedure. One patient had a wound infection at the insertion site which required parenteral antibiotic therapy. Symptomatic gastroesophageal reflux (GER) occurred in two patients and was controlled with medication. One patient developed a gastrocutaneous fistula, requiring surgical removal ofthe PEG tube. One patient underwent laparoscopic gastrojeju nostomy and Nissen fundoplicat ion for persistent vomiting. Two patients with mitoch ondri al disease expired. The oth crc leven devices have continued to function on follow-up. Placement of a PEG is a simple, feasible procedure for children with swallowing dif/Iculty who require long-term nutritional support. Although complications may sometimes occur, in our experience many can be managed conservatively. |
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