经皮内镜下胃造口的临床应用

0 引言 充足地营养支持可以减少危重病人的并发症及改善其预后,当胃肠功能正常时,肠内营养(EN)是营养支持的首选途径.肠内营养可以经鼻胃管、鼻肠管、胃造口和空肠造口等多种途径进行,其中插入鼻胃管或鼻肠管简便易行,但长期使用易造成病人不适.因此,危重病人需要长期肠内营养时,通常进行胃造口或空肠造口,病人耐受较好.传统使用手术胃造口,缺点是并发症多和病死率高,费用高.1980年,非手术经皮内镜下胃造口术(percustanous endoscopic gastrostomy,PEG)被介绍应用于临床,优点是操作简便,并发症少[1].     

经皮内镜下胃造口改善吞咽障碍病人的营养状况

目的：报道经皮内镜下胃造口（PEG）应用于鼻咽癌放疗后吞咽障碍病人的成功经验。方法：吞咽障碍病人2例，男性，55岁和62岁，鼻咽癌放疗后2年和4年，只能进流质饮食，每餐进食时间长达3－4h不等，严重影响生活质量与营养状态。均在局麻下行PEG。术后行家庭肠内营养支持，每月随访1次，检查体重，体质指数和卡氏行为状态评分（KPS）。结果：手术顺利，已随访3个月及4个月，均无并发症发生。体重比术前增加6kg和10kg，营养状态显著改善，生活质量明显提高。结论：PEG是鼻咽癌放疗后导致吞咽障碍的合理治疗方法之一。     

经皮内镜下胃造口置管术导致严重并发症3例分析

<正>经皮内镜下胃造口置管(PEG)术是在内镜引导下,经腹部皮肤穿刺放置胃造口管,直接给予肠内营养(EN)支持的一种手术,具有操作简单、只需局部麻醉、安全、并发症少的特点,对营养状况差和危重症病人也可进行该项手术。对需要空肠营养的病人,还可采用经皮内镜下胃造口空肠置管(PEJ)术。我院自2008年3月至2014年6月共开展PEG/PEJ术85例,其中有3例出现严重并发症,现报道如下。     

重型颅脑损伤病人经皮内镜下胃造口肠内营养的护理

0 引言 重型颅脑损伤病人由于原发损伤严重,多有合并损伤或并发症,导致意识障碍持续时间较长,甚至呈持续性植物状态.这些病人治疗康复时间较长,因病人的肠道功能基本完好,故保持良好的EN支持,是病人康复的重要因素之一[1].     

经皮内镜下胃造口空肠置管术在肠外瘘病人的应用

目的:研究经皮内镜下胃造口空肠置管术(PEJ)在肠外瘘病人应用的可行性、疗效和并发症. 方法:观察15例肠外瘘病人接受PEJ的置管时间、成功率、并发症和导管留置时间. 结果:平均置管时间为(17.1±6.6)min,成功率为93.75%(15/16),未发生置管相关并发症,置管后并发症的发生率为13.33%(2/15),空肠管堵塞和切口局部感染各1例.平均导管留置时间为(96.7±42.2)d. 结论:PEJ具有操作简便、快捷、安全、易于护理,病人痛苦少、易于耐受和可长期带管等优点,适合肠外瘘病人的使用.     

经皮内镜下胃造口空肠置管术在高龄病人营养支持中的作用

目的:观察经皮内镜下胃造口空肠置管术(PEJ)在高龄病人中应用的有效性和安全性.方法:回顾性分析55例行PEJ的高龄病人,年龄为75～97(83.1±6.9)岁.观察病人术前1d与术后3个月的体重、血红蛋白、血清清蛋白和肺部感染发生率的变化.结果:手术成功率为100％,病人术后无严重并发症,发生轻微并发症共4例.术后3个月病人体重、血红蛋白、血清清蛋白较术前1d显著增高,肺部感染率明显降低.结论:对高龄病人行PEJ手术,操作简便、安全、有效、并发症发生率低.     

内镜下胃肠造口在术后危重病人中的应用

目的:探讨内镜下胃肠造口在术后危重病人中的临床应用. 方法:对22例外科手术后出现并发症的危重病人进行经皮内镜下胃肠造口,并总结其手术指征、相关并发症、操作过程和临床疗效等. 结果:22例病人经皮内镜下胃肠造口术(PEG/PEJ)均获得成功,未发生与PEG/PEJ操作相关的死亡和严重并发症.21例(95%)病人放置PEG/PEJ管后进行肠道营养的时间超过30天.3例(14%)出现胃造口部位感染和渗漏,经局部换药、引流和全身应用抗生素后治愈.6例(27%)在后期出现空肠造口管的阻塞. 结论:外科术后危重病人,经皮内镜下胃肠造口术是建立长期胃肠道营养通路的安全、微创、简便、高效的方法.     

