经皮内镜下胃造瘘术21例临床应用

目的探讨经皮内镜胃造瘘术（PEG）的临床应用价值。方法 2000年6月—2009年12月对需要胃肠营养而无法进食的21例患者行PEG治疗。结果 21例共行PEG 23例次（2例造瘘管阻塞置换）,均成功,3例次出现造瘘管周围皮下感染,所有患者置入瘘管后营养迅速恢复。21例患者随访1个月~18个月无严重并发症发生。结论 PEG作为肠内营养替代鼻饲的一种新的治疗方法,能够有效地改善患者的营养状况,促进康复,是内镜治疗的经典之作。     

经皮内镜下胃造瘘术在吞咽障碍患者中的临床应用

目的 评估经皮内镜下胃造瘘术(PEG)在吞咽障碍患者中的临床应用以及安全性.方法 回顾性分析南华大学附属南华医院收治的18例吞咽障碍患者,对其实施PEG,观察其临床疗效及并发症情况.结果 成功实施PEG18例,平均耗时15 min.经造瘘管饲后,患者的营养状态明显改善.2例患者造瘘管局部出现红肿和脓性分泌物,l例患者造瘘管周围肉芽组织过度生长.此外未出现造瘘管脱出、坏死性筋膜炎、腹膜炎、胃肠穿孔及吸入性肺炎等严重并发症.结论 PEG对于吞咽困难的患者来说是一种安全有效的肠内营养方法.     

经皮内镜下胃造瘘术在上段食管癌患者中的临床应用

目的 探讨经皮内镜下胃造瘘术(percutaneous endoscopic gastrostomy,PEG)在上段食管癌患者中的临床应用.方法 回顾分析2005年1月~2010年3月在本院行PEG术的25例上段食管癌患者的临床资料.结果 所有患者PEG均获成功,术后患者营养状况明显好转.无手术相关死亡病例发生,25例患者中1例术后出现黑便,3例出现造瘘口局部少许渗血,2例出现造瘘管周围皮肤感染,经对症处理后均改善.结论 PEG技术操作简单易行、安全,创伤小,并发症少,可避免食管上段癌患者营养状态的恶化,是上段食管癌并恶性梗阻患者行肠内营养支持治疗的可供选择的一种方法.     

经皮穿刺内镜下胃造瘘术的临床应用及价值

目的探讨经皮穿刺内镜下胃造瘘术（Percutaneous Endoscopic Gastrostomy,PEG）的临床应用及价值。方法1999年9月～2008年2月间,因各种原因造成的经口进食困难引起营养不良需长期营养支持的患者116例,在本院内镜中心行PEG治疗。其中男性72例,女性44例,年龄16～94岁,平均年龄48．5岁。结果所有患者均成功完成内镜下胃造瘘术,平均耗时15min。术后跟踪随访,所有患者造瘘管置入后营养迅速恢复,停止静脉补液。造瘘管最长留置时间1．5年。116例病人中共4例发生造瘘管周围皮肤感染,6例出现反流性食管炎,经对症处理均显著改善。未发生消化道出血、穿孔等严重并发症。结论PEG技术操作简单易行、安全、并发症少,创伤小,临床效果显著,值得临床推广应用。     

经皮内镜胃造瘘和小肠造瘘术

目的探讨经皮内镜胃造瘘术（PEG）和经皮内镜小肠造瘘术（PEJ）建立肠内营养的方法。方法2006年6月至2008年8月PEG和PEJ共治疗18例病人,其中14例行PEG胃肠营养,4例行PEG胃肠减压加PEJ小肠内营养。结果18例共行PEG,PEG加PEJ4例次,其中PEG16例次（2例行造瘘管置换）,PEG加PEJ4例次,手术成功率100%,3例次出现造瘘管周围皮下感染。所有患者造瘘管置入后营养迅速恢复,停止静脉补液。18例病人随访1～24个月无严重并发症发生。结论PEG和PEJ是作为胃肠减压和肠内营养替代鼻饲的一种新的治疗方法,安全、有效、降低医疗费用和并发症少。     

