肠衰竭儿童胃造口管去除后胃皮肤瘘自发闭合的影响因素

　　背景：肠衰竭（IF）儿童通常需要使用胃造口管（GT）来进行长期的营养支持。IF儿科患者长期存在胃皮肤瘘（GCF）的危险因素普遍不知，但可能包括营养状态和导管留置时间两种潜在因素。

　　对象与方法：回顾行GT去除并允许其自发闭合的IF患者病历。利用Wilcoxon秩和检验进行非参数变量分析。利用析因分析确认的GT持续时间最佳阈值进一步通过受试者操作特征曲线来预测其自发闭合的可能性。

　　结果：进行GT去除的59例IF儿童参与了此次试验。其中36例（61%）自发闭合，23例（39%）平均在GT去除后67天时通过手术愈合。在自发闭合组中，GT留置时间明显缩短（11.5比21个月，P=0.002）。其中33例GT留置≤18月，28例（85%）自发闭合，与之对比，在26例GT留置时间＞18月的患者中，仅9例（35%）自发闭合（P＜0.001）。在GCF持续时间超过7天的患者中，仅21%（6/28）自发闭合，但同时GT时间＞18月的只有6%（1/18）。

　　结论：在所评价的危险因素中，只有GT留置时间延长与自发闭合失败的可能性增加有关。GCF持续时间＞7天的同时GT留置时间＞18月的IF儿科患者自发闭合的机率明显较少。在这种情况下应该考虑及早通过手术愈合。

JPEN J Parenter Enteral Nutr. 2015;39(7):860-3.

Factors Affecting Spontaneous Closure of Gastrocutaneous Fistulae After Removal of Gastrostomy Tubes in Children With Intestinal Failure.

Khan FA, Fisher JG, Sparks EA, Iglesias J, Zurakowski D, Modi BP, Duggan C, Jaksic T.

Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.

BACKGROUND: Children with intestinal failure (IF) frequently require gastrostomy tubes (GTs) for long-term nutrition support. Risk factors for persistent gastrocutaneous fistulae (GCFs) in pediatric patients with IF are largely unknown but may include underlying nutrition status and duration of indwelling GT.

MATERIALS AND METHODS: Records of patients with IF having undergone GT removal and allowed a trial at spontaneous closure were reviewed. Nonparametric continuous variables were analyzed using the Wilcoxon rank sum test. Post hoc analysis was performed to identify the optimal threshold of GT duration predicting probability of spontaneous closure identified using receiver operating characteristic curve analysis.

RESULTS: Fifty-nine children with IF undergoing GT removal were identified. Spontaneous closure occurred in 36 (61%) sites, while 23 (39%) underwent operative closure at a median 67 days after GT removal. The duration of indwelling GT was significantly shorter in the spontaneous closure group (11.5 vs 21 months, P = .002). Of 33 GT indwelling for ≤ 18 months, 28 (85%) closed spontaneously, compared with only 9 of 26 (35%) with duration >18 months (P < .001). With GCF persisting beyond 7 days, only 21% (6/28) of sites closed spontaneously, but this dropped to 6% (1/18) of cases with concurrent GT duration >18 months.

CONCLUSIONS: Of the risk factors evaluated, only prolonged GT duration was associated with an increased likelihood of failure to close spontaneously. It is significantly less likely in pediatric patients with IF in whom GCF persists >7 days, particularly if the duration of GT is >18 months. Relatively earlier operative closure should be considered in this group.

KEYWORDS: enteral access; life cycle; neonates; nutrition; pediatrics

PMID: 24993864

PMCID: PMC4625387

DOI: 10.1177/0148607114538058