两种内镜下胃造瘘方法的比较研究

Comparison of pull and introducer percutaneous endoscopic gastrostomies

目的比较目前两种常用的内镜下胃造瘘方法,探寻并发症更少、操作更方便的胃造瘘方法。方法回顾分析2006年8月～2010年6月在该院进行内镜下胃造瘘术患者90例,采用Pull法46例,采用In-troducer法44例。进行胃造瘘患者中,神志清醒者40例,神志不清者50例,所有进行胃造瘘患者术前均禁食8h,操作时患者取卧位,头偏向左侧,通过比较两种胃造瘘方法时的操作时间、患者耐受性(仅对于神志清醒患者)及并发症,随访90d,观察两种操作方法的造瘘管更换率。结果所有患者均成功地实施了胃造瘘术,采用Pull法造瘘的平均时间为(20±2.2)min,采用Introducer法平均时间为(18±1.3)min,72%患者术后认为难以忍受Pull法,14%的患者认为采用Introducer法难以忍受。Pull法发生并发症8例,其中气腹4例,造瘘口感染4例。Introducer法未发生并发症,随访90d,Introducer法有5例更换了造瘘管,造瘘管更换率高于Pull法。结论采用Introducer法进行胃造瘘操作时间短,患者耐受性高,术后并发症发生率低,特别适用于食管、贲门存在狭窄的患者,采用Pull法造瘘管更换率低,更为经济。

[Objective] To compare two common methods in PEG：Pull method and Introducer method.[Methods] Ninety patients（58 males and 32 females）,median age 48 years（range 32～78 years）,who were performed PEG between Aug 2006 and Jun 2010 were enrolled in this study,among that 46 patients were given PEG by the Pull method and 44 patients were given PEG by the Introducer method.50 patients in obnubilation were included in this study.The procedure time,safety and complications of both methods were compared and valuated,and tolerance rate was also compared in the two groups among the conscious patients.The long-term outcome measure was the rate of catheter replacement within 90 days of the PEG procedure.[Results] PEG placement was successful in all patients in this study.The average time of the procedure was（20±2.2） minutes in Pull method group and（18±1.3） minutes in Introducer method group.72% and 14%conscious patients considered a bad tolerance in Pull method group and Introducer method group respectively.There were 8 complications in Pull method group including 4 cases of pneumoperitoneum and 4 cases of peristomal infection,while there were no complications in Introduce method group.The rate catheter replacement was higher in Introducer method group than the Pull method group.[Conclusions] The PEG performed by the introducer method has short procedure time,high safety,well tolerance and lower complication rate and it is suitable for the patients with stenosis in the upper esophagus caused by malignant neoplasia,or head and neck tumors.Pull method group has the lower catheter replacement rate.it is the economic method in PEG.