经皮内镜下胃造瘘术及其临床应用探讨

目的探讨经皮内镜下胃造瘘术(PEG)方法及有关临床问题。方法分析27例患者行PEG治疗的临床资料。结果27例一次置管成功。所有患者营养迅速恢复,停止静脉输液,7例恢复饮食,拔管,14例置管1年以上,5例因原发病死亡;并发1例瘘管脱落,2例PEG瘘管旁渗血,2例瘘口周围感染,无其他严重并发症。结论PEG是操作方法简便、安全、有效的胃肠道营养方法,值得临床应用。     

经皮内镜下胃造瘘术治疗脑梗死合并吞咽障碍患者的疗效观察

目的：观察经皮内镜下胃造瘘术（perutaneous endoscopic gastrotomy,PEG）治疗脑梗死合并吞咽障碍患者的临床疗效,并评估其临床应用价值及安全性。方法选取2012年2月-2013年1月湘潭市第三人民医院收治的23例脑梗死合并吞咽障碍患者,对其实施PEG,观察其临床疗效及并发症情况。结果成功实施PEG 23例,平均耗时（15.3±2.6）min。经造瘘管饲后,患者的营养状态明显改善。3例患者造瘘管局部出现红肿和脓性分泌物,1例患者造瘘管周围肉芽组织过度生长。除此之外未出现造瘘管脱出、坏死性筋膜炎、腹膜炎、胃肠穿孔及吸入性肺炎等严重并发症。结论经皮内镜下胃造瘘术对脑梗死合并吞咽障碍患者来说是一种安全有效的肠内营养方法。     

护理干预在经皮内镜下胃造瘘术中的应用

目的:探讨护理干预在经皮内镜下胃造瘘术(PEG)患者中的应用。方法:通过护理干预,对7例吞咽障碍及2例食管癌晚期不能进食而胃肠道功能正常的患者实施经皮内镜下胃造瘘术。结果:9例患者均顺利实施了胃造瘘术,无气腹、胃肠道出血、感染及造瘘管滑脱等并发症。结论:PEG术是肠内营养的非手术途径,具有操作简便、并发症少、风险低、创伤小等优点,而及时充分的护理干预是PEG术成功的关键。     

经皮内镜下胃造瘘术32例的护理体会

目的:对经皮内镜下胃造瘘术(PEG)的临床应用和观察护理进行总结和分析。方法:回顾性分析本院2001￣2005年行PEG手术者32例,从术前、术中及术后三方面探讨PEG术的临床护理。结果:所有患者均顺利完成手术,行PEG肠内营养后营养状况均得到改善。术后2例病人出现局部切口感染,经换药及整体护理后痊愈;1例出现PEG管堵塞,经疏通后恢复正常输注。随访6个月￣2年,所有病人未有PEG管断裂、出血、误吸、腹膜炎、内垫综合征等并发症的发生。结论:PEG术具有操作简单、创伤小、并发症少等优点,是肠内营养的一种安全有效的非手术途径。术前良好的心理护理和充分准备、术中的准确配合、术后严格的饮食管理及造瘘管的护理是PEG术成功的重要条件。     

经皮内镜胃造瘘术的临床应用

目的 探讨经皮内镜胃造瘘术(P E G)的临床应用、操作技巧及并发症.方法 对3例颅脑疾病无法经口饮食的患者行PEG.结果 3例患者均获成功,术后顺利进行肠内营养,所有患者营养状况改善,其中1例患者经管饲1个月后营养状态改善拔管,改为经口饮食,1例术后近期伤口少许渗血,造瘘口周围肉芽组织增生,1例局部皮肤感染及炎症反应,经调整造瘘管固定片松紧,加强换药后,皮肤炎症减退,未发生重要并发症.结论 PEG是目前较为完善和成熟的微创技术,作为需长期肠内营养的一种新治疗方法,随着操作方法、操作技术的改进及对并发症的认识,P E G的适应证进一步扩大,安全性高,并发症少,医疗费用低.     

Percutaneous endoscopic gastrostomy in elderly patients

Percutaneous endoscopic gastrostomy (PEG) was performed on 28 elderly patients (mean age 82 years) who were dysphagic and intolerant of naso-gastric feeding. Twenty-six patients were recovering from a stroke; the interval between the onset of stroke and PEG averaged 63 days. The procedure was successful and well tolerated by all patients. Nineteen (68%) still had a functioning PEG a median of 14 weeks after placement. One patient whose swallowing recovered had the tube removed 6 months after its insertion. Seven patients (25%) subsequently died from their underlying disease, a mean of 92 days following PEG. There was one procedure-related death from peritonitis. PEG is a useful alternative to surgical gastrostomy in selected elderly patients with dysphagia who are intolerant of naso-gastric feeding.     

