Experiences with percutaneous endoscopic gastrostomy
Experiences with percutaneous endoscopic gastrostomy
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DOI：
10.1007/s002689900153
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发表时间：
1996-10-01
影响因子：
2.6
通讯作者：
Encke, A
中科院分区：
文献类型：
--
作者：
Gutt, CN;Held, S;Encke, A
今天选择的程序长期肠内管喂养的病人长期吞咽困难或残疾是经皮内镜胃造口术（PEG）。主要适应症为头颈癌、神经性吞咽困难、癌症恶病质、食管和咽部梗阻，有足够的空间进行内镜手术。该技术不需要全身麻醉，适用于有手术胃造口禁忌症的患者。1994年9月至1995年4月期间，共有115名患者接受了PEG放置尝试。我们采用15-Freka PEC管牵引技术，包括食管胃十二指肠镜检查在内的平均手术时间为17分钟。9例由于严重的食道梗阻，无法插入PEC。46例（40%）患者在术后第一天或第二天出现局部腹痛；其中7例患者需要外科会诊，不需要进一步的干预，只有1例患者出现了需要手术干预的严重并发症：推定穿孔，经复查后发现两者没有相关性。只有那些有腹部症状的病人我们才建议长期使用抗生素。报告的腹部症状是由于胃液轻微泄漏引起局部腹膜炎，不需要进一步治疗。根据我们的经验，PEG是外科胃造口术的有效替代方法。该手术的简单性导致并发症发生率低，住院时间短，并且可以在门诊进行。与鼻胃管相比，它具有成本效益和更好的心理承受力。
Today the procedure of choice for long-term enteral tube feeding in patients with prolonged swallowing difficulties or inabilities is percutaneous endoscopic gastrostomy (PEG). The primary indications are head and neck cancers, neurologic dysphagia, cancer cachexia, and obstruction of the esophagus and pharynx with enough space for an endoscopic procedure, This technique requires no general anesthesia and is possible in patients with contraindications to surgical gastrostomy. Between September 1994 and April 1995 a total of 115 patients underwent PEG placement attempts. We employed the pull-technique with 15-Freka PEC tubes, The average procedure time, including esophagogastroduodenoscopy, was 17 minutes. In nine cases PEC insertion was impossible owing to severe obstruction of the esophagus. In 46 (40%) patients local abdominal pains started on the first or second postoperative day; 7 of these patients required surgical consultation, and no Further intervention was needed, In only one patient was there a serious complication that required surgical intervention: a presumed perforation that turned out to have no correlate upon review All patients received single-shot antibiotic prophylaxis; and only in those patients with abdominal symptoms do we recommend a prolonged antibiosis. The abdominal symptoms reported were due to a slight leak of gastric fluid causing a topical peritonitis, which required no further treatment. In our experience PEG is a useful alternative to surgical gastrostomy. The simplicity of this procedure leads to low complication rates, short hospitalization, and is possible on an outpatient basis. It is cost-efficient and has a much better psychological tolerance than nasogastric tubes.