内镜下钛夹处理经皮胃造瘘术后瘘的临床分析  

Clinical analysis of endoscopic titanium clip in treatment of percutaneous gastrostomy postoperative fistula

作　　者：刘丽 吴宏博 刘俐 李向红 陈磊 LIU Li;WU Hong-bo;LIU Li;LI Xiang-hong;CHEN Lei(Department of Gastroenterology,First Hospital Affiliated to Army Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院消化内科,重庆400038

出　　处：《局解手术学杂志》2018年第12期910-913,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：重庆市卫计委项目(2018jstg022)

摘　　要：目的比较经皮胃造瘘术(PEG)术后瘘在内镜下的几种封闭处理方式,为临床寻求更有效、简便的方法以封闭PEG术后瘘。方法回顾性分析2017年1～12月我院消化内科住院治疗的3例PEG患者的临床资料(病例1为72岁男性晚期食道癌患者、病例2为52岁男性小脑出血后遗四肢功能障碍并吞咽障碍患者、病例3为46岁男性食管气管瘘3年后患者),均为解决胃肠道营养至我科经内镜下行经皮胃造瘘术。观察术后拔除造瘘管后,内镜下使用钛夹封闭瘘口的效果,并与其他封闭瘘口方式相比较。结果 3例PEG术后瘘口使用钛夹均封闭成功。病例1瘘口封闭后腹部脓性渗出物逐渐减少,1周后腹部创口闭合出院,1个月后行内镜复查瘘口已完全闭合;病例2在1个月后因述吞咽有所改变要求拔除造瘘管,继续康复科其他治疗;病例3在术后2个月回院拔除造瘘管。病例2和病例3在1个月后门诊行内镜复查造胃瘘口已完全愈合,钛夹脱落,局部瘢痕形成。结论对于PEG术后瘘,使用钛夹夹闭瘘口与其他封闭瘘口方式比较,具有更快速有效、简便经济等优点。Objective To compare several closed treatment methods for percutaneous gastrostomy(PEG)postoperative fistula under endoscopy,so as to explore a more effective and simple method for clinical application.Methods The clinical data of3PEG patients(case1:a72years old patient with advanced esophageal cancer;case2:a52years old patient with limb dysfunction and deglutition disorders after cerebellar hemorrhage;case3:a46years old patient with esophageal and tracheal fistula for three years)in our gastroenterology department from January2017to December2017were retrospectively analyzed.All3patients underwent PEG in our department to solve the problem of gastrointestinal nutrition.The efficacy of titanium clip sealing under endoscopy was observed and it was compared with the efficacy of other methods.Results All the3cases were successfully closed with titanium clips after PEG operation.In case1,the abdominal purulent exudate gradually decreased after the fistula be closed,and the patient was discharged1week after the closure of the abdominal wound.The fistula was completely closed after the endoscopic reexamination1month later.In case2,the patient required removal of the fistula after1month due to dysphagia and continued other treatments in the rehabilitation department.In case3,the patient returned to hospital to remove the fistula2months after surgery.Endoscopic reexamination1month after PEG showed that the gastrostomy fistula has completely healed and the local scar has formed with the titanium clip fell off in case2and case3.Conclusion Compared with other methods,it is faster,simpler,more effective and more economical to use titanium clip to close the postoperative fistula of PEG.

关 键 词：经皮胃造瘘术 术后瘘 钛夹 消化道内镜 

分 类 号：R656.61[医药卫生—外科学]