胃造口术在头颈肿瘤进食障碍病人中的应用

Usefulness of gastrostomy in head and neck cancer patients with dysphagia

目的:总结胃造口术在头颈肿瘤进食障碍病人中的应用经验。方法:回顾分析2016年1月至2017年12月339例头颈肿瘤病人采用胃造口建立肠内营养管道的情况。结果:339例病人中拉出法胃造口(Pull-PEG)303例(89.4%),介入法(Intro-PEG)34例(10.0%),改良手术造口2例(0.6%)。Intro-PEG中鼻胃镜引导造口30例,CT引导造口4例(其中超细推泵延长管充气3例,腹腔穿刺针刺入充气1例)。303例Pull-PEG出现5例并发症:管周感染2例,术后腹痛、造口出血及包埋综合征各1例。34例Intro-PEG病人中发生流出道不全梗阻1例。303例Pull-PEG中,125人顺利拔管,2例换管;34例Intro-PEG中换管1例,改良手术胃造口者无人拔管。结论:Pull-PEG、Intro-PEG和剖腹手术胃造口术是头颈肿瘤进食障碍病人建立肠内营养管道的有效方法;三种术式对上消化道径路依赖程度依次递减,但难度顺序递增,应根据病人上消化道径路情况早期选用。

Objective:To describe our experiences with gastrostomy in head and neck cancer patients with dysphagia.Methods:We retrospectively analyzed 339 patients with head and neck cancer who underwent gastrostomy for dysphagia from January 2016 to December 2018.Results:Among 339 patients,303 patients underwent pull-PEG(89.4%),34 patients underwent introduce-PEG(10.0%),2 patients underwent celiotomy(0.6%).Among 34 patients of introduce-PEG,30 patients were guided by transnasal ultrathin gastroscopy and 4 patients were guided by CT.Among the 4 patients guided by CT,3 patients’gastric lumen were dilated by injection of air through ultrathin nasogastric tube and 1 patient dilated by fine needle.Among 303 patients of Pull-PEG,complications occurred in 5 cases:1 bellyache,1 incision bleeding,1 buried bumper syndrome and 2 incision infections.Among 34 patients of Introduce-PEG,1 patient presented with a 24-hour abdominal cramping and vomiting.The balloon impacted in the duodenal apex and formed gastric outlet obstruction which was identified by CT.Among 303 patients of Pull-PEG,125 patients were underwent extubation,2 patients underwent tube exchange.Only 1 patient underwent tube exchange among 34 patients given Introduce-PEG.Conclusion:All three kinds of gastrostomy are feasible in head and neck cancer patients with dysphagia.Although dependence of operation procedure on upper digestive tract path is decreasing in turn of Pull-PEG,Introduce-PEG and celiotomy,difficulty of the procedures is increasing.Gastrostomy should be performed early before upper digestive tract stenosis.