经皮内镜下胃造瘘空肠置管术在高位肠外瘘患者中的临床应用

目的探讨经皮内镜下胃造瘘空肠置管术治疗高位肠外瘘患者的方法、并发症及疗效。方法回顾性分析经皮内镜下胃造瘘空肠置管术治疗我院24例高位肠外瘘患者的手术操作时间、成功率、并发症、导管留置时间及肠瘘治愈率。结果所有患者均置管成功,成功率为100%,平均置管时间为(16.5±3.8)min,无置管相关并发症;置管后并发症发生率为12.5%(3/24):2例营养管堵塞,1例造瘘管周围感染,平均导管留置时间(83.7±46.2)d。18例患者肠瘘愈合,治愈率为75%(18/24),5例肠瘘未愈行外科手术治疗,1例因原发病死亡。结论经皮内镜下胃造瘘空肠置管术具有操作简单易行、安全,住院时间短,空肠营养管越过肠瘘给予肠内营养等优点,可用于高位肠外瘘患者的临床治疗。     

床旁无痛经皮内镜下胃造口术在80岁以上老年患者中应用的临床研究

目的 探讨床旁无痛经皮内镜下胃造口术(PEG)和(或)空肠造口术(PU)在＞80岁老年患者中应用的安全性及临床价值. 方法 观察32例行鼻胃管灌食＞6月的＞80岁老年患者在静脉麻醉下行PEG(其中26例同时行空肠置管术PEJ)的并发症,比较术前术后患者舒适度、口鼻部、肺部感染的发生情况. 结果 平均置管时间为( 14.10±3.26) min,置管成功率为100％,置管后并发造瘘口皮肤轻微感染5例,经换药后痊愈,未发生与置管有关的并发症;与术前比较,术后患者口鼻咽部舒适,口鼻部、肺部感染的发生率明显下降(P＜0.05).结论 在＞ 80岁老年患者中应用床边无痛PEG/PEJ便捷、安全、并发症少;增加患者舒适度、依存性,减少口鼻损伤、感染,肺部感染比例明显低于经鼻胃管肠内营养.     

PICC与CVC置管在肝细胞癌患者中的应用比较

目的比较经外周穿刺中心静脉置管(PICC)与锁骨下静脉置管(CVC)在肝细胞癌患者治疗中的应用效果。方法 90例确诊为肝细胞癌的患者,随机选择留置PICC和CVC导管,PICC组、CVC组各45例,观察并比较一次性穿刺成功率、导管留置时间、并发症发生率等。结果 PICC组一次性置管成功率为91.1%,明显高于CVC组的75.6%(χ2=3.92,P=0.041);两组留置时间中位数比较,PICC组为182天,明显长于CVC组的65天(u=3.11,P=0.023);并发症总发生率比较,PICC组为8.8%,明显低于CVC组的24.4%(χ2=3.92,P=0.041)。结论 PICC较CVC方法 ,一次性穿刺成功率高、导管留置时间长、并发症少,应成为需要长期置管治疗的肝细胞癌患者的首选。     

肠梗阻导管联合泛影葡胺治疗儿童腹腔术后早期肠梗阻

目的 评估肠梗阻导管联合泛影葡胺在儿童腹腔术后早期肠梗阻治疗中的价值。方法 回顾性收集2014年8月至2022年12月于徐州市中心医院接受X线引导下肠梗阻导管置入联合泛影葡胺治疗的8例腹腔术后早期(30天内)肠梗阻患儿临床资料,分析置管成功率、症状缓解率、梗阻解除率、梗阻解除时间、肠梗阻导管留置时长、随访复发结果及置管并发症。结果 置管成功率、症状缓解率及梗阻解除率均为100%(8/8);梗阻解除平均时长3.75±1.58天;肠梗阻导管留置平均时长6.63±2.13天;随访时间最短者1个月,最长者93个月,复发率12.5%(1/8);置管并发症包括鼻部疼痛、鼻腔少量出血以及轻度的恶心、呕吐。结论 肠梗阻导管联合泛影葡胺治疗儿童腹腔术后早期肠梗阻安全、有效、复发率低、并发症轻微。     

