Pull和Introducer两种经皮内镜下胃造瘘方法的比较

Comparison of pull and introducer percutaneous endoscopic gastrostomy

目的介绍和比较Pull和Introducer两种胃造瘘方法的特点和应用价值。方法对8例连续住院需胃造瘘病人分别施行Pull(5例)和Introducer(3例)经皮内镜下胃造瘘。比较两种方法操作的时间、安全性和并发症。在术后第2～3周,在床边无内镜监视下对Introducer胃造瘘患者更换造瘘管。结果采用两种方法进行胃造瘘均取得了成功。胃造瘘的时间Pull法平均为(17±2.3)min,Introducer法平均为(17±3.6)min。两组均无并发症。对Introducer胃造瘘患者更换胃造瘘管平均用时(5±1.3)min,患者无任何不适。结论Pull和Introducer两种胃造瘘法都是安全的。Introducer法在更换胃营养管时不需要再次内镜监视,特别适于各种原因所致食管上段或咽喉部狭窄的患者。

Objective Percutaneous endoscopic gastrostomy（PEG） is the most common and preferred method for enteral tube placement, in which ＂pull＂ method was widely accepted. Although another method of PEG, ＂introducer＂ method, is less applied, it is proved to be valuable and optimal in some circumstance such as in patients with neck and head malignancies. In this study, both ＂pull＂ and ＂introducer＂ methods of PEG were introduced and compared. Methods Eight consecutive inpatients who needed PEG were given ＂pull＂ or ＂ introducer＂ PEG separately. The procedure time, safety and complications of both methods were compared and evaluated. In 2 - 3 weeks after PEG, PEG tubes in ＂introducer＂ method were changed without endoscopy monitoring. Results PEG was successfully performed in all patients in our group. Five of them in ＂pull＂ method, the other three in ＂introducer＂ method. The average time of the procedure was （17 ± 2.3）minutes in ＂pull＂ method and （17±3.6）minutes in ＂introducer＂ method. No complications happened in all patients. The PEG tubes were changed successfully in 2 - 3 weeks post-procedurally in patients with ＂introducer＂ method, without endoscopy inserting and monitoring. The average time to change PEG tubes took about （5±1.3）minutes; no discomfort was reported during the procedures. Conclusions Both ＂pull＂ and ＂introducer＂ PEG procedures were safe for clinical use. The ＂introducer＂ method was of advantage over ＂pull＂ method in the situation of changing PEG tubes because of endoscopy was unnecessary during the procedure. Hence, it is most recommended to the patients with stenosis in the upper esophagus caused by malignancies, or head and neck tumors.