目标:广泛肠切除术后,许多短肠综合征(SBS)患儿常规接受胃造瘘管(G管)喂养.这种营养途径旨在适应与SBS相关的胃和小肠运动障碍,促进断奶肠外营养(PN)实现肠内自主(EA)。这项研究的目的是研究胃造口术喂养对SBS患儿预后的影响。
方法:在我们的多学科肠道康复中心管理的所有SBS儿童的回顾性队列,作为肠道康复计划的一部分。SBS被定义为广泛肠切除术后超过六周的PN依赖性。在PN持续时间方面,将接受G管喂养的患者与未接受G管喂养的患者进行比较,到达EA,身体发育,和手术参数。
结果:纳入了2003年至2022年间诊断的36例SBS患者。最常见的病因包括先天性肠闭锁(31%)和坏死性小肠结肠炎(25%)。SBS-G管(A组)包含20名儿童,SBS(B组)包含16名儿童。共有21名儿童达到EA(58%);A组10名(50%),B组11例(69%)(p>0.05)。在EA患者中,A组平均PN持续时间为49±44个月,B组24±33个月(p>0.05)。与PN依赖性患者相比,达到EA的患者的残余小肠长22%(p=0.003)。然而,根据残余小肠和大肠长度和百分比调整结果,残留的回盲瓣,和结肠连续性,组间没有差异。A组三分之二的儿童报告了G管相关并发症(机械性,出血,或感染)。我们没有发现两组之间的平均身高和体重百分位数差异(p>0.05)。
结论:我们没有发现胃造口术喂养在达到EA方面的显著优势。因为这个手术有手术和机械并发症,需要进一步的前瞻性研究来确定G管与SBS儿童的相关性.
OBJECTIVE: Following extensive bowel resection, many children with short bowel syndrome (SBS) are routinely offered a placement of gastrostomy tube (G-tube) for feeding. This nutritional pathway is aimed to accommodate the gastric and small bowel motor disturbances related to SBS, and to promote weaning off parenteral nutrition (PN) to achieve enteral autonomy (EA). The aim of this study was to investigate the effect of gastrostomy feeding in outcomes of children with SBS.
METHODS: A retrospective cohort of all SBS children managed at our multidisciplinary Intestinal Rehabilitation Center as part of an Intestinal Rehabilitation Program. SBS was defined as PN dependence for more than six weeks following extensive bowel resection. Patients treated with G-tube feeding were compared with patients without G-tube in terms of PN duration, reaching EA, physical development, and surgical parameters.
RESULTS: A total of 36 SBS patients diagnosed between 2003 and 2022 were included. The most common etiologies included congenital intestinal atresia (31%) and necrotizing enterocolitis (25%). SBS-G-tube (group A) contained 20 children, and SBS (group B) contained 16 children. A total of 21 children reached EA (58%); ten from group A (50%), and 11 from group B (69%) (p > 0.05). Within EA patients, mean PN duration was 49 ± 44 months in group A, and 24 ± 33 months in group B (p > 0.05). Patients who reached EA had 22% longer residual small bowel when compared with PN-dependent patients (p = 0.003). However, the outcomes were adjusted for residual small and large bowel length and percentages, a residual ileocecal valve, and a colon in continuity with no differences between the groups. Two-thirds of children from group A reported G-tube related complications (mechanical, bleeding, or infections). We did not find differences in mean height and weight percentiles between the groups (p > 0.05).
CONCLUSIONS: We did not find significant advantage of gastrostomy feeding in reaching EA. Because there are surgical and mechanical complications related to this procedure, further prospective studies are required to determine G-tube relevance for children with SBS.