Benefits of jejunostomy feeding in patients who underwent gastrectomy for cancer treatment

BACKGROUND Gastric cancer is associated with significant undernutrition responsible for an increase in morbidity and mortality after gastrectomy.AIM To evaluate the impact of enteral nutrition by jejunostomy feeding in patients undergoing gastrectomy for cancer.METHODS Between 2003 and 2017,all patients undergoing gastrectomy for cancer treatment were included retrospectively.A group with jejunostomy(J+group)and a group without jejunostomy(J-group)were compared.RESULTS Of the 172 patients included,60 received jejunostomy.Preoperatively,the two groups were comparable with respect to the nutritional parameters studied(body mass index,albumin,etc.).In the postoperative period,the J+group lost less weight and albumin:5.74±8.4 vs 9.86±7.5 kg(P=0.07)and 7.2±5.6 vs 14.7±12.7 g/L(P=0.16),respectively.Overall morbidity was 25%in the J+group and 36.6%in the J-group(P=0.12).The J+group had fewer respiratory,infectious,and grade 3 complications:0%vs 5.4%(P=0.09),1.2%vs 9.3%(P=0.03),and 0%vs 4.7%(P=0.05),respectively.The 30-day mortality was 6.7%in the J+group and 6.3%in the J-group(P=0.91).CONCLUSION Jejunostomy feeding after gastrectomy improves nutritional characteristics and decreases postoperative morbidity.A prospective study could confirm our results.

Postoperative complications and weight loss following jejunostomy tube feeding after total gastrectomy for advanced adenocarcinomas

Objective： Patients undergoing total gastrectomy for cancer are at risk of malnourishment. The aim of this self- controlled study was to examine the effect of jejunostomy tube feeding （JTF） and other factors on postoperative weight and the incidence of jejunostomy-related complications in patients undergoing total gastrectomy for cancer. Methods： All consecutive patients who underwent total gastrectomy for gastric cancer with jejunostomy plaeement were included from a prospective single-center database （2003-2014）. Jejunostomy-related complications and postoperative weight changes were evaluated up to 12 months after surgery. Multivariable linear regression analysis was performed to identify factors associated with weight loss 12 months after gastreetomy. Results： Of 113 patients operated in the study period, 65 received JTF after total gastrectomy for a median duration of 18 d [interquartile range （IQR）, 10-55 d]. Jejunostomy-related complieations occurred in 11 （17%） patients, including skin leakage （n=3） and peritoneal leakage （n=2）, luxation （n=3）, occlusion （n=2）, infection （n=l） and torsion （n=l）. In 2 （3%） patients, a reoperation was needed due to jejtmostomy-related complications. The mean preoperative weight of patients was 71.8 kg （100%）, and remained stable during JTF （73.9 kg, 103%, P=0.331）. After JTF was stopped, the mean weight of patients decreased to 64.9 kg （90%） at 12 months after surgery （P〈0.001）. A high preoperative body mass index （BMI） （〉_25 kg/m2） was associated with high postoperative weight loss compared to patients with a low BMI （〈25 kg/m2） （16.3% vs. 8.6%, P=0.016）. Conclusions： JTF can prevent weight loss in the early postoperative phase. However, this is at the prize of possible complications. As weight loss in the long term is not prevented, routine JTF should be re-evaluated and balanced against the selected use in preoperatively malnourished patients. Special attention should be paid to patients with a high preoperative BMI, who are at risk of more postoperative weight loss.

