免疫抑制对儿童胃造口管置入并发症发生率的影响

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2025-04-07 DOI:10.1016/j.jpedsurg.2025.162324

Faraz N. Longi , Michela Carter , Audra J. Reiter , Lav Patel , Mehul V. Raval , Timothy B. Lautz

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引用次数: 0

摘要

免疫抑制儿童易发生术后并发症。本研究的目的是确定在胃造口管（g管）放置时免疫抑制的儿童是否比免疫功能正常的儿童有更高的术后并发症发生率。方法回顾性分析2019年6月- 2022年4月在某大型三级儿童医院行g管置入的≤18岁儿童。将g管放置前≤3个月或放置后≤30天接受化疗或移植后免疫抑制治疗的患者作为免疫抑制组，比较术后30天并发症发生率。对围手术期中性粒细胞减少的免疫抑制患儿进行亚群分析。结果553例患儿中有31例（5.6%）出现免疫抑制。免疫抑制患者年龄较大(中位[IQR] 48[19-156]个月vs. 9[4-31]个月，p <；0.001)。大多数患者接受腹腔镜放置（71.1%）。免疫抑制组有更多的PEG植入(22.6%比4.4%,p <；0.001)。免疫抑制组和免疫正常组30天并发症发生率无差异（29.0% vs 34.5%, p = 0.53）；然而，免疫抑制组的OR复发率更高（9.7%对2.7%,p = 0.03）。高危中性粒细胞减少亚组（n = 13, 41.9%）的亚组分析显示，与非中性粒细胞减少免疫抑制亚组相比，并发症发生率无差异。结论：在免疫抑制患者（包括围手术期中性粒细胞减少患者）中放置g管似乎是安全的，其安全性与在免疫功能正常的儿童中放置g管相当，但30天内返回手术室的比率更高。研究类型治疗研究。证据等级：III级。

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Impact of Immunosuppression on Complication Rates in Pediatric Gastrostomy Tube Placement

Introduction

Immunosuppressed children are vulnerable to post-operative complications. The purpose of this study is to determine if children who are immunosuppressed at gastrostomy tube (G-tube) placement experience higher rates of post-operative complications than children with normal immune function.

Methods

Children ≤18 years-old who underwent G-tube placement at a high-volume tertiary children's hospital between June 2019–April 2022 were retrospectively identified. Patients who received chemotherapy or post-transplantation immunosuppressive therapy ≤3 months before or 30 days after G-tube placement were identified as the immunosuppressed cohort and 30-day postoperative complication rates were compared. Subset analysis was performed for immunosuppressed children who were neutropenic in the perioperative period.

Results

Thirty-one (5.6 %) of 553 children who underwent G-tube placement were immunosuppressed. Immunosuppressed patients were older (median [IQR] 48 [19–156] months vs. 9 [4–31] months, p < 0.001). The majority underwent laparoscopic placement (71.1 %). There were significantly more PEG placements in the immunosuppressed cohort (22.6 % vs. 4.4 %, p < 0.001). There was no difference in 30-day complication rate between the immunosuppressed and immunocompetent cohorts (29.0 % vs. 34.5 %, p = 0.53); however, there was a higher rate of return to OR for the immunosuppressed cohort (9.7 % vs. 2.7 %, p = 0.03). Subset analysis of the high-risk neutropenic subgroup (n = 13, 41.9 %) revealed no difference in complication rates compared to the non-neutropenic immunosuppressed subgroup.

Conclusion

G-tube placement in immunosuppressed patients, including those with perioperative neutropenia, appears to be safe with a comparable safety profile to G-tube placement in children with normal immune function, with the exception of a higher rate of return to the OR within 30 days.

Study type

Treatment study.

Level of evidence

Level III.

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.