经胃镜结合缝线捆绑快速放置鼻空肠营养管应用体会

Experience of fast placing naso-jejunal feeding tube by endoscope combined with suture bundling

目的探讨胃镜下放置鼻空肠营养管的方法及应用效果。方法给2012年5月至2015年5月本院28例因疾病不适宜经口胃进食且下消化道无梗阻、需进行肠内营养患者放置鼻空肠管。先在鼻空肠管插入端小孔旁处捆绑扎紧缝线,每隔20 cm处用同样方法捆绑扎紧缝线共4处,留出线头2~3 cm,并在其中分段结扎2个结,在插入端小孔相间2 cm剪2个小侧孔,反复多次用活检钳钳夹缝线在胃镜引导下将鼻空肠管送至十二指肠降段远处。结果鼻空肠管放置达Treitz韧带以下20~30 cm成功率为100%,置管时间为(10.5±5.5)min,置管深度达110~130 cm,平均放置时间为(18.5±1.5)d,未发生严重并发症。结论经胃镜结合缝线捆绑辅助引导放置鼻空肠管是一种安全有效、经济便捷、准确快速、不易滑脱的肠内营养途径,值得临床推广应用。

Objective To explore the method of placing naso-jejunal feeding tube under endoscope and its application effect. Methods Naso-jejunal feeding tubes were placed for 28 patients in demand of enteral nutrition and not suitable for feeding by mouth. The push-in end of naso-jejunal feeding tube was bundled by suture, and the same bundling approach was applied four times with 20 cm interval. The end of suture kept 2 to 3 centimeters and ligated 2knots. At the push-in end hole, two side holes were made with 2 cm interval. Naso-jejunal feeding tube was delivered to the far end of descending duodenum under endoscope guidance using biopsy forceps tie up suture. Results The success rate of placing naso-jejunal feeding tube to 20~30 cm below Treitz anadesma was 100%, and the average duration was(10.5 ± 5.5) min. The depth of placement was 110~130 cm, and the average service days of the tube was(18.5 ± 1.5) d.There was no severe complication in this group. Conclusion The placement of naso-jejunal feeding tube by endoscope combined with suture bundling is a safe, economic, fast and stable way for enteral nutrition. It is worth to be recommended in the clinical application.