经皮内镜下胃造瘘术应用进展

经皮内镜下胃造瘘术应用进展湛先保，李兆申综述许国铭审校自１９７９年Ｐｏｎｓｋｙ等创用经皮内镜下胃造瘘术（Ｐｅｒｃｕｔａｎｅｏｕｓｅｎｄｏｓｃｏｐｉｃｇａｓｔｒｏｓｔｏｍｙ，ＰＥＧ）以来，其在国外已广泛应用。近年来关于ＰＥＧ技术改进、临床应用及并发症方...     

经皮内镜胃造瘘术的临床应用

经皮内镜胃造瘘术（ｐｅｒｃｕｔａｎｅｏｕｓ　ｅｎｄｏｓｃｏｐｉｃ　ｇａｓｔｒｏｓｔｏｍｙ，ＰＥＧ）是一项无需外科手术及全身麻醉的胃造瘘术，由于它具有简单易行、经济实惠、安全快捷等优点，近年来，国内也日益推广应用，已部分地替代了手术胃造瘘术，我院自１９９８年以来先后为２７例脑外伤或脑血管意外的患者施行了手术，效果满意，现总结报告如下。一、临床资料１９９８年２月至２００１年１月住院患者２７例，男２１例，女６例，年龄１８～７９岁，平均５１岁，所有病例均为心脑疾病造成昏迷或神志不清者，在行ＰＥＧ之前大多…     

经皮内镜胃造瘘术

经皮内镜胃造瘘术山东医科大学附属医院（２５００１２）赵幼安Ｐｏｎｓｋｙ等创用经皮内镜胃造瘘术（Ｐｅｒｃｕｔａ－ｎｅｏｕｓＥｎｄｏｓｃｏｐｉｃＧａｓｔｒｏｓｔｏｍｙ，ＰＥＧ）以来，在欧洲、美国、日本等国家已广泛应用于临床。我国近年来也有类似报道。ＰＥＧ...     

经皮内镜下胃造瘘术体会

经皮内镜下胃造瘘术(PEG)是通过内镜的协助，经腹壁穿刺放置胃造瘘管，以达到胃肠道营养或长期胃肠减压之目的。现将我院PEG的体会总结如下。     

经皮内镜下胃造瘘术

１９９４年９月～１９９５年２月共行经皮内镜下胃造瘘术３７例，全部成功，平均手术时间为１５分钟，仅６例出现局部皮肤炎症反应，无任何严重并发症。结果表明：经皮内镜下胃造瘘术安全、便捷、有效，为患者提供了一个不需剖腹手术安放胃造瘘管的新方法，颇具推广价值。本文也对操作经验及注意事项进行了总结。     

经皮内镜下胃造瘘术在长期昏迷患者中的应用

目的探讨经皮内镜下胃造瘘术(PEG)在长期昏迷鼻饲患者中的应用价值。方法对2011年1月至2013年12月我院住院治疗的32例长期昏迷患者行PEG并密切随访,对患者造瘘前后的上消化道出血率、误吸率和吸入性肺炎的发生率进行分析比较。结果造瘘后上消化道出血率、误吸率和吸入性肺炎的发生率均明显低于造瘘前(P0.05)。结论对于长期昏迷的患者,PEG能够减少因为长期置鼻胃管所致的上消化道出血、误吸和吸入性肺炎的发生。     

经皮内镜胃造瘘术的临床应用及护理

自1980年Gauderer MWL和Ponsky JL首先介绍经皮内镜胃造瘘术(Percutaneous endoscopic gastrostomy，PEG)以来，在美国、澳大利亚、欧洲等国家已广泛应用于临床，目前已成为胃造瘘管饲的首选方法。国内也逐渐开展了该项技术并取得了良好效果。但国内相当一部分医院，尤其是基层医院尚未开展，这与临床医师对PEG技术的认识与接受程度、临床科室与内镜医师的合作欠缺有很大关系。现结合我们的临床经验，对PEG的临床应用方法及护理情况介绍如下，供同道参考。     

经皮内镜胃造瘘术10例临床分析

我们自１９９６年４月至１９９８年５月开展经皮内镜胃造瘘术（ｐｅｒｃｕｔａｎｅｏｕｓｅｎｄｏｓｃｏｐｉｃｇａｓｔｒｏｓｔｏｍｙＰＥＧ）１０例,术后对患者进行随访,取得满意疗效。现对于操作技术、并发症预防和处理、造瘘管置换等方面报道如下。一、对象和方法１．病例选择：本组１０例中脑梗塞患者５例,脑出血术后２例,脑外伤术后１例,精神异常昏迷１例,胃底贲门梗阻１例。男６例,女４例;年龄２２～８１岁,平均５４岁。本组例１患者置鼻胃管长达４５９ｄ,导致鼻腔、咽喉及食管部位粘膜糜烂、出血,且因张口呼吸致颞颌关节…     

经皮内镜胃造瘘术的临床应用

经皮内镜胃造瘘术的临床应用赵幼安张尚忠陈建经皮内镜胃造瘘术（ｐｅｒｃｕｔａｎｅｏｕｓｅｎｄｏｓｃｏｐｉｃｇａｓ－ｔｒｏｓｔｏｍｙ，ＰＥＧ）是一项无需外科手术及全身麻醉的胃造瘘技术。我院用美国产的ＰＲＧ２４蘑菇头式胃造瘘管先后为４例患者施行手术，取得满...     

