经皮内镜下胃造口术后造口周围转移的初步探讨

Progress in Prevention and Treatment of the fistula metastasis after percutaneous endoscopic gastrostomy in head and neck/Esophageal tumors

头颈部及食管恶性肿瘤病人常常因为肿瘤压迫、堵塞及抗肿瘤治疗出现吞咽困难、食欲下降、味觉消失等症状,导致其营养不良及体重下降,从而需要营养支持治疗。经皮内镜下胃造口术操作简单、并发症较少,可改善病人的营养状况及生活质量,因而广泛应用于临床。然而造术后出现造口肿瘤转移的现象因发病率较低而容易被忽略,其发病机制尚不明确,造口术前行放化疗、造口时外套管和聚维酮碘的使用以及术后良好的造口护理等均可减少此并发症的发生。手术切除、组织间近距离照射以及射频消融治疗等可能对其有效。本文将对经皮内镜下胃造口术后造口转移的发病机制、防治及预后等做一综述。

Because of tumor compression, blockage, and anti-tumor treatment, patients with head and neck cancer or esophagus cancer often have many adverse reactions, such as dysphagia, loss of appetite, taste disappeared and so on, leading to malnutrition and weight loss, which requires nutritional support treatment. Percutaneous endoscopic gastrostomy（PEG） is a simple technology widely used in clinic which has less complications can improve patients＇ nutritional status and quality of life. However, the phenomenon of fistula metastasis is easy to be neglected due to lower incidence. the pathogenesis of fistula metastasis is unclear. The occurrence of complications can be reduced by preoperative radiotherapy and chemotherapy, overtubes, povidone iodine and a good fistula care. Surgery, interstitial brachytherapy and radiofrequency ablation therapy may be effective. This article will review the pathogenesis, prevention and prognosis of tumor metastasis after percutaneous endoscopic gastrostomy.