한국임상수의학회지 (Journal of Veterinary Clinics)

  • 제32권1호
  • /
  • Pages.28-35
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  • 2015
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  • 1598-298X(pISSN)
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  • 2384-0749(eISSN)
한국임상수의학회 (The Korean Society of Veterinary Clinics)
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비글견에서 복강경을 이용한 위관삽입술의 유용성 평가 연구

Feasibility Study of Laparoscopic Gastrostomy Tube Placement in Beagle Dogs

  • 이재웅 (충남대학교 수의과대학.동물의과학연구소) ;
  • 박지영 (충남대학교 수의과대학.동물의과학연구소) ;
  • 이해범 (충남대학교 수의과대학.동물의과학연구소) ;
  • 정성목 (충남대학교 수의과대학.동물의과학연구소)
  • Lee, Jae-Woong (College of Veterinary Medicine, Research of Veterinary Medicine, Chungnam National University) ;
  • Park, Ji Young (College of Veterinary Medicine, Research of Veterinary Medicine, Chungnam National University) ;
  • Lee, Hae-Beom (College of Veterinary Medicine, Research of Veterinary Medicine, Chungnam National University) ;
  • Jeong, Seong Mok (College of Veterinary Medicine, Research of Veterinary Medicine, Chungnam National University)
  • 심사 : 2015.02.14
  • 발행 : 2015.02.28
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초록

본 연구는 개에서 복강경 위관삽입술(LG)을 시행, 수술시간, 합병증, 유착부를 평가하여 수의분야에서 LG의 유용성을 내시경 유도하 경피 위관삽입술(PEG)에 준하여 확인하였다. 정상 비글견 8마리를 두 군으로 나누어 Tri-Funnel Replacement Gastrostomy tube (Bard Inc., USA, 20 Fr.)와 PEG kit (Ponsky "Pull" PEG Kit$^{(R)}$, Bard Inc., USA, 20 Fr.)를 이용하여 LG 및 PEG를 실시하였다. 위관을 통한 영양 공급은 유지 열량 요구량(MER)을 1일 3회로 나누어 2주간 진행하고 LG와 PEG의 수술 중, 수술 후, 사후로 나누어 평가하였다. 모든 개체에서 위관삽입은 성공적이었고, PEG 군에서의 평균 수술 시간이 LG군에 비해 유의적으로 짧았다(p < 0.05). 위-복막간 유착은 군간 모든 개체에서 양호하게 형성되었으나 평균 유착 길이(AL)와 너비(AW)의 수치가 LG군에서 PEG군에 비해 유의하게 높았다 (p < 0.05). 평균 유착 거리(AD)는 군간 차이를 보이지 않았다(p = 0.182). 본 연구를 통해 개에서 LG는 최소 침습적이면서 쉽고 안전하게, 그리고 효과적으로 장관 영양 공급을 실시할 수 있는 방법임이 확인되었다.

Aim of this study is demonstrate the feasibility of Laparoscopic gastrostomy (LG) tube placement in dogs by comparing with percutaneous endoscopic gastrostomy (PEG) tube placement, based on operative time, complications and gastro-peritoneal adhesion evaluation. Eight intact male beagle dogs were used in this study. Tri-Funnel Replacement Gastrostomy tube (Bard Inc., USA) of 20 Fr was used for LG technique and PEG kit (Ponsky "Pull" PEG Kit$^{(R)}$, Bard Inc., USA) with soft silicone retention dome consisting of a 20 Fr gastrostomy tube was used. Feeding via gastrostomy tube was performed in two weeks, maintenance energy requirement (MER) divided into 3 separate feeding. LG and PEG were evaluated at intraoperative, postoperative and postmortem period. Mean operative time for the PEG group was significantly shorter when compared with the LG group (p < 0.05). Successful maintenance of gastrostomy tube was confirmed in all dogs. Gastric and peritoneal wall adhesions were formed successfully in each group. The mean adhesion length (AL) and width (AW) were significantly larger in LG group compared with in PEG group (p < 0.05). The mean adhesion distance (AD) was not significantly different between two groups (p = 0.182). Consequently, LG is an effective minimally invasive, safe and easy to perform technique for providing enteral nutritional support in dogs.

