改良内镜引导下三腔喂养管置管法的临床应用  

Establishment and clinical application of modified endoscopic freka trelumina placement

作　　者：冯雁康 崔明 何芸 赵玺龙 Feng Yankang;Cui Ming;He Yun;Zhao Xilong(Department of General Surgery,920th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army,Kunming 650032,China;Department of Anesthesiology,920 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army,Kunming 650032,China;Department of Pathology,920 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Kunming 650032,China)

机构地区：[1]解放军联勤保障部队第九二O医院普通外科,昆明650032 [2]解放军联勤保障部队第九二0医院麻醉科,昆明650032 [3]解放军联勤保障部队第九二.医院病理实验科,昆明650032

出　　处：《中华胃肠外科杂志》2019年第1期79-84,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：云南省科技厅-昆明医科大学联合专项基金(2017FE467-090).

摘　　要：目的探讨改良内镜引导下三腔喂养管(FT)置管法对需要进行肠内营养和胃肠减压的患者中应用的安全性及可行性。方法采用回顾性队列研究方法,分析2016年1月至2018年1月间在解放军联勤保障部队第九二○医院普通外科应用改良内镜引导下置管法(改良组)和传统内镜旁置管法(传统组)行FT置管术患者的临床资料。纳入标准:下消化道功能正常;不能经口或鼻胃管进食,需进行肠内营养或胃肠减压;预计FT留置时间不超过2个月。排除标准包括胃镜检查禁忌证、疑休克或消化道穿孔、疑精神病或存在消化道炎性病变以及患有胸腹主动脉瘤者。改良组是将FT经一侧鼻腔插入胃内,胃镜进至胃腔,经活检孔用活检钳夹住FT前端细部,胃镜直视下将活检钳和FT插入幽门或吻合口,并向十二指肠或输出袢推送5cm以上,推送过程中胃镜不通过幽门或吻合口;松开并退出活检钳,同步将FT向十二指肠或输出袢推送,经活检孔插入异物钳,在胃内钳夹FT管身推进至幽门或胃肠吻合口;多次同法操作,直至负压吸引腔到达幽门或胃肠吻合口;轻柔退出胃镜,将导丝缓慢退出,固定FT。传统组则采用异物钳钳夹FT前端,在操作中需胃镜、异物钳、FT三者一起同时经过幽门或胃肠吻合口,整体到达十二指肠降部或输出袢进行置管。记录置管时间,置管后1h内行X线透视检查FT位置,并评估比较置管成功率及置管后并发症发生率。结果共纳入141例患者。改良组72例,男45例,女27例,平均年龄55.8(37~76)岁,上消化道解剖正常27例(结肠癌和直肠癌术后胃瘫综合征各分别有17例和10例),上消化道解剖改变45例(胃癌伴幽门梗阻和胃肠吻合术后吻合口梗阻分别有18例和27例)。传统组69例,男41例,女28例,平均年龄55.3(36~79)岁,上消化道解剖正常33例(结肠癌与直肠癌术后胃瘫综合征分别有20例和13例),上消化道解剖改变36例(胃癌伴�Objective To establish a modified endoscopic Freka Trelumina placement(mEFTP)for modifying or substituting the traditional endoscopic Freka Trelumina placement(EFTP)and to explore the safety and feasibility of mEFTP in patients requiring enteral nutrition and gastrointestinal decompression in general surgery.Methods A retrospective cohort study was conducted to analyze the clinical data of patients undergoing EFTP or mEFTP at General Surgery Department of 920 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from January 2016 to January 2018.Inclusion criteria: the function of lower digestive tract was normal;patients who could not eat through mouth or nasogastric tube needed to have enteral nutrition and gastrointestinal decompression;the retention time of Freka Trelumina(FT)was not expected to exceed 2 months.Exclusion criteria: contraindication for gastroscopy;suspected shock or digestive tract perforation;suspected mental diseases;infectious diseases of digestive tract;thoracoabdominal aortic aneurysm.mEFIP procedure was as follow.FT was inserted into stomach through one side nasal cavity,gastroscope was inserted into stomach cavity,and the front part of FT was clamped with biopsy forceps through biopsy hole.Biopsy forceps and FT were inserted into the pylorus or anastomosis under gastroscope,and they were pushed into the duodenum or output loop.During pushing,the gastroscope did not pass through the duodenum or output loop.The biopsy forceps was released and pushed out,and FT was pushed with biopsy forceps synchronously into the duodenum or output loop more than 5 cm.The foreign body forceps was inserted through the biopsy hole,and the FT tube was held in the stomach and pushed to the duodenum or output loop.The previous steps repeated until the suction cavity reached the pylorus or anastomosis.The gastroscope was exited gently;the guide wire was pulled out slowly.EFTP procedure: foreign body forceps was used to clamp the front part of FT,and gastroscope,foreign body force

关 键 词：置管方法 内镜 三腔喂养管 肠内营养 

分 类 号：R459.3[医药卫生—治疗学]