头颈部恶性肿瘤致吞咽困难患者行透视下经皮胃造瘘术的护理

The nursing care for patients receiving percutaneous fluoroscopy-guided gastrostomy for treatment of dysphagia caused by head and neck cancer

目的探讨头颈部恶性肿瘤致吞咽困难患者行透视下经皮胃造瘘术(PFG)的护理方法。方法选择15例因头颈部恶性肿瘤导致无法进食、胃肠功能仍存在、需依赖静脉营养、行PFG手术患者,术前给予充分准备和心理护理,术后给予全面周到的护理,严密观察病情变化,预防各种并发症。结果15例患者均造口成功,术后1例发生胃出血,1例发生造瘘口周围感染,2例发生脱管,经处理后恢复正常。其余患者未发生并发症。15例患者术后均摆脱静脉内营养,行肠内营养支持治疗,明显提高生活质量。结论 PFG具有操作简单、创伤小、并发症少等优点,为头颈部恶性肿瘤致吞咽困难患者提供了一个肠内营养支持治疗的新途径,良好的心理护理、术前充分准备、术后全面周到的护理和出院指导是保证PFG成功的重要条件。

Objective To discuss the nursing management for patients receiving percutaneous fluoroscopy - guided gastrostomy （PFG） for the treatment of dysphagia caused by head and neck cancer. Methods A total of 15 patients with dysphagia caused by head and neck cancer received PFG. Before PFG sufficient preparation and psychological nursing care were carried out for all the 15 patients. After the operation the patients were kept under close observation for any changes in his or her clinical conditions. Proper prevention measures against complications were adopted. Results PFG procedure was successfully accomplished in all 15 patients. Postoperative complications included gastric bleeding （n = 1）, stoma infection （n = 1） and proctoptosis （n = 2）, and the disorders were recovered after clinical management. After PFG intravenous nutrition was no longer employed in all patients, and enteral nutrition was conducted. The quality of life was significantly improved in all patients. Conclusion PFG is technically - simple and minimally- invasive with fewer complications. This technique provides a new way to give enteral nutrition for patients with dysphagia caused by head and neck cancer. Excellent psychological nursing, sufficient preoperative preparation, comprehensive postoperative nursing care and medical advices at the time of discharge are the key points to ensure a successful PFG.