DSA X线透视下经皮胃造瘘术在肿瘤患者营养治疗中的应用  

Application of percutaneous gastrostomy guided by DSA X-ray fluoroscopy in nutrition therapy for patients with malignancy

作　　者：王秋香[1] 李丽[1] 李智岗[1] 李顺宗[1] 杨光[1] 苌英利[1] WANG Qiuxiang;LI Li;LI Zhigang;LI Shunzong;YANG Guang;CHANG Yingli(Department of Radiology,Fourth Hospital of Hebei Medical University,Shijiazhuang,Hebei Province 050011,China)

机构地区：[1]河北医科大学第四医院放射科,石家庄050011

出　　处：《介入放射学杂志》2020年第8期811-814,共4页Journal of Interventional Radiology

摘　　要：目的探讨DSA X线透视下经皮胃造瘘术在肿瘤患者营养治疗中的应用。方法对2018年2月以来诊治的36例不能经口进食的恶性肿瘤患者行DSA X线透视引导下经皮胃造瘘术。结果①所有患者均成功完成手术,技术成功率达100%,其中34例(94.4%)一次穿刺置管成功;2例(5.6%)二次穿刺置管成功,手术耗时18~35 min,平均24 min;②并发症发生率为16.7%(6/36),轻微并发症5例,其中1例术后造瘘口周围渗血,1例术后出现腹痛,1例术后第2 d出现肠梗阻,1例术后造瘘管周围红肿,1例术后17 d一侧胃壁固定线脱落;严重并发症1例,术后20 d出现急性胃溃疡出血;③术后3个月内患者体重平均增长2.8 kg,5例患者术后营养状态好转后针对原发病进行了放疗、化疗或靶向治疗;④随访至今,1例患者术后42 d出现堵管,2例患者术后3个月出现脱管,26例患者定期更换了胃瘘管,5例患者因病情改善拔除胃瘘管,无胃瘘管相关死亡事件发生。结论DSA X线透视引导下经皮胃造瘘术是一种安全、高效、并发症少、饲管易于维护的一种长期的肠内营养供给方式,改善了晚期肿瘤患者生活质量和预后,值得广泛推广应用。Objective To discuss the application of percutaneous gastrostomy guided by DSA X-ray fluoroscopy in maintaining nutrition for patients with malignancy.Methods A total of 36 patients with malignant tumors,who could not eat through mouth and were admitted to authors’hospital since February 2018,were enrolled in this study.Percutaneous gastrostomy guided by DSA X-ray fluoroscopy was carried out in all 36 patients.Results①Successful percutaneous gastrostomy was accomplished in all patients,the technical success rate was 100%.Among them,successful implantation of gastric tube was accomplished with single puncture in 34 patients(94.4%)and with twice punctures in 2 patients(5.6%).The mean time spent for the procedure was 24 min(18-35 min).②The incidence of complications was 16.7%(6/36).Mild complications was seen in 5 patients,including postoperative peristomal bleeding(n=1),postoperative abdominal pain(n=1),intestinal obstruction(n=1,occurring in the second day after operation),redness and swelling around the fistula(n=1),dropping of gastric wall fixation suture at 17 days after operation(n=1).Severe complication occurred in one patient,the patient developed acute gastric ulcer with hemorrhage at 20 days after operation.③The patient’s body weight increased by a mean of 2.8 kg within 3 months after operation.Radiotherapy,chemotherapy or targeted therapy were performed for the primary disease in 5 patients after their nutritional status was improved.④During the follow-up period lasting so far,gastric tube obstruction occurred in one patient at 42 days after operation,shedding of gastric tube was seen in 2 patients at 3 months after operation,regular replacement of gastric tube was carried out in 26 patients,and gastric tube was removed in 5 patients when their conditions were improved.No gastric tube-related death occurred.Conclusion Percutaneous gastrostomy guided by DSA X-ray fluoroscopy is a safe,highly effective method for maintaining long-term enteral nutrition supply with less complications.The feeding

关 键 词：经皮胃造瘘术 恶性肿瘤 胃溃疡 腹膜炎 

分 类 号：R735[医药卫生—肿瘤] R730.5[医药卫生—临床医学]