超声引导下应用Seldinger技术行PICC置管的效果评价

目的:探讨在超声引导下改良Seldinger技术行外周静脉置入中心静脉导管(PICC)的临床应用价值。方法:选择我院住院需行PICC置管的患者300例作为观察对象,随机设为观察组(150例)和对照组(150例)。观察组患者采用超声引导下改良Seldinger技术行PICC置管,对照组采用传统穿刺法进行PICC置管。观察记录2组贵要静脉使用情况、导管末端位置、留置时间、并发症发生情况,评价2组穿刺、置管的一次性成功率。结果:观察组一次性穿刺成功率99.3%(149/150),一次性置管成功率98.7%(148/150),总置管成功率100%,贵要静脉使用率95.3%(143/150),导管末端位于上腔静脉的比例94.7%(142/150),均显著高于对照组(均P0.05);观察组导管留置时间(151±17)d亦明显较对照组延长(P0.05);观察组静脉血栓、机械性静脉炎及周围组织损伤的发生率均显著低于对照组(均P0.05),穿刺点渗血及导管相关感染发生率比较,两组无显著差异性。结论:PICC置管在超声引导下应用改良Seldinger技术,可显著提高置管成功率,具有较高的临床应用价值。     

长期深静脉留置双腔导管血液透析的临床应用

目的 :探讨长期血液透析留置双腔导管的效果和退出原因 ,延长其使用期限。　 方法 :随访血液透析患者留置导管的使用情况和并发症 ,记录导管使用终点。　 结果 :①实施深静脉留置长期带涤纶环导管术 1 39例次 ,其中 1 0例次为再次置管 ;经颈内静脉入路 1 0 4例次 (成功率 98% ) ,经颈外静脉切开插管 1 3例次 (成功率 81 % ) ,经锁骨下静脉 2 2例次 (成功率 95 % )。置管成功率 1 0 0 %。②导管使用期限 :平均 (1 4 5± 1 0 4 )个月 ,使用留置导管时间分别为 :>72个月 1例 ,>36个月 7例 ,≥ 2 4个月 1 8例 ,≥ 1 2个月 37例次 ,≥ 6个月 4 2例次 ,<6个月 30例次 (大部分在继续使用 ) ,其余失访。观察导管使用终点 6 5例次 ,约占 4 6 % ,导管退出时平均使用时间 3～ 4 6 (1 0 2± 8 3)个月。退出原因 :患者死亡 4 0例 ,其余为感染拔管、导管拔脱、血流不畅和肾移植。在导管使用终点 ,90 % (5 8/ 6 5 )的导管功能良好。③导管透析充分性 :1 1 4例患者透析后尿素下降率平均 70 % ,平均Kt/V达 1 5 5。与内瘘透析患者Kt/V =1 5 0±0 33(n =30 )比较无显著差别。④导管动静脉端反接对透析效果影响 ,比较 35例导管动静脉端正接和反接 ,血流量2 0 0～ 2 5 0ml/min ,单次透析正接Kt/V =1 5 5± 0 4 3,反接     

彩色多普勒超声引导下经皮门静脉穿刺留置导管的临床应用

目的探讨彩色多昔勒超声引导下经皮经肝穿刺门静脉留置导管的临床应用价值。方法100例肝细胞癌或转移癌患者，在彩色多普勒超声引导下经皮经肝穿刺门静脉置人中心静脉导管，观察穿刺及置管成功率、导管留置天数、并发症发生率和治疗效果。结果在100例患者中，穿刺一次成功率和置管一次成功率为98．0％；早期导管留置天数为7-14d，平均9．2±2．7d，改进后为23-60d，平均44．7±13．5d；无严重并发症发生。经门静脉注药治疗原发性肝癌和转移性肝癌的疗效优于外周静脉给药。讨论该方法可重复门静脉给药，能增加局部药物浓度，提高药物治疗的效果．并且安全、可靠，无严重并发症。     

专科培训对护理人员PICC置管维护及KAP水平的影响

<正>经外周静脉置入中心静脉导管(PICC)就是经由外周静脉将导管置入患者中心静脉的操作。PICC易于操作,安全性高,创伤小,便于维护,因此该方法在临床上得到了广泛使用。但PICC置管后会出现部分并发症,对护理人员开展PICC专项知识培训并对患者给予相应的护理措施,可显著降低并发症发生率,提高置管成功率,延长PICC导管留置时间。因此本文调查了100名护理人员培训前后PICC置管成功率、并     

