两种胃造瘘术对头颈部癌症放疗患者营养状况的影响

Effect of Two Kinds of Gastrostomy on Nutritional Status of Patients with Head and Neck Cancer Treated with Radiotherapy

目的比较内镜引导下经皮胃造瘘术和CT引导下经皮胃造瘘术对接受放疗的头颈部癌症患者营养状况的影响。方法将福建医科大学肿瘤临床医学院2021年1月至2023年12月间首次接受胃造瘘的头颈部癌症放疗患者纳入回顾性研究,收集临床资料并分析。由放疗科医师根据营养风险评估,行经皮胃造瘘术,分为内镜组(43例)和CT引导组(26例)。观察比较两组患者置管并发症、放疗后并发症发生情况,以及两组营养指标状况。结果放疗后,内镜组体质量指数(BMI)、前白蛋白、血清白蛋白水平,以及疼痛、渗液并发症发生率均高于CT引导组(均P<0.05)。放疗后内镜组营养风险筛查2002(NRS-2002)评分、口腔黏膜炎严重程度低于CT引导组(均P<0.05)。结论CT引导下经皮胃造瘘术具有并发症少的优点,两种胃造瘘置管方法在改善营养指标和并发症发生率方面均展现出各自的特点。

Objective To compare the effects of endoscopic-guided percutaneous gastrostomy and CT-guided percutaneous gastrostomy on the nutritional status of head and neck cancer patients undergoing radiotherapy.Methods Retrospective study was conducted on patients with head and neck cancer who underwent gastric fistula for the first time between January 2021 and December 2023 at the Clinical Oncology School of Fujian Medical University,Clinical data were collected and analyzed.Percutaneous gastrostomy was performed by a radiologist based on nutritional risk assessment,divided into endoscopic group(43 cases)and CT-guided group(26 cases).Observation and comparison of the two groups of patients with complications of tube placement,the occurrence of complications after radiotherapy,as well as the status of nutritional indicators of the two groups.Results After radiotherapy,the BMI,prealbumin and serum albumin levels,as well as the incidence of pain and oozing complications were higher in the endoscopy group than in the CT-guided group(all P<0.05).The NRS-2002 score and severity of oral mucositis were lower in the endoscopy group than in the CT-guided group after radiotherapy(all P<0.05).Conclusions CT guided percutaneous gastrostomy has the advantage of fewer complications.Both methods of gastric fistula placement have shown their own characteristics in improving nutritional indicators and incidence of complications.