经皮穿刺联合内镜下胃造瘘术的临床应用

Clinical application of percutaneous puncture combined with endoscopic gastrostomy

目的探讨经皮穿刺内镜下胃造瘘术(percutaneous endoscopic gastrostomy,PEG)的临床应用价值。方法 2003年5月～2010年5月,因各种原因造成的经口进食困难引起营养不良需长期营养支持的患者66例,在本院内镜中心行PEG,术后给予肠内营养。结果所有患者成功完成内镜下胃造瘘术,平均耗时20min。术后跟踪随访,所有患者造瘘管置入后营养迅速恢复,停止静脉补液。造瘘管最长留置时间2年。5例患者发生造瘘管周围皮肤感染,6例出现反流性食管炎,2例发生造瘘管旁渗血,对症处理后治愈。无消化道出血、腹膜炎等严重并发症。结论 PEG是作为胃肠减压和肠内营养替代鼻饲的一种新的治疗方法 ,其技术操作简单易行、安全、有效并发症少,创伤小,值得临床推广应用。

Objective To investigate the clinical effect on percutaneous puncture combined with endoscopic gastrostomy.Methods Sixty-six malnutrition cases with transoral feeding difficulty caused by various causes were required to long tern nutritive support,which these patients underwent percutaneous puncture combined with endoscopic gastrostomy and enteral nutrition were given after operation.Results All cases underwent percutaneous puncture combined with endoscopic gastrostomy successfully.Average operative time was 20 minutes.The nutritive states of all cases were restored promptly after placing gastrostomy tube and fluid infusions were stopped.The time of longest placing gastrostomy tube was two years.The skin infection of peri-gastrostomy tube,reflux esophagitis and oozing of blood of para-gastrostomy tube were found in 5,6 and 2 cases respectively.All postoperative complications were cured after expectant treatment.No hemorrhage and perforation of digestive tract were found.Conclusion Percutaneous puncture combined with endoscopic gastrostomy possesses simplified manipulation,safty,few-complications,less trauma,lower medical cost and a good efficacy.Therefore,it is a new therapeutic method served as gastrointestinal decompression and enteral nutrition to replace naso-feeding.