不同静脉置管在颅脑损伤危重患者中的效果观察

目的观察不同静脉置管方法在颅脑危重患者中的应用效果。方法96例置管患者随机分为外周静脉穿刺导入中心静脉置管（PICC）组48例和锁骨下静脉组48例,分别观察两种方法置管的1次置管成功率、并发症及置管时间的长短。结果PICC组一次置管成功率为100.0%,而锁骨下静脉置管组的一次置管成功率为67.8%,差异有统计学意义（P〈0.05）;PICC组导管留置时间长于锁骨下静脉组,差异有统计学意义（P〈0.01）;锁骨下静脉组发生导管相关性感染、邻近动脉损伤、导管脱落的例数较多,与PICC组比较,差异有统计学意义（P〈0.01）。结论PICC导管的穿刺简便易行,并发症少,可长期留置。     

经锁骨下静脉置入动脉鞘管在危重患者中的应用效果观察

目的对比分析动脉鞘和中心静脉导管经锁骨下静脉置管在抢救危重患者的临床效果。方法选择需抢救的危重患者82例,随机分为两组,观察组采用动脉鞘置管,对照组采用中心静脉导管置管,比较两组置管成功率、置管时间、液体流速。结果观察组置管成功率为95.2%,对照组为80%,两组比较差异有统计学意义(P0.01)。观察组置管平均时间为(3.57±0.63)min,对照组为(9.74±1.36)min,两组比较差异有统计学意义(P0.01);观察组液体流速为(65.5±1.7)mL/min,对照组液体流速为(38.4±2.1)mL/min,观察组液体流速明显快于对照组,差异有统计学意义(P0.01)。结论动脉鞘比中心静脉导管经锁骨下静脉置管穿刺成功率高、操作所用时间短、液体流速快,而且建立一条静脉通路可实施多项操作,为抢救患者生命赢得宝贵的时间,提高抢救成功率。     

内镜下扩张联合注射博来霉素治疗食管手术后吻合口良性狭窄的安全性和有效性

目的分析内镜下扩张联合注射博来霉素治疗食管手术后吻合口良性狭窄的安全性和有效性。方法回顾性分析2015年6月至2019年6月佛山市第一人民医院收治的食管手术后吻合口良性狭窄的55例患者。其中25例患者接受内镜下扩张联合注射博来霉素治疗(内镜下扩张联合博来霉素组),30例患者接受单纯内镜下扩张治疗(单纯内镜下扩张组)。比较两组患者缓解食管狭窄需要的时间、扩张相关的治疗费用、1年无狭窄生存时间、并发症发生情况。结果两组患者均顺利完成了内镜下治疗,治疗后短期内都达到了内镜和临床缓解。两组患者术后均未出现严重并发症,且两组患者术后并发症发生率差异无统计学意义[8.0%(2/25) vs 6.7%(2/30),χ~2=0.046,P=0.83]。在1年的随访时间内,内镜下扩张联合博来霉素组患者无狭窄生存时间长于单纯内镜下扩张组患者[(11.1±0.4)个月vs (3.9±0.2)个月],前者需要达到食管狭窄缓解的扩张次数更少[1 (1,2)次vs 3 (3,4)次],费用更低[5791.2 (4987.4,9974.8)元vs 16084.0 (14036.1,19094.0)元],且差异均有统计学意义(χ~2=54.322,Z=7.103、6.653,P均<0.01)。结论内镜下扩张联合注射博来霉素治疗食管手术后吻合口良性狭窄的疗效优于单纯内镜下扩张,可获得更长的无狭窄生存时间,并减少扩张次数。     

透明帽在经口内镜下肌切开术中的应用价值

目的初步探讨透明帽在经口内镜下肌切开术中的应用价值。方法回顾性分析2011年7月-2013年7月由同一操作者采用透明帽辅助的经口内镜下肌切开术治疗54例贲门失驰缓症患者,统计手术时间、手术成功率、并发症发生率、患者住院时间等。结果共54例贲门失驰缓症患者行经口内镜下肌切开术,成功54例,手术成功率100%,16例出现术中或术后并发症,并发症发生率为29.6%,手术时间45~396 min,平均(125±61)min,患者住院时间为5~28 d,平均(13.0±4.5)d。结论透明帽应用于经口内镜下肌切开术安全、方便、有效,能够缩短手术操作时间,提高手术成功率,降低并发症发生率,缩短患者住院时间。     

Endoscopic palliative intubation of the esophagus invaded by lung cancer.

