经皮透视引导下胃造瘘和胃空肠造瘘术的临床应用

Clinical application of percutaneous gastrostomy and gastrojejunostomy under fluoroscopic guidance

目的评估经皮透视引导下胃造瘘和胃空肠造瘘术的临床应用,探讨影像导引下置管的技术操作及其适应证、禁忌证和并发症。方法回顾性分析2002年5月-2010年6月在我院实施透视引导下胃造瘘和胃空肠造瘘术的40例患者的临床资料。采用Seldinger技术造痿,成功置入饲养管。分析手术指征,操作过程,技术成功率,手术相关并发症和饲养管留置时间。结果经皮透视引导下实施胃造瘘术30例,其中神经系统疾病13例,反复发作性吸入性肺炎6例,胃肠道功能紊乱引起胃食管反流3例,胃大部切除术2例,食管纵隔瘘1例及食管癌5例。经皮透视引导下实施胃空肠造瘘术10例,其中球麻痹3例,恶性十二指肠梗阻4例及外科胃造口术后并发症3例。所有患者均使用2个锚型固定器。技术成功率100%。未发生术中置管相关并发症及术后严重并发症,轻微并发症发生率10%,包括局部软组织感染1例,穿刺部位疼痛1例,胃造瘘管移位1例及胃空肠造瘘管阻塞1例。在随访过程中未出现胃食管反流或吸入性肺炎加重等异常。饲养管留置时间是115～585 d(平均150 d)。结论经皮透视引导下胃造瘘和胃空肠造瘘术是安全,简单,有效的微创治疗,适用于肠内营养支持和胃肠减压。

Objective To evaluate the safety and effectiveness of percutaneous gastrostomy（PRG） and gastrojejunostomy（PRGJ） under fluoroscopic guidance,and to discuss its technical manipulation,the indications and contraindications as well as the complications.Methods During the period from May 2002 to June 2010 in authors＇ hospital fluoroscopically-guided PRG or PRGJ was carried out in 40 patients.The clinical data were retrospectively analyzed.With Seldinger technique and under fluoroscopic guidance,a 14 F radiopaque gastrostomy or gastrojejunostomy feeding catheter was successfully placed.The indications,operation procedures,clinical success rate,procedure-related complications,and tube indwelling time,etc.were discussed and analyzed.Results PRG was conducted in 30 patients.The reasons for performing PRG included neurologic disease（n = 13）,recurrent aspiration pneumonia（n = 6）,gastroesophageal reflux due to disfunction of gastrointestinal tract（n = 3）,subtotal gastrectomy（n = 2）,esophagomediastinal fistula（n = 1） and esophageal carcinoma（n = 5）.PRGJ was carried out in 10 patients.The disorders included bulbar paralysis（n = 3）,malignant duodenal obstruction（n = 4） and previous gastrostomy-related complications（n = 3）.Two anchors were used in all patients receiving PRG or PRGJ.Clinical success was achieved in all study patients.No procedure-related or severe complications occurred.Minor complications were observed in four patients（10%）,which included local soft tissue infection（n = 1）,severe puncture site pain（n = 1）,gastrostomy tube dislodgement（n = 1） and obstruction of gastrojejunostomy tube（n = 1）.During the follow-up period,no aggravation of gastroesophageal reflux or aspiration pneumonia was observed in all patients.The tube indwelling time was 115 to 585 days（mean of 150 days） after tube placement.Conclusion Fluoroscopically-guided percutaneous gastrostomy or gastrojejunostomy is a safe,simple and minimally-invasive technique.This technique is effective and suitable for clinical enteral nutrition support therapy as well as for upper gastrointestinal tract decompression treatment.