计算机断层扫描引导下胃造瘘术与内镜胃造瘘术成功率和安全性对比研究  

A comparative study on the success rate and safety between computed tomography-guided gastrostomy and endoscopic gastrostomy

作　　者：杜可朴[1] 何玉成[2] 娄小飞[1] 王猛[1] 李亚丹[1] 高梦宇 高飞[1] 周志刚[1] Du Kepu;He Yucheng;Lou Xiaofei;Wang Meng;Li Yadan;Gao Mengyu;Gao Fei;Zhou Zhigang(Department of Radiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Radiology,First People′s Hospital of Chenzhou,Chenzhou 423099,China)

机构地区：[1]郑州大学第一附属医院放射科,郑州450052 [2]郴州市第一人民医院放射科,郴州423099

出　　处：《中华消化杂志》2023年第2期102-106,共5页Chinese Journal of Digestion

摘　　要：目的对比分析计算机断层扫描(CT)-经皮放射学引导胃造瘘术(PRG)与经皮内镜胃造瘘术(PEG)的技术成功率和安全性。方法收集2017年1月至2022年1月于郑州大学第一附属医院因无法经口进食行胃造瘘术的76例患者的资料,其中采用PEG(PEG组)和CT-PRG(CT-PRG组)各38例。比较PEG组与CT-PRG组患者的手术相关情况和并发症发生情况。手术相关情况包括技术成功率、手术时间、术后体重指数和住院时间;并发症包括轻微并发症(瘘口周围感染、肉芽组织增生、渗漏、气腹、造瘘管堵塞、导管脱落、持续疼痛)和严重并发症(出血、腹膜炎、结肠穿孔、30 d内死亡)。统计学方法采用独立样本t检验、卡方检验和Fisher确切概率法。结果 CT-PRG组的技术成功率高于PEG组[100.0%(38/38)比78.9%(30/38)],手术时间短于PEG组[(17.16±8.52) min比(29.33±16.22) min],差异均有统计学意义(χ^(2)=1.19,t=2.36;P=0.038、0.011)。PEG组与CT-PRG组患者的术后体重指数[(16.29±3.56) kg/m2比(16.12±3.17) kg/m2]、住院时间[(4.13±1.26) d比(3.52±1.13) d]比较,差异均无统计学意义(均P>0.05)。PEG组轻微并发症发生率为42.1%(16/38),包括瘘口周围感染6例、渗漏1例、造瘘管堵塞5例、造瘘管脱落1例、持续疼痛3例;严重并发症发生率为5.3%(2/38),包括出血和结肠穿孔各1例。CT-PRG组轻微并发症发生率为39.5%(15/38),包括瘘口周围感染5例、肉芽组织增生1例、气腹3例、造瘘管堵塞3例、造瘘管脱落2例、持续疼痛1例;严重并发症发生率为0。PEG组与CT-PRG组轻微并发症发生率比较,差异无统计学意义(P>0.05);CT-PRG组的严重并发症发生率低于PEG组,差异有统计学意义(Fisher确切概率法,P=0.043)。结论 PEG是安全、有效的胃造瘘方法,但对于食管梗阻患者,CT-PRG可作为PEG的有效补充。Objective To compare and analyze the technical success rate and safety between computed tomography(CT)-percutaneous radiological gastrostomy(PRG)and percutaneous endoscopic gastrostomy(PEG).Methods From January 2017 to January 2022,at the First Affiliated Hospital of Zhengzhou University,the data of 76 patients who underwent gastrostomy due to inability to eat orally were collected,including 38 patients in PEG group and 38 patients in CT-PRG group.Surgical outcomes and complications were compared between the PEG and CT-PRG groups.Surgical outcomes included technical success rate,operation time,postoperative body mass index and hospital stay;while complications included minor complications(such as perifistula infection,granulation tissue proliferation,leakage,pneumoperitoneum,fistula tube obstruction,fistula tube detachment and persistent pain)and serious complications(such as bleeding,peritonitis,colonic perforation and death within 30 d).Independent sample t test,chi-square test,and Fisher exact probability test were used for statistical analysis.Results The technical success rate of CT-PRG group was higher than that of the PEG group(100.0%,38/38 vs.78.9%,30/38),and the operation time was shorter than that of the PEG group((17.16±8.52)min vs.(29.33±16.22)min),and the differences were statistically significant(χ^(2)=1.19,t=2.36;P=0.038 and 0.011).There were no significant differences in postoperative body mass index((16.29±3.56)kg/m2 vs.(16.12±3.17)kg/m2)and hospital stay((4.13±1.26)d vs.(3.52±1.13)d)between PEG group and CT-PRG group(both P>0.05).The incidence of minor complications in the PEG group was 42.1%(16/38),including 6 cases of perifistulal infection,1 case of leakage,5 cases of fistula tube obstruction,1 case of fistula tube detachment,and 3 cases of persistent pain.The incidence of serious complications was 5.3%(2/38),including 1 case of bleeding and 1 case of colonic perforation.The incidence of minor complications in the CT-PRG group was 39.5%(15/38),including 5 cases of perifistula infection

关 键 词：胃造口术 经皮内镜胃造瘘术 经皮放射学引导胃造瘘术 计算机断层扫描引导 技术成功率 安全性 

分 类 号：R656.61[医药卫生—外科学]