Duodenum-preserving resection and Roux-en-Y pancreatic jejunostomy in benign pancreatic head tumors

This study was conducted to explore the feasibility of partial pancreatic head resection and Roux-en-Y pancreatic jejunostomy for the treatment of benign tumors of the pancreatic head(BTPH). From November 2006 to February 2009, four patients(three female and one male) with a mean age of 34.3 years(range: 21-48 years) underwent partial pancreatic head resection and Roux-en-Y pancreatic jejunostomy for the treatment of BTPH(diameters of 3.2-4.5 cm) using small incisions(5.1-7.2 cm). Preoperative symptoms include one case of repeated upper abdominal pain, one case of drowsiness and two cases with no obvious preoperative symptoms. All four surgeries were successfully performed. The mean operative time was 196.8 min(range 165-226 min), and average blood loss was 138.0 m L(range: 82-210 m L). The mean postoperative hospital stay was 7.5 d(range: 7-8 d). In one case, the main pancreatic duct was injured. Pathological examination confirmed that one patient suffered from mucinous cystadenoma, one exhibited insulinoma, and two patients had solid-pseudopapillary neoplasms. There were no deaths or complications observed during the perioperative period. All patients had no signs of recurrence of the BTPH within a follow-up period of 48-76 mo and had good quality of life without diabetes. Partial pancreatic head resection with Roux-en-Y pancreatic jejunostomy is feasible in selected patients with BTPH.

Critical analysis of feeding jejunostomy following resection of upper gastrointestinal malignancies

AIM To assess nutritional recovery,particularly regarding feeding jejunostomy tube(FJT)utilization,following upper gastrointestinal resection for malignancy. METHODS A retrospective review was performed of a prospectively-maintained database of adult patients who underwent esophagectomy or gastrectomy(subtotal or total)for cancer with curative intent,from January 2001 to June 2014. Patient demographics,the approach to esophagectomy,the extent of gastrectomy,FJT placement and utilization at discharge,administration of parenteral nutrition(PN),and complications were evaluated. All patients were followed for at least ninety days or until death.RESULTS The 287 patients underwent upper GI resection,comprised of 182 esophagectomy(n=107 transhiatal,58.7%; n=56 Ivor-Lewis,30.7%)and 105 gastrectomy [n=63 subtotal(SG),60.0%; n=42 total(TG),40.0%]. 181 of 182 esophagectomy patients underwent FJT,compared with 47 of 105 gastrectomy patients(99.5% vs 44.8%,P < 0.0001),of whom most had undergone TG(n=39,92.9% vs n=8 SG,12.9%,P < 0.0001). Median length of stay was similar between esophagectomy and gastrectomy groups(14.7 d vs 17.1 d,P=0.076). Upon discharge,87 esophagectomy patients(48.1%)were taking enteral feeds,with 53(29.3%)fully and 34(18.8%)partially dependent. Meanwhile,20 of 39 TG patients(51.3%)were either fully(n=3,7.7%)or partially(n=17,43.6%)dependent on tube feeds,compared with 5 of 8 SG patients(10.6%),all of whom were partially dependent. Gastrectomy patients were significantly less likely to be fully dependent on tube feeds at discharge compared to esophagectomy patients(6.4% vs 29.3%,P=0.0006). PN was administered despite FJT placement more often following gastrectomy than esophagectomy(n=11,23.4% vs n=7,3.9%,P=0.0001). FJT-specific complications requiring reoperation within 30 d of resection occurred more commonly in the gastrectomy group(n=6),all after TG,compared to 1 esophagectomy patient(12.8% vs 0.6%,P=0.0003). Six of 7 patients(85.7%)who experienced tube-related complications required PN.CONCLUSION Nutritional recovery following esophagectomy and gastrectomy is distinct. Operations are associated with unique complication profiles. Nutritional supplementation alternative to jejunostomy should be considered in particular scenarios.