Thirty-two patients with esophageal involvement by lung cancer were managed by endoscopic intubation. In 22 patients with extrinsic esophageal strictures, the success rate of intubation was 91%, and 82% were discharged with their dysphagia relieved and esophageal patency restored. The mean survival rate was 4.4 months. In 10 patients with esophago-bronchial fistulas, 3 had the fistulous tract obliterated and lived a mean of 5 months. This low success rate of closing fistulas is due to failure to seal off the space between the stent and the fistula because of absence of tumor-associated stenosis. The overall morbidity rate was 28.1% (18.8% perforation, 6.3% hemorrhage, and 3.1% tracheal obstruction). The overall mortality rate was 18.8%. Although complications were more frequent than in primary esophageal tumors, endoscopic intubation was the only way to palliate this desperate condition and provided 66.6% of patients with relief of symptoms, nutritional improvement, and a mean survival time of 4.5 months.     

A new endoscopic technique for suspension of esophageal prosthesis for refractory caustic esophageal strictures

SUMMARY. There is no clear consensus concerning the best endoscopic treatment of benign refractory esophageal strictures due to caustic ingestion. Different procedures are currently used: frequent multiple dilations, retrievable self‐expanding stent, nasogastric intubation and surgery. We describe a new technique to fix a suspended esophageal silicone prosthesis to the neck in benign esophageal strictures; this permits us to avoid the frequent risk of migration of the expandable metallic or plastic stents. Under general anesthesia a rigid esophagoscope was placed in the patient's hypopharynx. Using transillumination from the optical device, the patient's neck was pierced with a needle. A n.0 monofilament surgical wire was pushed into the needle, grasped by a standard foreign body forceps through the esophagoscope and pulled out of the mouth (as in percutaneous endoscopic gastrostomy procedure). After tying the proximal end of the silicone prosthesis with the wire, it was placed through the strictures under endoscopic view. This procedure was successfully utilized in four patients suffering from benign refractory esophageal strictures due to caustic ingestion. The prosthesis and its suspension from the neck were well‐tolerated until removal (mean duration 4 months). A postoperative transitory myositis was diagnosed in only one patient. One of the most frequent complications of esophageal prostheses in refractory esophageal strictures due to caustic ingestion is distal migration. Different solutions were proposed. For example the suspension of a wire coming from the nose and then fixed behind the ear. This solution is not considered optimal because of patient complaints and moreover the aesthetic aspect is compromised. The procedure we utilized in four patients utilized the setting of a silicone tube hanging from the neck in a way similar to that of endoscopic pharyngostomy. This solution is a valid alternative both for quality of life and for functional results.     

内镜下扩张联合黏膜下注射曲安奈德在食管良性狭窄治疗中的应用价值研究

目的探讨内镜下扩张联合黏膜下注射曲安奈德治疗食管良性狭窄的安全性及其应用价值。方法69例患者随机分为3组,分别接受单纯内镜下扩张治疗（A组）、内镜下扩张联合单次注射注射曲安奈德治疗（B组）和内镜下扩张联合多频次注射注射曲安奈德治疗（C组）。比较3组并发症发生情况、治愈率、持续症状缓解时间、再次行内镜下扩张治疗的间隔时间、内镜治疗结束后Stooler分级评分。结果术后部分患者出现胸痛及反流症状,均经对症治疗后症状改善,未出现严重出血、感染、穿孔及局部组织萎缩坏死等并发症。内镜治疗结束后3组Stooler分级评分均较术前有明显改善（P〈0．05）,各组间比较差异无统计学意义（P〉0．05）。随访至52周,A组平均持续症状缓解时间及再次行内镜下扩张治疗的间隔时间分别为（14．4±3．2）周和（18．2±3．7）周,B组分别为（19．3±3．9）周和（24．6±4．2）周,C组分别为（20．2±4．2）周和（26．1±4．5）周,B组和C组均明显长于A组（P〈0．05）,B、C组问差异无统计学意义（P〉0．05）;A组治愈率为29．2％（7／24）,B组为27．3％（6／22）,C组为43．5％（10／23）,C组明显高于A组和B组（P〈0．05）,A、B组间差异无统计学意义（P〉0．05）。结论食管良性狭窄采取内镜下扩张联合黏膜下注射曲安奈德治疗是安全的,多频次注射可明显提高治愈率。     

