经数字减影血管造影(DSA)联合超滑导丝引导的鼻空肠营养管放置术-困难置管的解决方案

A new approach to placing nasal-jejunum nutrition tube using digital subtraction angiography (DSA) in cases with difficulty

目的:将经DSA联合超滑导丝引导放置空肠营养管的方法,与经鼻胃镜联合超滑导丝和经胃肠造影机联合超滑导丝引导的方法进行比较,探讨针对上消化道存在明显狭窄和有胃肠改道手术等困难置管病人的价值。方法:回顾性分析2009年6月至2018年1月间空肠营养管放置困难的96例病人,将96例病人全部纳入A组,均经鼻胃镜联合超滑导丝引导放置空肠营养管;将A组中置管失败的69例病人纳入B组,改行经胃肠造影机联合超滑导丝引导放置;将B组中置管失败的20例病人纳入C组,改行经DSA联合超滑导丝引导放置;对3组的置管成功率,置管过程、置管时间、麻醉方式、联合留置胃管成功率和并发症发生率进行对比分析。结果:经DSA联合超滑导丝引导放置空肠营养管的方法较经鼻胃镜联合超滑导丝引导或经胃肠造影机联合超滑导丝引导的方法困难置管成功率明显提高(P<0.05),且经DSA联合超滑导丝引导放置的方法可单人完成,操作简单,不需静脉麻醉,操作时间一般在(30±5)min;较经鼻胃镜联合超滑导丝引导的方法操作时间缩短(15±5)min,联合留置胃管成功率明显提高(P<0.05),并发症发生率明显降低(P<0.05);较经胃肠造影机联合超滑导丝引导的方法操作时间缩短(10±5)分钟,联合留置胃管成功率与并发症发生率无明显差异(P>0.05)。结论:经DSA联合超滑导丝引导的方法因对上消化道存在明显狭窄和有胃肠改道手术等困难置管病人的置管成功率明显提高,是一种更具优势的空肠营养管放置方法,但因资源有限,成本昂贵,医护人员及病人辐射危害等原因,目前仍不能常规替代经鼻胃镜联合超滑导丝引导或经胃肠造影机联合超滑导丝引导的放置方法,可作为困难置管的替代方法。

Objective:To evaluate the efficacy and feasibility of placing nasal-jejunum nutrition tube using digital subtraction angiography (DSA)in patients suffering from severe,stricture of upper gastrointestinal tract or gastrointestinal surgical history.Methods:From June 2009 to January 2018,96 cases of patients who required nasal-jejunum nutrition tube with difficulty of catheterization were firstly given endoscopic catheter under the Canalizer guide in group A.And those 69.failure cases in Group A were enrolled into Group B with alternative tube procedure under gastrointestinal contrast imaging orientation.Lastly,20 cases Group B who failed to gastrointestinal contrast imaging were enrolled in Group C with alternative tube procedure using DSA orientation.Successful catheter rate,duration of catheter,average anesthetic time,success rate of united tabulation,and complication rate were evaluated among 3 groups.Results: Placing nasal-jejunum nutrition tube using DSA has significant advantages including the success rate of difficult intubation and being a single and simple procedure without anesthetics.The mean duration is around (30±5)minutes which is shorter than that of endoscopic group (P <0.05).No significant difference in complication and success rate was found between 2 groups (P <0.05).Conclusion:Placing of nasal-jejunum tube using DSA in combination with Canalizer guide is an effective and safe procedure for patients who suffering from stricture of upper gastrointestinal tract or who has history of gastrointestinal.surgery.However,due to the limited clinical application,it could only an alternative to endoscopic procedure.