Impact of jejunostomy during esophagectomy for cancer on health related quality of life

Background： The aim of this study was to evaluate the impact of jejunostomy during esophagectomy for cancer on postoperative health-related quality of life（HRQL）.Methods： We evaluate all consecutive patients who underwent esophagectomy for cancer at the surgical oncology unit of the Veneto Institute of Oncology（IOV-IRCCS） between January 2008 and March 2014. The primary outcome was HRQL, which was assessed using nine scales of EORTC C30 and OES18 questionnaires. General linear models were estimated to evaluate mean score difference（MD） of each selected scale in patients with and without jejunostomy, adjusting for clinically relevant confounders. The secondary outcomes were morbidity, hospital stay, postoperative weight loss and postoperative albumin impairment. Results： Jejunostomy was performed in 40 on 109 patients（41.3%） who participated in quality of life investigation. A clinically and statistically significantly worse eating at admission（P=0.009） became not clinically significant at 3 months after surgery（MD =9.1）. Jejunostomy was associated to clinically and statistically significantly poorer emotional function（EF） at 3 months after surgery（MD =-15.6; P=0.04）. Hospital stay was longer in jejunostomy group（median, 20 vs. 17 days, P=0.02）.Conclusions： In our series patients who had a jejunostomy during esophagectomy had been selected for their risk for postoperative complication. However, their postoperative outcome was actually similar compared to those without jejunostomy. Nevertheless, jejunostomy was associated to clinically and statistically significantly poorer EF at 3 months after surgery. Therefore, patient candidate to esophagectomy and feeding jejunostomy should receive additional psychological support.

Knot formation in the feeding jejunostomy tube:A case report and review of the literature

Jejunostomy feeding tubes provide surgeons with an excellent method for providing nutritional support, but there are several complications associated with a tube jejunostomy, including complications resulting from placement of the tube, mechanical problems related to the location or function and development of focally thickened small-bowel folds. A 76-year old man who presented with multiple medical diseases was admitted to our hospital due to aspiration pneumonia with acute respiratory failure and septic shock. He underwent exploratory laparotomy with feeding jejunostomy using a 14-French nasogastric tube for nutritional support. However, occlusion of the feeding tube was found 30 d after operation, and a rare complication of knot formation in the tube occurred after a new tube was replaced. On the following day, the tube was removed and replaced with a similar tube, which was placed into the jejunum for only 15 cm. The patient's feedings were maintained smoothly for two months. Knot formation in the feeding tube seems to be very rare. To our knowledge, this is the third case in the literature review. Its incidence is probably related to the length of the tube inserted into the lumen.

Percutaneous endoscopic gastrostomy and jejunostomy:Indications and techniques

Nutritional support is essential in patients who have a limited capability to maintain their body weight.Therefore,oral feeding is the main approach for such patients.When physiological nutrition is not possible,positioning of a nasogastric,nasojejunal tube,or other percutaneous devices may be feasible alternatives.Creating a percutaneous endoscopic gastrostomy(PEG)is a suitable option to be evaluated for patients that need nutritional support for more than 4 wk.Many diseases require nutritional support by PEG,with neurological,oncological,and catabolic diseases being the most common.PEG can be performed endoscopically by various techniques,radiologically or surgically,with different outcomes and related adverse events(AEs).Moreover,some patients that need a PEG placement are fragile and are unable to express their will or sign a written informed consent.These conditions highlight many ethical problems that become difficult to manage as treatment progresses.The aim of this manuscript is to review all current endoscopic techniques for percutaneous access,their indications,postprocedural follow-up,and AEs.

Jejunostomy Feeding Tube Placement in Gastrectomy Procedures: A Systematic Review

Many nutritional interventions have been developed to improve nutritional outcomes following upper gastrointestinal surgery. The aim of this systematic review was to investigate whether or not the routine use of intraoperative jejunostomy feeding tubes in partial and total gastrectomy procedures is warranted when assessing complications and nutritional benefits such as improved chemotherapy tolerance. An electronic search of MEDLINE, Web of Science, Embase and CINAHL databases was performed to identify studies which reported complications and/or post-operative outcomes of patients who received an intraoperative jejunostomy feeding tube in gastrectomy procedures. Five articles met the inclusion criteria (n = 636) with four retrospective cohort studies and one RCT. Studies varied in regards to the complications and nutritional outcomes reported. Jejunostomy feeding tube insertion may carry a risk of increased infectious complications but appears to reduce patient post-operative weight-loss and may improve chemotherapy tolerance. Due to the lack of high-quality studies, it is unclear if the routine use of an intraoperative jejunostomy feeding tube is indicated for all patients undergoing gastrectomy procedures or only those at a high-risk of post-operative malnutrition. More comprehensive research is recommended, particularly on the usefulness of home enteral nutrition post-gastrectomy.