内镜黏膜下剥离术治疗消化道黏膜下肿瘤的疗效分析

目的探讨内镜黏膜下剥离术(ESD)治疗消化道黏膜下肿瘤(submucosal tumor,SMT)的疗效及安全性。方法选取我院2008年3月-2011年6月经胃肠镜检查发现消化道黏膜下肿瘤48例,回顾性分析48例患者资料,包括患者的基本情况、病变部位、大小、治疗经过以及病理结果等,统计并发症发生情况及术后随访结果。结果病灶直径为0.8～5.8 cm,平均(3.3±0.75)cm,ESD手术时间为27～167 min,平均(71.0±22.6)min,ESD完整切除病灶45例(45/48,93.75%),穿孔3例(3/48,6.25%),其中1例大出血,1例食管患者ESD术后出现食管狭窄,经内镜下球囊扩张食管狭窄消失。所有病人均完成了术后6个月的内镜随访,1例患者见肿瘤复发。结论 ESD技术对较大病变可以整块切除,并提供完整的病理诊断资料;消化道SMT行ESD术是安全、有效的。     

Esophageal Biopsy Does Not Predict Clinical Outcome after Percutaneous Endoscopic Gastrostomy in Children

Clinically symptomatic gastroesophageal reflux may occur after percutaneous endoscopic gastrostomy (PEG). Preoperative evaluation for gastroesophageal reflux does not reliably predict those individuals who will develop reflux unresponsive to medical management after PEG. Esophageal histology at the time of PEG might be used to identify patients at risk for developing intractable gastroesophageal reflux. The study aim was to correlate the clinical outcome after PEG with esophageal histology at the time of PEG insertion. A retrospective review of 68 consecutive children who had an esophageal biopsy obtained at the time of PEG insertion was undertaken. Preoperative evaluation, esophageal histology, and clinical outcomes were compared. Preoperative gastroesophageal reflux was present in 23% of upper gastrointestinal series performed, in 10% of pH probe studies, and in 29% of reflux scans. Histology was normal in 57% of esophageal biopsies obtained at the time of PEG insertion. Symptomatic gastroesophageal reflux requiring antireflux surgery or conversion to gastrojejunostomy developed in 10% of patients after PEG placement. Only one of these patients had esophagitis on biopsy. In conclusion, preoperative esophageal histology does not reliably predict the development of symptomatic gastroesophageal reflux after PEG placement.     

内镜超声引导下反向切开术治疗食管良性难治性狭窄的初步应用

目的 探讨内镜超声引导下反向切开术治疗食管良性难治性狭窄的疗效及安全性。 方法 回顾性分析2016年1月—2019年12月在南方医科大学顺德医院消化内镜中心行内镜超声引导下反向切开术治疗的17例食管良性难治性狭窄患者的临床资料,观察手术成功率、并发症、临床疗效等。 结果 17例患者均成功一次完成内镜下反向切开术,术后胃镜均能自由通过,操作时间（38.82±24.27）min。17例患者均无大出血、穿孔、感染等严重并发症发生。随访时间3~44个月,4例患者分别于术后3、12、18、26个月再次出现吞咽困难症状,复查胃镜示狭窄复发,余13例患者未出现再次狭窄。 结论 内镜超声引导下反向切开术治疗食管良性难治性狭窄安全、有效,值得进一步研究。     

Endoscopic placement of direct percutaneous jejunostomy tubes in patients with complications after esophagectomy

BACKGROUND: Complications after esophagectomy may prevent oral intake, lead to dependence on total parenteral nutrition, and lengthen hospital stay. Direct percutaneous endoscopic placement of a jejunostomy tube allows enteral feeding in the presence of postoperative complications and eliminates the need for total parenteral nutrition. METHODS: A total parenteral nutrition database was used to identify patients who received total parenteral nutrition because of complications after esophagectomy. Records of all patients subsequently referred for percutaneous endoscopic jejunostomy placement were reviewed. RESULTS: Twenty-five patients with postesophagectomy complications were referred for percutaneous endoscopic jejunostomy placement. A percutaneous endoscopic jejunostomy was successfully placed in 21 patients (84%), all of whom were weaned off total parenteral nutrition. Six patients (29%) in whom percutaneous endoscopic jejunostomy placement was successful died during hospitalization at a mean of 20 days (range 5-40 days) after the procedure for reasons unrelated to percutaneous endoscopic jejunostomy tube insertion. The remaining 15 patients were discharged while receiving nutrition by means of the percutaneous endoscopic jejunostomy. Ten of them had subsequent removal of the percutaneous endoscopic jejunostomy at a mean of 131 days (range 20-281 days). There were no major percutaneous endoscopic jejunostomy-related complications. Minor complications occurred in 4 patients (19%). CONCLUSION: Percutaneous endoscopic jejunostomy placement may be considered in patients with complications after esophagectomy. In these patients, percutaneous endoscopic jejunostomy placement avoids the need for total parenteral nutrition.