PEJ和鼻肠管置管在晚期上消化道恶性肿瘤病人家庭肠内营养的应用

Application of percutaneous endoscopic gastrostomy jejunostomy and naso-intestinal tube in home enteral nutrition in advanced upper-gastrointestinal cancer patients

目的:探讨经皮内镜下胃造口空肠置管术(PEJ)和鼻肠管置管在晚期上消化道恶性肿瘤病人家庭肠内营养(HEN)的应用效果。方法:回顾分析2009年1月至2013年1月,我科收治的未接受剖腹手术的105例病人,其中48例接受PEJ,57例鼻肠管置管晚期上消化道恶性肿瘤病人开展HEN情况,病人每2个月到我科或电话随访1次,直至出院后6个月或病人死亡。比较两种置管方式在HEN中的应用、并发症发生率和病死率等情况。结果:病人出院后6个月内,PEJ组EN支持率明显高于鼻肠管组(95.8%vs 78.9%,P<0.05)。PEJ组的EN相关并发症发生率明显低于鼻肠管组(22.9%vs 45.6%,P<0.05)。PEJ组的管道相关并发症发生率明显低于鼻肠管组(6.3%vs 21.1%,P<0.01)。而出院后2、4和6个月时两组病人的功能状态评分和病死率均无显著性差异(P>0.05)。结论:PEJ是晚期上消化道恶性肿瘤病人开展HEN的有效途径。

Objective： To investigate the application of percutaneous endoscopic gastrostomy jejunostomy（ PEJ） and naso-intestinal tube in home enteral nutrition in advanced upper-gastrointestinal cancer patients. Methods： In the retrospective study,the information about home enteral nutrition and follow-up records of 105 patients with advanced upper-gastrointestinal cancer patients（ 48 patients underwent percutaneous endoscopic jejunostomy,57 patients given naso-intestinal tube） were collected from January 2009 to January 2013,and two ways were compared in home enteral nutrition. Results： The rate of enteral nutrition support within 6 months after discharging in PEJ group was significantly higher than in the naso-intestinal tube（ NIT） group（ 95. 8% vs 78. 9%,P〈0. 05）. Enteral nutrition-related complication rate was significantly lower in PEJ group than in the NIT group（ 22. 9% vs 45. 6%,P〈0. 05）. The morbidity in PEJ group was significantly lower than in the NIT group（ 6. 3% vs 21. 1%,P〈0. 01）. The two groups had no significant difference in mortality（ P≥0. 05）. Conclusion： Percutaneous endoscopic gastrostomy jejunostomy is an effective way to carry out home enteral nutrition in advanced upper gastrointestinal cancer patients.