Small bowel intussusception in a child following feeding jejunostomy: A rare case with review of literature

Jejuno-jejunal intussusception is a rare complication of feeding jejunostomy tube placement. A case of one year old child who underwent gastric pull-up for complicated tracheo-esophageal fistula had jejuno-jejunal intussusception induced by Witzel's feeding jejunostomy tube;is discussed with review of literature.

Jejunojejunal Intussusception following Jejunostomy

Intussusception is an invagination of a segment of the gastrointestinal tract into an adjacent one. Jejunojejunal intussusception is a rare complication of jejunostomy tube placement with an incidence of 1%. We are reporting a case of 35-year-old man who was suffering from severe oral, lesions due to Ingestion of acide agents. He received Witzel jejunostomy for early feeding. Ileus developed postoperatively and plain X-ray of the abdomen showed distended small bowel loop. Abdominal computed tomography revealed target sign as well as the feeding tube in a dilated jejunum and intussusception was diagnosed. Exploratory laparotomy was required due to failure of expectant therapy. Reduction of intussusception was done during exploratory laparotomy. The jejunostomy feeding was continued and the postoperative course was uneventful.

机器人辅助与单孔腹腔镜胆总管囊肿切除术的对比研究

目的探讨机器人辅助腹腔镜胆总管囊肿切除术的临床效果。方法回顾性比较2020年10月~2022年6月我科21例机器人辅助(机器人组)与22例单孔腹腔镜胆总管囊肿切除术(腹腔镜组)的临床资料,比较2组手术时间、术中出血量、术后引流管留置时间、禁食时间、住院时间及手术费用。结果机器人组术中出血量[10.0(8.0,13.0)ml vs.15.0(11.8,18.0)ml,Z=-3.292,P=0.001]、引流管留置时间[5.0(4.5,6.0)d vs.7.0(5.8,8.2)d,Z=-3.256,P=0.001]、禁食时间[4.0(3.0,4.5)d vs.6.0(5.0,7.0)d,Z=-4.348,P=0.000]及住院时间[6.0(6.0,7.0)d vs.8.0(6.0,9.3)d,Z=-3.061,P=0.002]均明显短于腹腔镜组。机器人组手术时间[394.0(305.0,420.0)min vs.351.5(269.3,379.8)min,Z=-2.236,P=0.025]和住院综合费用[(7.92±0.39)万元vs.(3.11±0.30)万元,t=45.386,P=0.000]明显长于/高于腹腔镜组。术后并发症及疼痛评分2组比较无差异无统计学意义(P>0.05)。所有患儿随访4~24个月,中位数13个月,无胆漏、胰漏、吻合口狭窄、胆管炎、胰腺炎、肠梗阻、切口感染和切口疝等并发症发生。结论机器人辅助腹腔镜胆总管囊肿切除术可以达到单孔腹腔镜手术同样的治疗效果。

