经皮穿刺胃造瘘和胃空肠造瘘术

Percutaneous gastrostomy and gastrojejunostomy under fluoroscopic guidance

目的探讨透视引导下经皮穿刺胃造瘘术(PG)和胃空肠造瘘术(PGJ)的可行性和安全性.方法23例吞咽困难的患者.上段食管癌10例,中段食管癌1例,咽部癌6例,球麻痹2例,脑转移瘤4例.采用美国Cook公司生产的Marx-cope PGJ套装.先经鼻饲管经鼻或经口途径置入导管后注入气体800～1000 ml,至胃腔明显扩张.然后在透视引导下采用Seldinger技术将PG饲管置入胃腔内,或将PGJ饲管经胃腔、十二指肠置入空肠内.术后严密观察腹部症状和体征.随访饲管使用情况.结果23例患者均成功完成PG术,技术成功率为100%.其中将饲管置入空肠内13例,均成功.术后出现上腹部疼痛1例,造瘘口周围感染1例,经处理后均痊愈.1例于术后第2天,因胃内容物反流出现窒息死亡.随访期间经饲管给予顺利.恶性肿瘤患者18例死亡,另3例仍在随访中,中位生存期为6.5个月.球麻痹患者1例更换新的PG饲管,另1例失访.结论透视引导下PG和PGJ术,成功率高,并发症少,是建立长期胃肠内营养的良好途径.

Objective To evaluate the feasibility and safety of fluosocopically guided percutaneous gastrostomy （PG） and gastrojejunostomy （PGJ）. Methods Twenty-three patients with swallowing disorders （15 men,8 women; age range 54-78 years; mean 64 years） were performed pereutaneous PG and PGJ. The PG tubes （Marx-cope PGJ set ; Cook ） were successfully placed in 23 patients and the PGJ tubes were accomplished in 13 patients. Results The 23 patients had technically successful placement of PG tubes （ n = 23） and PGJ tubes （ n =13）. The technical success rates were both 100% . The times for performing procedures and fluroscopy were 30-90min （mean 60 min） and 5-10 min （mean 5.5 min）, respectively. Regurgitation of gastric content occurred in 1 patient with PG tubes 2 days after procedure and the patient died due to apnea. Upper abdominal pain occurred in 1 patient and peri-tube infection in another after operation, both were successfully treated with oral antibiotics. The tubes sustained safely during follow up period （1 -16 months, mean 6）. Conclusions Pereutaneous approach of fluoroscopically guided PG and PGJ are safe and feasible. （J Intervent Radiol, 2005,14：394-397. ）