经皮胃造瘘术治疗肌萎缩侧索硬化症吞咽困难51例

Percutaneous radiologic gastrostomy for the treatment of dysphagia associated with amyotrophic lateral sclerosis:preliminary results in 51 cases

目的评价X线下经皮胃造瘘术(PRG)在51例肌萎缩侧索硬化症(ALS)吞咽困难患者中的临床应用,评估PRG对肺功能不全ALS患者的安全性及营养状况的改善作用。方法回顾性分析51例行PRG手术的ALS患者。记录手术成功率,观察术后并发症情况。术后对患者进行定期随访,记录患者长期并发症及术后1、3、6个月病死率,评估术后营养状况的改变。结果为51例ALS患者行PRG手术,手术成功率100%。7例患者(13.7%)出现轻微并发症,出现1例(2.0%)大出血严重并发症,术后未发现患者呼吸功能受损情况。术后1、3个月无患者死亡,术后6个月死亡3例(6.8%,3/44)。术后1个月31例患者体重增加超过1 kg,平均BMI从术前18.60±2.14增加到19.27±1.81(术后1个月)、19.17±1.93(术后3个月)和18.89±2.33(术后6个月)。结论 PRG无需胃镜和麻醉,降低了肺功能差的ALS患者的经皮胃造瘘术的误吸窒息风险,提高了手术成功率和安全性,是保证肺功能不全ALS患者足够的能量摄入、改善患者营养状况的有效手段之一。

Objective To discuss the clinical application of percutaneous radiologic gastrostomy （PRG） in treating dysphagia associated with amyotrophic lateral sclerosis （ALS）, and to evaluate its safety and improvement effect on patient＇s nutritional status in ALS patients with pulmonary insufficiency. Methods The clinical data of 51 ALS patients who received PRG were retrospectively analyzed. The success rate of surgery and postoperative complications were recorded. All patients were regularly followed up, and the long- term complications as well as the one-, 3- and 6-month mortality rates after the surgery were documented. The improvement of patient＇s nutritional status was evaluated. Results PRG was successfully accomplished in all 51 patients, the technical success rate was 100%. Mild postoperative complications occurred in 7 patients （13.73%） and severe massive hemorrhage in one patient （2.0%）. After PRG, no signs or symptoms of impaired respiratory function were observed. No death occurred in one month and in 3 months after PRG. Six months after PRG, three patients died（6.8 %, 3/44）. One month after PRG, 31 patients had an increase in body weight of more than 1 kg, and the mean BMI was increased from preoperative 18.60±2.14 to postoperative 19.27±1.81 （one month after PRG）, 19.17±1.93 （3 month after PRG） and 18.89±2.33 （6 month after PRG）. Conclusion For the performance of PRG no gastroscopy or anesthesia is needed, thus, the risk of aspiration asphyxia can be reduced in ALS patients complicated by pulmonary insufficiency and the success rate as well as the safety can be improved. Therefore, this technique is an effective means to ensure that the ALS patients with pulmonary insufficiency can get adequate energy intake to improve their nutritional statns.（J Intervent Radiol, 2017, 26： 147-152）