ERAS模式在Ivor-Lewis联合空肠造瘘术在下段食管癌中应用的临床观察

目的 分析ERAS模式在Ivor-Lewis联合空肠造瘘术治疗中下段食管癌效果。方法 选取我院2015年12月至2021年10月收治的117例中下段食管癌患者的临床资料。患者均接受Ivor-Lewis联合空肠造瘘术治疗。随机数字表法分为常规组(n=58,常规模式)与ERAS组(n=59,ERAS模式)。比较两组术中与术后指标、应激指标、生活质量及并发症。结果 ERAS组胃肠功能恢复时间、住院时间、引流管留置时间及肛门排气时间均短于常规组,术中出血量少于常规组(P<0.05)。术后,两组应激指标CRP、TNF-α及IL-6水平均较术前增高,ERAS组应激指标水平均低于常规组(P<0.05)。术后,两组EORTCQLQ-C30量表躯体、情绪、角色、认知、社会功能及总体健康评分均较术前增高,且ERAS组上述评分均高于常规组(P<0.05)。ERAS组并发症总发生率为15.25%,常规组并发症总发生率为20.69%,组间差异无统计学意义(P>0.05)。结论 在空肠造瘘术联合Ivor-Lewis术治疗中下段食管癌中采用ERAS模式可改善患者生活质量,减轻其应激反应,促进患者康复。

Jejunostomy in the palliative treatment of gastric cancer:A clinical prognostic score

BACKGROUND Clinical stage IV gastric cancer(GC)may need palliative procedures in the presence of symptoms such as obstruction.When palliative resection is not possible,jejunostomy is one of the options.However,the limited survival of these patients raises doubts about who benefits from this procedure.AIM To create a prognostic score based on clinical variables for 90-d mortality for GC patients after palliative jejunostomy.METHODS We performed a retrospective analysis of Stage IV GC who underwent jejunostomy.Eleven preoperative clinical variables were selected to define the score categories,with 90-d mortality as the main outcome.After randomization,patients were divided equally into two groups:Development(J1)and validation(J2).The following variables were used:Age,sex,body mass index(BMI),American Society of Anesthesiologists classification(ASA),Charlson Comorbidity index(CCI),hemoglobin levels,albumin levels,neutrophil-lymphocyte ratio(NLR),tumor size,presence of ascites by computed tomography(CT),and the number of disease sites.The score performance metric was determined by the area under the receiver operating characteristic(ROC)curve(AUC)to define low and high-risk groups.RESULTS Of the 363 patients with clinical stage IVCG,80(22%)patients underwent jejunostomy.Patients were predominantly male(62.5%)with a mean age of 62.4 years old.After randomization,the binary logistic regression analysis was performed and points were assigned to the clinical variables to build the score.The high NLR had the highest value.The ROC curve derived from these pooled parameters had an AUC of 0.712(95%CI:0.537–0.887,P=0.022)to define risk groups.In the validation cohort,the diagnostic accuracy for 90-d mortality based on the score had an AUC of 0.756,(95%CI:0.598–0.915,P=0.006).According to the cutoff,in the validation cohort BMI less than 18.5 kg/m2(P<0.001),CCI≥1(P=0.001),ASA III/IV(P=0.002),high NLR(P=0.012),and the presence of ascites on CT exam(P=0.004)were significantly associated with the high-risk group.The risk groups showed a significant association with first-line(P=0.012),second-line chemotherapy(P=0.009),30-d(P=0.013),and 90-d mortality(P<0.001).CONCLUSION The scoring system developed with 11 variables related to patient’s performance status and medical condition was able to distinguish patients undergoing jejunostomy with high risk of 90 d mortality.

腹腔镜手术治疗新生儿胆总管囊肿17例临床分析

目的总结腹腔镜手术治疗新生儿胆总管囊肿的诊治经验。方法回顾性分析江西省儿童医院2014年6月至2022年11月,腹腔镜手术住院治疗的17例新生儿胆总管囊肿患儿临床资料。患儿男8例,女9例,入院年龄(9.95±8.52)d,体重(3.38±0.48)kg;根据Todani分型Ⅰ型13例,Ⅳ型4例;囊肿最大直径(5.24±2.12)cm;多以黄疸(12/17)、产前超声诊断(7/17)、呕吐(3/17)就诊。结果17例新生儿均完成腹腔镜手术,其中1例患儿术后第6天肠管从脐部切口脱出行非计划再次手术。所有患儿出院前复查肝功能黄疸较术前有明显下降,差异有统计学意义(P<0.05),陶土样便者术后大便颜色转为正常;2例患儿出院前丙氨酸氨基转移酶较术前异常升高,其余患儿出院前丙氨酸氨基转移酶指标均在正常范围,门诊随访2周~2个月肝功能及黄疸均恢复正常。随访3~48个月,无吻合口狭窄、肠梗阻伴粘连、反流性胆管炎等并发症。结论新生儿期胆总管囊肿腹腔镜微创手术可有效控制和改善肝功能损伤、梗阻性黄疸、胆道炎症等并发症的发生,安全、可行。

