经皮内镜下胃造瘘术和胃空肠造瘘术在危重患者中的临床应用

Clinical application of percutaneous endoscopic gastrostomy and percutaneous endoscopic jejunostomy in critically illed patients

目的评估经皮内镜引导下胃造瘘和胃空肠造瘘术的临床应用,探讨经皮内镜引导下胃造瘘和胃空肠造瘘术的技术操作要点及适应证、禁忌证和并发症。方法回顾性分析2009年12月～2011年3月在该院对20例患者成功实施经皮内镜引导下胃造瘘术(PEG)及经皮内镜引导下胃空肠造瘘术(PEJ)的临床资料。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。结果经皮内镜引导下实施胃造瘘和胃空肠造瘘术20例,其中脑外伤12例,球麻痹2例,食管癌1例,反复发作的吸入性肺炎2例,食管-纵膈瘘2例,恶性十二指肠梗阻1例。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,发生1例胃造瘘管移位。结论经皮内镜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,适用于营养支持和胃肠减压。

[Objective] To evaluate the safety and effectiveness of percutaneous gastrostomy（PEG） and percutaneous endoscopic jejunostomy（PEJ） under fluoroscopic guidance and to discuss its technical manipulation the indications and contraindications as well as the complications.[Methods] During the period from 2009 to 2010 in our hospital fluoroscopically-guided PEG or PEJ was carried out in 40 patients.The clinical data were retrospectively analyzed.The indications operation procedures,clinical success rate,procedure-related complications and tube indwelling time etc.were discussed and analyzed.[Results] PEG or PEJ was conducted in 20 patients.The reasons for performing PEG or PEJ included brain trauma（n=12）,bulbar paralysis（n=2）,esophageal cancer（n=1）,recurrent aspiration pneumonia（n=2）,esophagomediastinal fistula（n=2） and malignant duodenal obstruction（n=1）.Clinical success was achieved in all study patients.No procedure-related or severe complications occurred.Just patient one experienced gastrostomy tube dislodgement.[Conclusion] PEG or PEJ 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.