Percutaneous endoscopic gastrostomy — its application in patients with neurological disease

We performed percutaneous endoscopic gastrostomy (PEG) in 30 patients with prolonged swallowing difficulty (>4 weeks duration). The average procedure time was 25 minutes. PEG insertion was done on an outpatient basis in four patients. The complication rate was 10% and included failed insertion, peristomal infection and herniation of the gastric mucosa at the gastrostomy exit site. At follow-up, the PEG tube continued to function in 18/22 of the surviving patients with a median in-use time of 85 days. Seven patients died from their original disease. Over a 28-day period, the weight gain among the patients ranged from 3kg to 7kg (mean 4.5kg) and average serum albumin increased from 29g/dl to 35g/ dl. This confirms that PEG is a safe, easy and effective method of long-term enteral feeding in patients with neurological disease.     

长期肠内营养置管途径：经皮内窥镜引导下胃造口术

自1980年首例报告经皮内窥镜引导下胃造口术(PEG)以来,该方法已在国外广泛应用于吞咽困难、需要长期肠内营养支持的患者。进食困难患者肠内营养置管喂养超过3～4周以上就应考虑PEG,但由于诸多原因该方法在国内使用尚不普遍。本文介绍了PEG的适应证和益处,及可能发生的风险、局限性、禁忌证和并发症,尤其是危重患者。     

Percutaneous endoscopic gastrostomy.

Percutaneous endoscopic gastrostomy (PEG) is now the technique of choice for patients requiring long-term enteral feeding. It is a good method for feeding patients with neurological dysphagia and can safely be kept in situ for long periods. PEG feeding requires a multidisciplinary approach, involving doctors, nurses, pharmacists, speech therapists, dieticians and carers. The insertion of a PEG, which requires two operators and two endoscopy nurses, is described in full. Feeding can commence after a few hours. Various types of feed and feed-ing patterns are described and their relative merits discussed. Although psychological problems may occur following PEG insertion, the procedure is usually well accepted by patients.     

Mortality Trend and Predictors of Mortality in Dysphagic Stroke Patients Postpercutaneous Endoscopic Gastrostomy

Background:

Percutaneous endoscopic gastrostomy (PEG) feeding is widely used in stroke patients suffering from persistent dysphagia; however, predicting the risks and benefits of PEG insertion in the individual patient is difficult. The aim of our study was to investigate if candidate risk factors could predict short-term mortality risk in poststroke patients who had PEG tube insertion for persistent dysphagia.

Methods:

This was a retrospective study of 3504 consecutive stroke patients admitted to two metropolitan hospitals during the period January 2005 to December 2013 and who also underwent PEG insertion for feeding due to persistent dysphagia.

Results:

A total of 102 patients were included in the study. There were 22 deaths in 6 months after insertion of PEG tubes and 20 deaths of those occurred within 3 months post PEG. Those who survived beyond 6 months showed significantly lower mean age (75.9 ± 9.0 years vs. 83.0 ± 4.9 years, P < 0.001), a lower mean American Society of Anesthesia (ASA) score (3.04 ± 0.63 vs. 3.64 ± 0.58, P < 0.001) compared to nonsurvivors. In multiple Logistic, age (P = 0.004, odds ratio [OR] = 1.144; 95% confidence interval [CI]: 1.044–1.255); ASA (P = 0.002, OR = 5.065; 95% CI: 1.815–14.133) and albumin level pre-PEG insertion (P = 0.033, OR = 0.869; 95% CI: 0.764–0.988) were the independent determinants of mortality respectively.

Conclusions:

We propose that age, ASA score and albumin level pre-PEG insertion to be included as factors to assist in the selection of patients who are likely to survive more than 3 months post PEG insertion.     

A prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with acute dysphagic stroke

Dysphagia following stroke is common problem and is of particular concern because of its potental for malnutrition. Nasogastric (NG) and percutaneous endoscopic gastrostomy (PEG) tube feeding are recognized methods for nutritional support for patients with persistent neurologic dysphagia. However, the former is associated with tube dislodgement and blockage that might compromise the patients' nutritional status. There have been few randomized prospective studies to date comparing the efficacy and safety of these 2 modes of dysphagia management in stroke patients. The objective of this study was to compare PEG with NG tube feeding after acute dysphagic stroke in terms of nutritional status and treatment failure. This was a randomized prospective clinical trial. A total of 23 consecutive patients who fulfilled the criteria were recruited from the medical wards in Hospital Universiti Kebangsaan Malaysia. The diagnosis of stroke (acute cerebral infarct) was based on clinical and brain computed tomographic (CT scan) findings; and the diagnosis of dysphagia was done clinically by using the 'swallowing test'. At recruitment, upper-arm skin fold thickness (triceps and biceps) and mid-arm circumference were measured; and blood was drawn for serum albumin level. They were then followed up at 4 weeks where the above tests were repeated. A total of 22 patients completed the study (12 patients in the NG group and 10 patients in the PEG group). Serum albumin levels (p = 0.045) were significantly higher in the PEG as compared to the NG group at 4 weeks post-intervention. There were statistically significant improvements in serum albumin level (p = 0.024) in the PEG group; and statistically significant reductions in serum albumin level (p = 0.047) in the NG group 4 weeks after the intervention. However, there were no significant differences in anthropometric parameters between the two groups and no significant changes in these parameters for each group 4 weeks after the intervention. Treatment failure occurred in 5 out of 10 patients (50.0%) in the NG group, but none in PEG group (p = 0.036). PEG tube feeding is more effective than NG tube feeding in improving the nutritional status (in terms of the serum albumin level) of patients with dysphagic stroke. NG tube feeding, in fact, reduced the nutritional status (in terms of the serum albumin level) of the patients.     

Evaluation of percutaneous endoscopic gastrostomy in elderly patients with silicosis and co-morbidities

To clarify the indications and usefulness of Percutaneous endoscopic gastrostomy (PEG) in patients with Silicosis and some co-morbidities, we analyzed eight cases of silicosis, who suffered from dysphagia and had received a PEG for tube feeding during the period from 1998 to 2002. The characteristics, and clinical course, of each case were statistically analyzed before and during PEG usage. All cases were bed-ridden males, with a mean age of 80 years. The profusion rate (PR) grade of silicosis was for five cases in category 2, and for three cases in category 4. Most of the co-morbidities were dementia (five cases), and chronic heart failure (four cases). There were no significant improvements in the measured nutrition criteria (albumin, lymphocytes) nor in respiratory function (arterial O2) between before and during PEG usage. Tube feeding through the PEG was not performed in three cases because of repeated aspiration pneumonia. The mean duration of PEG usage was 9 months, ranging from 5 to 20 months. Five cases died of the co-morbidities. Furthermore, there was significant deterioration in the bacteriological data (p = 0.001), suggesting a worsening of the swallowing disturbances during PEG usage, or the emergence of more resistant organisms as a result of empirical antibiotic therapy. The present results suggest that the indications of PEG in cases of severe chronic obstructive pulmonary disease (COPD) such as silicosis, associated with other morbidities, and with dysphagia, are somewhat limited. The patient's general condition should be an important factor in deciding whether or not this technique should be used.     

Percutaneous endoscopic gastrostomy — results of an irish single unit series

The technique of percutaneous endoscopic gastrostomy (PEG) was first described in 1980, as an alternative to traditional surgical methods. The main indication for PEG is the need for longterm nutritional support. It is reported to have many advantages over surgical gastrostomy, being safer and cheaper. We reviewed our experience with the first 44 patients referred to our unit for PEG. The most common indications for referral were stroke, head injury and post brain surgery. There was a success rate of 97.6% and a complication rate of 13.8%. One patient (2.3%) suffered major complications as a result of early tube displacement. There were no procedure related deaths in our series and no deaths as a result of an underlying disease process within 30 days, reflecting appropriate patient selection. All patients benefited nutritionally from PEG placement. Two patients recovered sufficiently to no longer require a gastrostomy and the tube was easily removed in both cases.