腹腔镜胃癌手术空肠造口与鼻饲管优劣对比

目的分析腹腔镜下胃癌根治术空肠造口和鼻饲营养管的优劣。方法收集2019年01月-2021年01月期间接受的胃癌手术患者共计150例。按照空肠造口和鼻饲营养管的不同分为两组,空肠造口组(n=74例,行空肠造口)和鼻饲营养管组(n=76例,行鼻饲营养管)。密切观察两组患者手术持续时间、术后肺炎、腹腔感染、吻合口漏的预防和治疗以及患者的耐受性、拔管难易、造口并发症、住院时间等指标,并比较两者的优劣。结果空肠造口组术后肺炎、拔管困难、造口并发症发生率均多于鼻饲营养管组(P<0.05);鼻饲营养管组术后腹腔感染多于空肠造口组(P<0.05);两组患者在手术持续时间、住院时间、吻合口漏的预防和治疗上均无明显差异(P>0.05)。结论空肠造口和鼻饲营养管均可用于吻合口漏的预防和治疗,但空肠造口具有较高的并发症风险。

经皮内镜胃造瘘和小肠造瘘术的临床应用(附24例报告)

目的 :探讨经皮内镜胃造瘘术 (PEG)和经皮内镜小肠造瘘术 (PEJ)的临床应用价值。方法 :1 996年 6月～ 2 0 0 2年 8月PEG和PEJ共治疗 2 4例病人 ,其中 1 3例行PEG胃肠营养 ;1 1例行PEG胃肠减压加PEJ小肠内营养。结果 :2 1例共行PEG ,PEG加PEJ 2 8例次 ,其中PEG 1 7例次 (4例行造瘘管置换 )、PEG加PEJ 1 1例次 ,手术成功率 1 0 0 %。 2 / 2 8例次出现造瘘管周围皮下感染。所有患者造瘘管置入后营养迅速恢复 ,停止静脉补液。 2 4例病人随访 1～ 48个月无严重并发症发生。结论 :PEG和PEJ是作为胃肠减压和肠内营养替代鼻饲的一种新的治疗方法 ,安全、有效。

经皮穿刺胃造瘘和胃空肠造瘘术

目的探讨透视引导下经皮穿刺胃造瘘术(PG)和胃空肠造瘘术(PGJ)的可行性和安全性.方法23例吞咽困难的患者.上段食管癌10例,中段食管癌1例,咽部癌6例,球麻痹2例,脑转移瘤4例.采用美国Cook公司生产的Marx-cope PGJ套装.先经鼻饲管经鼻或经口途径置入导管后注入气体800～1000 ml,至胃腔明显扩张.然后在透视引导下采用Seldinger技术将PG饲管置入胃腔内,或将PGJ饲管经胃腔、十二指肠置入空肠内.术后严密观察腹部症状和体征.随访饲管使用情况.结果23例患者均成功完成PG术,技术成功率为100%.其中将饲管置入空肠内13例,均成功.术后出现上腹部疼痛1例,造瘘口周围感染1例,经处理后均痊愈.1例于术后第2天,因胃内容物反流出现窒息死亡.随访期间经饲管给予顺利.恶性肿瘤患者18例死亡,另3例仍在随访中,中位生存期为6.5个月.球麻痹患者1例更换新的PG饲管,另1例失访.结论透视引导下PG和PGJ术,成功率高,并发症少,是建立长期胃肠内营养的良好途径.

