X射线透视下经皮胃造瘘术胃壁穿刺点位置的临床观察

Clinical observation of the location of gastric wall puncture points in X-ray assisted percutaneous fluoroscopical gastrostomy

目的探讨X射线透视下经皮胃造瘘穿刺点位置与并发症发生的关系。方法采用回顾性描述性研究方法分析2021年1月-2023年1月因吞咽困难于首都医科大学宣武医院普通外科行X射线透视下经皮胃造瘘手术的67例患者的临床资料, 其中男性42例, 女性25例, 年龄(57.3±12.6)岁, 年龄范围22~90岁。描述全部患者的手术成功率、穿刺点分布以及并发症发生率情况;分析不同胃型以及穿刺点位置与并发症发生的关系。正态分布的计量资料以均数±标准差(x±s)表示, 计数资料以例数表示, 组间比较采用Pearsonχ^(2)检验。结果 67例吞咽困难患者均行X射线透视下经皮胃造瘘手术, 手术技术成功率为100%, 胃空虚状态下, 30例患者的穿刺点位于胃大小弯中点, 28例偏向胃大弯侧, 9例偏向胃小弯侧。所有患者均未出现急性消化道出血及穿孔等严重并发症, 7例患者出现不同程度的疼痛, 其中瀑布型胃5例, 与其他胃型存在显著差异(χ^(2)=3.889,P=0.049);其中6例患者的术后疼痛与穿刺点位置有关, 5例偏向胃大弯侧, 1例偏向胃小弯侧。结论 X射线透视下经皮胃造瘘手术安全可靠, 胃壁穿刺点空虚与扩张状态不完全一致, 术后疼痛的发生可能与患者胃型以及空虚状态下穿刺点的位置变化有关。

Objective To explore the relationship between the location of puncture points and the occurrence of complications in X-ray assisted percutaneous fluoroscopic gastrostomy(PFG).Methods The retrospective and descriptive study was conducted.The clinical data of a total of 67 patients,including the gender,age,etiology,nutritional status.All data of 67 patients who received with X-ray assisted PFG surgery during the period from January 2021 to January 2023 in Xuanwu Hospital of Capital Medical University were retrospectively analyzed.There were 42 males and 25 females,aged(57.3±12.6)years,ranging from 22 to 90 years old.The technical success rate,distribution of puncture points,and incidence of complications were described.The relationship between different gastric types and puncture sites and complications was analyzed.Measurement data with normal distribution were represented as mean±standard deviation(x±s).Count data were represented as numbes and Pearson chi-square test was used between groups.Results A total of 67 patients with dysphagia were included in our study,all of whom underwent X-ray assisted PFG in our institution.The technical success rate was 100%.In the empty state,the puncture point of 30 patients was located at the midpoint of the gastric cavity,28 cases were leaned towards to the greater curvature,and 9 cases were leaned towards to the lesser curvature.No operation-related severe complications occurred,such as acute gastrointestinal bleeding and perforation.A total of 7 patients experienced varied degree of pain complication during follow-up period,including 5 cases of waterfall type stomach,which showed significant differences with other gastric types(χ^(2)=3.889,P=0.049).Pain complication of 6 patients was related to the location of the puncture point,with 5 cases leaning towards to the greater curvature and 1 case leaning towards to the lesser curvature.Conclusions PFG surgery is safe and reliable,the gastric wall puncture point is not completely consistent between the empty and dilated gastric state.The occurrence of postoperative pain may be related to the patient's gastric type pearson and changes in the position of the puncture point at the empty gastric state.