经皮内镜下胃造口(PEG)与肠内营养

营养支持是20世纪后期医学的一大进展。最近的研究认为肠内营养有着更大的优势：(1)营养物质经门脉系统吸收输送至肝脏，对循环干扰少，有助于肝脏合成内脏蛋白；(2)给胃肠道机械刺激，保持和增加肠道黏膜的血流量，避免黏膜萎缩，保持黏膜屏障和网状内皮的功能，增加肠道和黏膜相关淋巴组织的量，防止肠道内细菌和内毒素易位；(3)费用较低，严重并发症较少。所以有学者提出这样的观点：只要肠道存在功能，就应该应用肠内营养。     

经皮内镜下胃造口置管术对脑卒中后吞咽障碍病人生活质量的影响

目的:观察和比较经皮内镜下胃造口置管术(PEG)和置入鼻胃管(NGT)两种肠内营养(EN)途径对脑卒中后吞咽障碍病人生活质量的影响. 方法:选取脑卒中后吞咽障碍需长期EN治疗的病人74例,根据病人和家属选择分为PEG组(n=24)和NGT组(n=50),分别在EN治疗第1、2和3个月后采用SF-36(the MOS 36-item short-form health survey)量表和微型营养评价法(MNA)对病人进行生活质量评价和营养评估,并观察其并发症.结果:PEG组EN治疗1个月后生活质量未见改善(P＞0.05);2个月和3个月后生活质量均明显改善(P＜0.05),且均优于NGT组(P＜0.05).EN治疗1、2和3个月后,两组病人的营养状况均明显改善(P＜0.05).两组病人吸人性肺炎的发生率无显著性差异(P＞0.05),但营养治疗的失败率PEG组低于NGT组(P＜0.05). 结论:脑卒中后吞咽障碍需长期EN的病人,PEG有利于改善生活质量,并能改善营养状况,降低营养治疗的失败率.     

经皮内镜下胃和空肠造口术在临床中的应用

目的: 探讨经皮内镜下胃和空肠造口术的方法. 方法: 114例病人胃造口术(PEG)采用Pull法,26例空肠造口术(PEJ),在PEG基础上用异物钳钳夹胃腔内空肠造口管,推送胃镜将其送至Treitz韧带以下. 结果: PEG成功率为100%,通过改良胃镜下直接置管方法,26例PEJ全部一次放置成功.15例局部有活动性出血, 8例局部有分泌物和红肿,经相应处理后缓解.21例引起呼吸道感染,用抗生素治愈,1例胃黏膜下出血,形成血肿, 1例在第8天发现胃造口内固定片嵌顿,未出现严重并发症. 结论: PEG简单、安全、可行;PEJ方法可一次使造口管到达空肠,有临床应用价值.     

高龄危重病患者经皮内镜下胃空肠造瘘术营养支持的研究

目的 评价经皮内镜下胃空肠造瘘术( PEG/J),在高龄危重病患者临床治疗中的应用价值.方法 选择32例住院高龄患者因疾病无法经口饮食者,采用PEG/J前后自身对照的方法,比较其营养水平、肺部感染的发生率及对胃肠功能的影响.结果 32例患者PEG/J后营养状况均得到改善,术前体质量、血红蛋白、血清白蛋白平均数分别为(47.4±3.2)kg、( 86.2±4.0)g/L、(24.6±2.4)g/L,术后3个月明显提高,分别为(55.6±2.5)kg、(102.0±5.4)g/L、( 32.6±3.6) g/L,术后与术前比较,差异有统计学意义(P＜0.05).吸入性肺炎的发生次数减少,平均感染时间缩短,胃肠功能恢复.结论 PEG/J可有效改善高龄危重病患者的营养状况,减少肺部感染的发生率,改善胃肠功能,阻止多器官功能障碍的发生;且可在床边操作,值得老年病房推广.     