经皮内镜下胃造瘘术和胃空肠造瘘术在危重患者中的临床应用

目的评估经皮内镜引导下胃造瘘和胃空肠造瘘术的临床应用,探讨经皮内镜引导下胃造瘘和胃空肠造瘘术的技术操作要点及适应证、禁忌证和并发症。方法回顾性分析2009年12月～2011年3月在该院对20例患者成功实施经皮内镜引导下胃造瘘术(PEG)及经皮内镜引导下胃空肠造瘘术(PEJ)的临床资料。分析手术指征、操作过程、技术成功率、手术相关并发症和饲养管留置时间。结果经皮内镜引导下实施胃造瘘和胃空肠造瘘术20例,其中脑外伤12例,球麻痹2例,食管癌1例,反复发作的吸入性肺炎2例,食管-纵膈瘘2例,恶性十二指肠梗阻1例。技术成功率100%,未发生术中置管相关并发症及术后严重并发症,发生1例胃造瘘管移位。结论经皮内镜引导下胃造瘘和胃空肠造瘘术是安全、简单,有效的微创治疗,适用于营养支持和胃肠减压。

经皮内窥镜引导下胃/肠造口术的临床应用

目的总结经皮内窥镜引导下胃/肠造口的经验,探讨内窥镜置管的技术操作及其适应证、禁忌证和并发症。方法回顾性分析了2001年7月～2007年12月在我院成功实施经皮内窥镜引导下胃/肠造口术的578例患者的临床资料,观察了置管的种类、目的、时间、成功率、并发症及留置时间。结果578例患者中,经皮内窥镜引导下胃造口(PEG)247例,经皮内窥镜引导下胃空肠造口(PEGJ)293例,经皮内窥镜引导下十二指肠造口(PED)4例,直接法经皮内窥镜引导下空肠造口(DPEJ)4例,经皮内窥镜引导下结肠造口(PEC)4例,PEG/J联合食管支架26例。其中,肠内营养329例,减压同时联合肠内营养133例,胃肠减压103例,肠内营养联合胆汁回输5例,围手术期应用4例,顺行灌肠4例。PEG平均操作时间为(7.5±1.9)min,PEGJ为(17.7±4.2)min,DPEJ为(14.8±2.1)min,PED为(12.3±2.5)min,PEC为(11.3±2.6)min,PEG/J联合支架为(30.2±5.2)min。技术成功率为98.0%(578/590),严重并发症发生率1.04%(6/578),轻微并发症发生率6.23%(36/578),平均留置时间(168.37±198.64)d。结论经皮内窥镜引导下胃/肠造口术操作简便、有效、并发症少,易于护理、患者耐受良好、易于接受、可长期带管,适用于肠内营养支持、胃肠减压、胆汁回输、围手术期应用等。

空肠置管肠内营养对胃癌患者术后生活质量的影响

目的评估空肠穿刺置管肠内营养对胃癌患者术后生活质量的影响。方法回顾性分析北京协和医院104例胃癌患者的临床病理、营养支持及生活质量资料。所有调查资料均来自前瞻性维持的胃癌数据库。比较空肠置管组与未置管组患者生活质量的差异。结果两组患者基线特征、生活质量评分及术后辅助化疗疗程差异均无统计学意义(P均>0.05)。术后1个月,两组患者的总体健康状况评分(P=0.154)、躯体功能评分(P=0.321)、角色功能评分(P=0.492)和疲劳症状评分(P=0.845)差异均无统计学意义;术后3个月及6个月,与未置管组比较,空肠置管组患者均具有较高的总体健康状况评分(P<0.001,P=0.038)、躯体功能评分(P=0.004,P=0.005)、角色功能评分(P=0.002,P=0.038)及较低的疲劳症状评分(P=0.020,P=0.043)。结论术中空肠置管肠内营养可改善胃癌患者手术生活质量。