Introduce法经皮胃造瘘术在上消化道狭窄肿瘤患者中的应用  

Usefulness of Introducer technique for percutaneous endoscopic gastrostomy in patients with upper digestive tract stenosis

作　　者：吴嘉骏[1] 王繁麟 葛卫文 范晶娴[1] 曾丽婷 王齐 谢挺[1] 张霖[2] 徐兵[1] 葛奎[1] WU Jia-jun;WANG Fan-lin;GE Wei-wen;FAN Jing-xian;ZENG Li-ting;WANG Qi;XIE Ting;ZHANG Lin;XU Bing;GE Kui(Department of Emergency,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine.Shanghai 200011,China;Department of Oromaxillofacial Head and Neck Oncology,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine.Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院急诊科,上海200011 [2]上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科,上海200011

出　　处：《中国口腔颌面外科杂志》2020年第1期60-63,共4页China Journal of Oral and Maxillofacial Surgery

基　　金：上海交通大学医工交叉课题（YG2016MS12）;上海市卫计委重要薄弱学科建设基金(2016ZB0203-01)

摘　　要：目的:总结Introduce法经皮胃造瘘术在上消化道狭窄肿瘤患者中的应用经验。方法:对61例上消化道部分或完全梗阻肿瘤患者[男48例,女13例;年龄18~90岁,平均(60.02±9.88)岁],采用Introduce法经皮胃造瘘建立肠内营养管道,分析术前准备、胃腔充气膨胀方式、胃壁固定穿刺置管、术中及术后并发症等情况。结果:61例患者中,造瘘成功60例,失败1例。鼻胃镜充气膨胀52例,超细管充气4例,腹腔穿刺针刺入充气5例,其中1例穿刺充气失败,原因是穿刺针滑入胃壁,造成胃黏膜下充气,形成夹层。鼻胃镜引导手术顺利,术后无并发症;CT引导下手术后1例伤口出血,止血处理后出院。结论:Introduce法经皮胃造瘘术是上消化道梗阻患者建立肠内营养途径的有效方法。鼻胃镜和CT均可引导胃造瘘,但前者可提供可视窗口,安全性较好;CT不能实时监控,需严格掌握适应证。PURPOSE:To describe our experiences with Introducer technique for percutaneous endoscopic gastrostomy in patients with upper digestive tract stenosis. METHODS: A retrospective analysis was conducted in 61 patients with Introduce-PEG from January 2016 to December 2018. The gastric lumen was dilated by injection of room air through transnasal ultrathin gastroscopy, nasogastric tube, or fine needle, and introduce gastrostomy procedures were divided into two kinds according the procedure guided by transnasal ultrathin gastroscopy or CT. RESULTS: Among 61 patients, 60 finished surgery successfully, 1 patient failed. Fifty-two patients were dilated by transnasal ultrathin gastroscopy and 4 patients by nasogastric tube successfully. Among 5 patients dilated by fine needle, one patient failed for the reason of dilating the gastric wall. No complications were observed by transnasal ultrathin gastroscopy guided PEG. One patient had postoperative bleeding during CT guided gastrostomy. CONCLUSIONS: Introduce-PEG is an effective technique to establish nutritional channel for patients with upper digestive tract stenosis. Transnasal ultrathin gastroscopy can monitor the procedure real time, and will be more safety than CT guided PEG.

关 键 词：介入法胃造瘘术 上消化道狭窄 超细鼻胃镜 CT 

分 类 号：R782.05[医药卫生—口腔医学]