키워드

참고문헌

  1. Abood S, Buffington C. Enteral feeding of dogs and cats: 51 cases (1989-1991). J Am Vet Med Assoc 1992; 201: 619-622.
  2. Akay B, Capizzani TR, Lee AM, Drongowski RA, Geiger JD, Hirschl RB, Mychaliska GB. Gastrostomy tube placement in infants and children: is there a preferred technique? J Pediatr Surg 2010; 45: 1147-1152. https://doi.org/10.1016/j.jpedsurg.2010.02.079
  3. Antonoff MB, Hess DJ, Saltzman DA, Acton RD. Modified approach to laparoscopic gastrostomy tube placement minimizes complications. Pediatr Surg Int 2009; 25: 349-353. https://doi.org/10.1007/s00383-009-2340-z
  4. Aprahamian CJ, Morgan TL, Harmon CM, Georgeson KE, Barnhart DC. U-stitch laparoscopic gastrostomy technique has a low rate of complications and allows primary button placement: experience with 461 pediatric procedures. J Laparoendosc Adv Surg Tech A 2006; 16: 643-649. https://doi.org/10.1089/lap.2006.16.643
  5. Armstrong PJ, Hardie EM. Percutaneous endoscopic gastrostomy. J Vet Intern Med 1990; 4: 202-206. https://doi.org/10.1111/j.1939-1676.1990.tb00898.x
  6. Bankhead RR, Fisher CA, Rolandelli RH. Gastrostomy tube placement outcomes: comparison of surgical, endoscopic, and laparoscopic methods. Nutr Clin Pract 2005; 20: 607-612. https://doi.org/10.1177/0115426505020006607
  7. Bright R. Percutaneous endoscopic gastrostomy. Vet Clin North Am Small Anim Pract 1993; 23: 531-545. https://doi.org/10.1016/S0195-5616(93)50303-0
  8. Crane SW. Placement and maintenance of a temporary feeding tube gastrostomy in the dog and cat. Compend Contin Educ Pract Vet 1980; 11: 770-776.
  9. Crowe D. Nutritional support for the hospitalized patient: an introduction to tube feeding. Compend Contin Educ Vet 1990; 12: 1711-1721.
  10. Dempsey D, Mullen J, Buzby G. The link between nutritional status and clinical outcome: can nutritional intervention modify it? Am J Clin Nutr 1988; 47: 352-356. https://doi.org/10.1093/ajcn/47.2.352
  11. Devitt C, Seim H. Clinical evaluation of tube esophagostomy in small animals. J Am Anim Hosp Assoc 1997; 33: 55-60. https://doi.org/10.5326/15473317-33-1-55
  12. Gauderer MW, Ponsky JL, Izant RJ. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 1980; 15: 872-875. https://doi.org/10.1016/S0022-3468(80)80296-X
  13. Giner M, Laviano A, Meguid MM, Gleason JR. In 1995 a correlation between malnutrition and poor outcome in critically ill patients still exists. Nutrition 1996; 12: 23-29. https://doi.org/10.1016/0899-9007(95)00015-1
  14. Hewitt SA, Brisson BA, Sinclair MD, Foster RA, Swayne S-L. Evaluation of laparoscopic-assisted placement of jejunostomy feeding tubes in dogs. J Am Vet Med Assoc 2004; 225: 65-71. https://doi.org/10.2460/javma.2004.225.65
  15. Ireland LM, Hohenhaus AE, Broussard JD, Weissman BL. A comparison of owner management and complications in 67 cats with esophagostomy and percutaneous endoscopic gastrostomy feeding tubes. J Am Anim Hosp Assoc 2003; 39: 241-246. https://doi.org/10.5326/0390241
  16. Jergens AE, Morrison JA, Miles KG, Silverman WB. Percutaneous endoscopic gastrojejunostomy tube placement in healthy dogs and cats. J Vet Intern Med 2007; 21: 18-24. https://doi.org/10.1111/j.1939-1676.2007.tb02923.x
  17. Khattak I, Kimber C, Kiely E, Spitz L. Percutaneous endoscopic gastrostomy in paediatric practice: complications and outcome. J Pediatr Surg 1998; 33: 67-72. https://doi.org/10.1016/S0022-3468(98)90364-5
  18. Kirby DF, Craig RM, Tsang T-K, Plotnick BH. Percutaneous endoscopic gastrostomies: a prospective evaluation and review of the literature. JPEN J Parenter Enteral Nutr 1986; 10: 155-159. https://doi.org/10.1177/0148607186010002155
  19. Lantz M, Hultin Larsson H, Arnbjornsson E. Literature review comparing laparoscopic and percutaneous endoscopic gastrostomies in a pediatric population. Int J Pediatr 2010; doi: 10.1155/2010/507616
  20. Loser C, Aschl G, Hebuterne X, Mathus-Vliegen E, Muscaritoli M, Niv Y, Rollins H, Singer P, Skelly R. ESPEN guidelines on artificial enteral nutrition-percutaneous endoscopic gastrostomy (PEG). Clin Nutr 2005; 24: 848-861. https://doi.org/10.1016/j.clnu.2005.06.013
  21. Marks SL. The principles and practical application of enteral nutrition. Vet Clin North Am Small Anim Pract 1998; 28: 677-708. https://doi.org/10.1016/S0195-5616(98)50062-9
  22. Mauterer J. Endoscopic and nonendoscopic percutaneous gastrostomy tube placement. In: Kirk's Current Veterinary Therapy XII Small Animal Practice, 12th ed. Philadelphia: WB Saunders. 1995: 669-674.
  23. Rabeneck L, McCullough LB, Wray NP. Ethically justified, clinically comprehensive guidelines for percutaneous endoscopic gastrostomy tube placement. Lancet 1997; 349: 496-498. https://doi.org/10.1016/S0140-6736(96)07369-2
  24. Rothenberg S, Bealer J, Chang J. Primary laparoscopic placement of gastrostomy buttons for feeding tubes. Surg Endosc 1999; 13: 995-997. https://doi.org/10.1007/s004649901154
  25. Waschak MJ1, Payne JT, Pope ER, Jones BD, Wagner-Mann CC. Evaluation of percutaneous gastrostomy as a technique for permanent gastropexy. Vet Surg 1997; 26: 235-241. https://doi.org/10.1111/j.1532-950X.1997.tb01491.x
  26. Yoshimoto SK, Marks SL, Struble AL, Riel DL. Owner experiences and complications with home use of a replacement low profile gastrostomy device for long-term enteral feeding in dogs. Can Vet J 2006; 47: 144-150.
  27. Zamakhshary M, Jamal M, Blair GK, Murphy JJ, Webber EM, Skarsgard ED. Laparoscopic vs percutaneous endoscopic gastrostomy tube insertion: a new pediatric gold standard? J Pediatr Surg 2005; 40: 859-862. https://doi.org/10.1016/j.jpedsurg.2005.02.001