经皮经胃镜胃造口在老年人中的临床应用价值  

Critical analysis of percutaneous endoscopic gastrostomy in elderly in one hospital

作　　者：陈孝[1] 王志强[1] 张子其[1] 张钰[1] 刘婧[1] 王鸣[1] 周庆[1] Chen Xiao;Wang Zhiqiang;Zhang Ziqi(Division of Digestive Endoscopy,Department of Geriatrics Gastroenterology,General Hospital of PLA,Beijing 100853,China)

机构地区：[1]解放军总医院第二医学中心消化内科内镜中心,北京100853

出　　处：《中华保健医学杂志》2019年第2期137-139,共3页Chinese Journal of Health Care and Medicine

摘　　要：目的探讨老年患者进行胃造口的临床特征,为在老年患者中推广该微创手术提供依据。方法回顾性分析解放军总医院第二医学中心2004年9月～2017年12月55例住院老年患者进行胃造口术的造口原因、造口方式以及造瘘管使用情况和并发症发生情况。结果所有病例均顺利完成胃造口术,其中经皮经胃镜胃造口术(PEG)32例,经皮经胃镜肠造口术(PEG-J)23例。反复误吸并发生吸入性肺部感染25例(45.45%)、营养不良16例(29.09%)、头颈部恶性肿瘤7例(12.73%)是最主要的胃造口原因,少见原因是鼻胃管不耐受、严重的颅脑损伤、食管气管瘘。发生的并发症包括造围手术期的瘘口渗血1例、局部皮肤感染4例;瘘道形成后瘘管被无意拔出5例、蘑菇头腹壁嵌顿1例。手术期发生肺部感染4例。55例患者,术后随访48例,随访率87.27%。瘘管使用的中位时间12月,平均使用时间20月(最长127月,最短2月)。结论经皮经胃镜胃造口术并发症较低,在老年患者中应用有效、安全,是需进行长期胃肠内喂养者的一种主要选择途径。Objective To investigate the clinical outcomes of the percutaneous endoscopic gastrostomy in the elderly patients. Methods 55 consecutive geriatrics patients which accepted the percutaneous endoscopic gastrostomy for diverse causes were involved in our hospital from September 2004 to December 2017. All clinical data were retrospectively analyzed. Results Indications for percutaneous endoscopic gastrostomy were recurrent pulmonary aspiration in 25 patients,malnutrition in 16 patients,head and neck malignancies in 7 patients,nasogastric tube intolerance in 3 patients,severe head injury in 2 patients and esophago-tracheal fistula in 2 patients. The procedures were successfully completed for all the patients. 32 patients underwent percutaneous endoscopic gastrostomy and 23 patients underwent percutaneous endoscopic jejunostomy. Minor complications occurred in 11 patients including local bleeding,peristomal infection,button dislodgement and inadvertent tube removal. The system complications of aspiration pneumonia occurred in 4 patients. 48 patients accepted follow-up. The mean time of tube usage was 20 months(range 2-127). Conclusions Percutaneous endoscopic gastrostomy is a minimally invasive gastrostomy method with low complications,and is easy to replace. PEG tube can been selected as a mainly long-term enteral feeding in older patients.

关 键 词：经皮经胃镜胃造口 管饲 老年人 营养不良 

分 类 号：R573[医药卫生—消化系统]