X线引导下经皮胃造瘘术和鼻-胃营养管置入术的疗效比较

Fluoroscopy-guided percutaneous gastrostomy and nasogastric feeding tube placement:comparison of the clinical effect

目的探讨X线引导下经皮胃造瘘术和鼻-胃营养管置入术的临床疗效和安全性。方法回顾性分析67例吞咽困难患者,其中喉癌14例,食管-纵隔瘘18例,颈段食管癌35例。22例行X线引导下经皮胃造瘘术,45例行X线引导下鼻-胃营养管置入术。结果所有患者均成功实施介入治疗,技术成功率为100%。术后8 d、1个月两组患者的血清白蛋白、前白蛋白和淋巴细胞计数较术前明显升高(P<0.05)。术后1、3个月两组患者的体重及生活质量较术前明显提升(P<0.05)。术后1个月胃造瘘组的血清白蛋白和生活质量明显高于鼻-胃营养管置入组(P<0.05)。术后两组的总并发症发生率差异无统计学意义(P>0.05)。胃造瘘组的治疗费用为鼻-胃营养管置入组的2.6倍。结论 X线引导下经皮胃造瘘术和营养管置入术均可改善患者的营养状况,且安全、有效,胃造瘘术的临床疗效优于营养管置入术,但费用较昂贵。

Objective To investigate the clinical effect and safety of fluoroscopy- guided percutaneous gastrostomy and nasogastric feeding tube placement. Methods The clinical data of sixty-seven patients with dysphagia were retrospectively analyzed. The primary diseases included laryngocarcinoma （n = 14）, esophagomediastinal fistula （n = 18） and cervical esophageal carcinoma （n = 35）. Twenty-two patients underwent fluoroscopy- guided percutaneous gastrostomy （group G） and forty- five patients received fluoroscopy-guided nasogastric feeding tube placement （group N）. The resuhs were analyzed and compared between the two methods. Results The interventional therapy was successfully accomplished in all patients with a technical success rate of 100%. In both groups, the levels of the serum albumin （ALB）, prealbumin （PA） and total lymphocyte count （TLC） determined at 8 days and one month after the procedure were significantly higher than those determined before the therapy （P 〈 0.05）. One and three months after the treatment, the patient＇s body weight was significantly increased and the living quality was significantly improved when compared to those evaluated before the treatment （P 〈 0.05）. One month after the operation, The level of the ALB and the quality of life of the patients in group G were significantly better than those of the patients in group N （P 〈 0.05）. No statistically significant difference in the incidence of postoperative complications existed between the two groups （P 〉 0.05）. The medical expense of pereutaneous gastrostomy was about 2.6 times of that of nasogastric feeding tube placement. Conclusion Both percutaneous gastrostomy and nasogastric feeding tube placement, which are performed under fluoroscopic guidance, are clinically safe and effective, both of them can improve patient＇s nutrition state. However, the gastrostomy is superior to nasogastric feeding tube placement in clinical effectiveness,ahhough the expense of gastrostomy is higher than that of nasogastric feeding tube placement.