Percutaneous endoscopic gastrostomy: The preferred method of elective feeding tube placement in trauma patients
Percutaneous endoscopic gastrostomy: The preferred method of elective feeding tube placement in trauma patients
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DOI：
10.1097/00005373-200201000-00007
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发表时间：
2002-01-01
影响因子：
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通讯作者：
Fakhry, SM
中科院分区：
文献类型：
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作者：
Dwyer, KM;Watts, DD;Fakhry, SM
目的：本研究的目的是确定经皮内窥镜途径放置胃饲管是否会比开放式胃造口术 (SG) 产生更少、更不严重的并发症。方法：对 1/94 至 12/98 入院的所有选择性放置饲管的创伤患者的病历进行单独审查。记录所有与管相关的并发症。在 8119 名筛查患者中，158 名 (1.9%) 符合纳入标准。 95 例（60.1%）接受了经皮内窥镜胃造口术（PEGS），63 例（39.9%）接受了外科胃造口术。大多数患者 (79.1%) 的主要诊断是 AIS 3 级或以上的头部或脊髓损伤，导致置管。结果：总体而言，SG 患者出现胃造口管并发症的可能性是 PEG 患者的 5.4 倍（95% CI，2.1-13.8）。他们发生主要并发症（内漏、裂开、腹膜炎和瘘管）的可能性高出 2.6 倍，发生轻微并发症（意外切除、移位、外漏、皮肤感染和功能障碍）的可能性高出 5.5 倍。各组在 ISS、ICU LOS、总 LOS 或死亡率方面没有差异 (p > 0.05)。总体而言，26 名不同患者中总共发现了 39 种与置管相关的并发症（PEG，7；SG，19）。需要手术干预的所有四种主要并发症均出现在 SG 组中。轻微并发症 31 例，其中 PEG 组 8 例，SG 组 27 例。 PEG 组放置的平均总费用也显着低于 SG 组（1271 美元 vs. 2761 美元，p < 0.1001）结论：通过经皮内窥镜途径放置胃造口管的并发症发生率显着低于手术放置管。此外，安置所产生的费用也明显减少。根据本研究的结果，对于没有特定手术禁忌症的创伤患者，应考虑将 PEG 视为放置胃饲管的首选方法。
Purpose: The purpose of this study was to determine whether gastric feeding tubes placed by the percutaneous endoscopic route resulted in fewer and less severe complications than open surgical gastrostomy (SG).Methods: Charts for all trauma patients admitted 1/94 to 12/98, which had an electively placed feeding tube, were individually reviewed. All tube-related complications were recorded. Of 8119 patients screened, 158 (1.9%) met inclusion criteria. Percutaneous endoscopic gastrostomies (PEGS) were placed in 95 (60.1%) and surgical gastrostomies in 63 (39.9%). Most patients (79.1%) had AIS 3 or greater head or spinal cord injury as the primary diagnosis leading to tube placement.Results: Overall, SG patients were 5.4 times more likely than PEG patients to have a complication from their gastrostomy tube (95% CI, 2.1-13.8). They were 2.6 times more likely to have a major complication (internal leakage, dehiscence, peritonitis, and fistula), and 5.5 times more likely to have a minor complication (unplanned removal, dislodgment, external leak, skin infection, and nonfunction). The groups did not differ on ISS, ICU LOS, total LOS, or mortality (p > 0.05). Overall, a total of 39 individual complications related to tube placement were noted in 26 separate patients (PEG, 7; SG, 19). All four of the major complications requiring operative intervention were in the SG group. There were 31 minor complications, 8 in the PEG group and 27 in the SG group. Mean total charges for placement were also significantly lower in the PEG group than the SG group ($1271 vs. $2761, p < 0.1001)Conclusion: Gastrostomy tubes placed via the percutaneous endoscopic route had a significantly lower complication rate than surgically placed tubes. In addition, the charges incurred for their placement were also significantly less. Based on the findings of this study, PEG should be considered as the method of choice for gastric feeding tube placement for trauma patients who do not have specific contraindications to the procedure.