预防性经皮内镜胃造瘘术在接受放化疗的头颈部肿瘤患者中的应用

Prophylactic percutaneous endoscopic gastrostomy in patients with head and neck cancer undergoing radiotherapy and chemotherapy

目的 :探讨拟接受放化疗头颈肿瘤患者胃造瘘的时机。方法 :回顾分析2016年1月—12月间接受放化疗的头颈肿瘤患者,由放疗科医师根据营养风险评估,估计存在营养障碍问题,拟行经皮内镜胃造瘘术(PEG),分为放化疗前预防性胃造瘘组(预防性PEG组)和放化疗期间胃造瘘组(反应性PEG组),其中预防性PEG组234例,反应性PEG组93例。检测2组患者置管前、后的体重、白蛋白水平,计算并比较置管前、后BMI及白蛋白变化程度;观察2组患者耐管及创面感染情况,比较2组放疗结束后拔管率的变化。采用SPSS 11.5软件包对2组患者的数据进行团体t检验和χ2检验。结果:放化疗结束后,预防性PEG组BMI、白蛋白值及拔管率均显著高于反应性PEG组(P<0.01),而预防性PEG组的感染率显著低于被动性PEG组(P<0.05)。结论 :预防性PEG术能改善头颈部肿瘤患者接受放化疗后的营养状况,减轻放化疗引起的并发症。

PURPOSE： To investigate the timing of percutaneous endoscopic gastrostomy（PEG） in patients with head and neck cancer undergoing radiotherapy and chemotherapy. METHODS： This retrospective study analyzed the data of patents with head and neck cancer who underwent radio-chemotherapy from January 2016 to December 2016（patients required gastrostomy according to nutritional risk assessed by radiotherapy physicians）. With informed consent the patients were divided into chemotherapy before gastrostomy（prophylactic PEG group） and chemotherapy during gastrostomy（reactive PEG group）. There were 234 cases in prophylactic PEG group and 93 cases in reaction PEG group. BMI and albumin level of patients were recorded and analyzed before and after cathetering. Wound infections and extubation rates of the two groups were also recorded and compared. SPSS 11.5 software package was used for comparison between the two groups. RESULTS： After chemotherapy and radiotherapy, BMI, albumin and extubation rates of the prophylactic PEG group were significantly higher than those of the reactive PEG group（P0.01）, while the infection rate in the prophylactic PEG group was significantly lower than that in the reactive PEG group（P0.05）. CONCLUSIONS： Prophylactic PEG can improve the nutritional status of patients with head and neck cancer after radiotherapy and chemotherapy, and reduce complications of radiotherapy and chemotherapy.