Quantifying amount of adsorption of levothyroxine by percutaneous endoscopic gastrostomy tubes

BACKGROUND: It has been the authors' clinical experience that hypothyroid patients who achieve a euthyroid state on a steady dose of oral levothyroxine often become hypothyroid over time if the medication is given via a feeding tube. The authors hypothesize that the tubing and enteral feeds may adsorb a significant percentage of the levothyroxine and thereby reduce its bioavailability. To the authors' knowledge, no previous research has been reported on this subject. They therefore performed an in vitro assessment of the degree of levothyroxine adsorption to quantify the amount of drug adsorbed to the percutaneous endoscopic gastrostomy (PEG) tube and how enteral tube feeds mitigate or exacerbate this adsorption. METHODS: Using levothyroxine radiolabeled with an I 125 tracer, a known dose of levothyroxine was passed through 60 new PEG tubes. One-half of the tubes were pretreated with Jevity feeds, and the other half were not. The authors measured the activity of the radiolabeled levothyroxine before and after it had passed through the tubes and, using a subtraction analysis, inferred the amount of thyroxine left within the tube. RESULTS: Tubes presoaked with feeds had a greater uptake in radioactivity by 326.4 cpm (95% confidence interval, 226.7-426.1), corresponding to a 45.08% relative increase in uptake compared with virgin PEG tubes without feeds. CONCLUSIONS: Although the authors found statistically significant differences in mean drug concentrations, they conclude that the amount of uptake of levothyroxine by PEG tubes and adsorption of levothyroxine by PEG tubes is probably clinically insignificant. The differences found may be attributed to the amount of drug lost during crushing and transfer.     

Safety techniques for percutaneous endoscopic gastrostomy tube placement in Pierre Robin Sequence

Pierre Robin Sequence (PRS) is a craniofacial anomaly characterized by a triad of micrognathia, glossoptosis, and cleft palate. Infants with PRS frequently have feeding problems that may require supplemental nutrition through a nasogastric or gastrostomy tube. Very few published studies have illustrated the most appropriate method for securing an enteral feeding route in this patient population. One case report described a major complication leading to death from airway compromise following percutaneous endoscopic gastrostomy (PEG) tube placement. The authors describe a case of an infant with PRS who underwent successful PEG tube placement without complications, and they highlight certain techniques to improve procedure success and patient safety.     

Duodenal perforation due to compression necrosis by the tip of percutaneous endoscopic gastrostomy tube

Percutaneous endoscopic gastrostomy (PEG) is a common and safe procedure for enteral nutrition. There are few reports concerning its complications. We managed a 31-y-old bedridden case with punched out duodenal perforation without inflammation, from which the tip of the PEG tube protruded. Simple x-ray and computed tomography showed incarceration of the balloon in the duodenal bulb and extravasation of the tip of the tube. We performed simple closure with omental patching for duodenal perforation. Postoperative gastrointestinal fiberscopy on the 11th day revealed scar phase. Some PEG tubes have a balloon, which can prevent the removal of the tube, fix the position of the tube, and prevent the leakage of gastric contents from fistula. However, in our case, the inflated balloon was transferred into the duodenal bulb according to gastric strong peristalsis. This pathophysiologic mechanism is the same as ball bulb syndrome, which is known as gastroduodenal obstruction by incarceration of the gastric submucosal tumor. There is a risk of wedging of the inflated balloon of the PEG tube and perforation of the duodenum. We must not insert the tube too deeply, must not continue to inflate the balloon for a long time, and must check its position using a stethoscope, simple x-ray examination, or ultrasound.     

经皮内镜下胃造瘘术及其临床应用的研究

目的　探讨经皮内镜下胃造瘘术 (PEG)的方法及有关临床问题。方法　对需胃肠营养而无法经口进食的 2 4例患者行PEG术。结果　行PEG术后置管 3d～ 3个月 14例 ;置管 3个月以上 10例 ,其中置管 1年以上 4例 ;并发造瘘口周围感染 2例 ,造瘘管脱落 2例 ,胃潴留 1例 ,脾破裂 1例。结论　PEG术后无肺部感染并发症 ,能有效改善病人的营养状况 ,促进康复 ,提高生活质量 ,是内镜治疗的经典之作     

Necrotizing Candida infection after percutaneous endoscopic gastrostomy: a fatal and rare complication

Gastrostomy site infections following percutaneous endoscopic gastrostomy (PEG) are the most common complication after PEG placement. Recent meta-analyses were able to show that PEG site infections can be reduced significantly with a systemic antimicrobial prophylaxis. This mostly cephalosporin- or penicillin-based prophylaxis does not cover fungal infections. Although Candida skin infections after PEG placement are rarely described, a mucosal colonization or infection of the upper GI tract with Candida species is very common, especially in severely ill patients such as those requiring artificial nutrition. The authors report a rare and lethal case of a necrotizing PEG site infection with Candida albicans in a patient with diabetes with multiple comorbidities, presenting like gas gangrene. In patients with probable immunodeficiency or visible candidiasis of the skin, oropharynx, or esophagus, a Candida infection should be considered in case of a gastrostomy site infection.