Percutaneous endoscopic gastrostomy (PEG): A critical appraisal

Percutaneous endoscopic gastrostomy (PEG) can quickly, reliably, and safely establish enteral feedings for a wide variety of indications. Morbidity associated with PEG is less than conventional surgical gastrostomy, and no mortality has been reported to date. PEG can be performed safely at the bedside, if needed. Moreover, there is no period of gastric atony, and feedings can be initiated after 1 day. PEG is contraindicated in patients with altered hemostasis or mechanical barriers to apposing the stomach to the anterior abdominal wall. Routine broad spectrum antibiotic prophylaxis may limit procedure-related cellulitis and pneumonia.     

Long-term outcomes of patients receiving percutaneous endoscopic gastrostomy tubes

OBJECTIVE: Percutaneous endoscopic gastrostomy (PEG) tube placement is the preferred method for long-term enteral feeding of patients who are unable to take food by mouth. Despite the widespread acceptance of the procedure, no large-scale study of the long-term outcomes of patients receiving PEG tubes has been reported. The objective of this study was to determine the survival of patients in whom PEG tubes are placed. DESIGN: Retrospective cohort study using data obtained from two computerized databases. SETTING: Department of Veterans Affairs hospitals. PATIENTS: Seven thousand three hundred sixty-nine patients who received a PEG tube in fiscal years 1990 through 1992. RESULTS: For the 7,369 patients, the mean age was 68.1 years and 98.6% were men. PEG tubes were most commonly placed in patients with cerebrovascular disease (18.9%), other organic neurologic disease (28.6%), or head and neck cancer (15.7%). Although the complication rate of the procedure itself was low (4%), because of the severity of their underlying disease, 1,732 patients (23.5%) died during the hospitalization in which the PEG tube was placed. The median survival of the full cohort was 7.5 months. CONCLUSIONS: This study documents the widespread placement of PEG tubes in severely ill patients, half of whom are in the terminal phase of their illness. Further study is needed to determine whether these patients benefit from PEG tube placement in terms of their quality of life and survival. From the Department of Veterans Affairs Health Services Research and Development (HSR&D) Field Program, and the Department of Medicine, Baylor College of Medicine, Houston, Tex. Supported by the Department of Veterans Affairs Health Services Research and Development Houston Field Program. Presented at the 95th annual meeting of the American Gastroenterological Association, New Orleans, La., May 15–18, 1994.     

Laparoscopy-assisted percutaneous endoscopic gastrostomy enables enteral nutrition even in patients with distorted anatomy

AIM:To analyzed whether laparoscopy-assisted percutaneous endoscopic gastrostomy(PEG)could be a valuable option for patients with complicated anatomy.METHODS:A retrospective analysis of twelve patients(seven females,five males;six children,six young adults;mean age 19.2 years)with cerebral palsy,spastic quadriparesis,severe kyphoscoliosis and interposed organs and who required enteral nutrition(EN)due to starvation was performed.For all patients,standard PEG placement was impossible due to distorted anatomy.All the patients qualified for the laparoscopyassisted PEG procedure.RESULTS:In all twelve patients,the laparoscopy-assisted PEG was successful,and EN was introduced four to six hours after the PEG placement.There were no complications in the perioperative period,either technical or metabolic.All the patients were discharged from the hospital and were then effectively fed using bolus methods.CONCLUSION:Laparoscopy-assisted PEG should become the method of choice for gastrostomy tube placement and subsequent EN if PEG placement cannot be performed safely.     

Percutaneous endoscopic gastrostomy feeding in patients with cystic fibrosis

Background—Malnutritionis a common management problem in patients with cystic fibrosis (CF).Various approaches to supplemental nutrition by both parenteral andenteral routes have been used.
Aim—To analyse theefficacy and acceptability of supplemental overnight feeding using apercutaneous endoscopic gastrostomy (PEG) in patients with CF.
Patients—53 patientswith CF (43 adults; age >17 years) with severe pulmonary disease.
Methods—The technicalsuccess and complications of PEG insertion were documented togetherwith changes in nutritional and pulmonary status of the cohort.
Results—PEGtubes were successfully inserted in all patients, with immediatecomplications (respiratory depression) in two (4%) and latecomplications in 13 (25%). Feeding was well tolerated by 50/51 (98%)of the cohort during a mean (SEM) follow up of 14.5 (2.1) months. Theadult cohort had a significant increase in weight and body mass indexat six months which was maintained at 12 months. Serum albuminconcentration remained stable at six months but had fallen by 12 months, although the differences were not statisticallysignificant. These results were reflected in the paediatric cohort.Pulmonary function in those followed up for one year had apparentlystabilised, but the number of admissions to hospital over the yearbefore and the year after PEG did not change. Half of the cohort wereaccepted for heart-lung/lung transplantation, the improvement innutritional status being a prerequisite for this.
Conclusion—SupplementalPEG tube feeding is well tolerated and results in a significantimprovement in nutritional status and an apparent stabilisation ofpulmonary function in severely malnourished CF patients with advancedpulmonary disease.

Keywords:cystic fibrosis; malnutrition; enteral nutrition; percutaneous endoscopic gastrostomy

     

Long-term follow-up of consequences of percutaneous endoscopic gastrostomy (PEG) tubes in nursing home patients

PEG (percutaneous endoscopic gastrostomy) tubes are frequently placed in nursing home patients. The aim of this study was to assess retrospectively the long-term changes in functional and nutritional statuses, tube-related complications, and factors influencing survival in 46 nursing home residents, mean age 73.6 years (range 19–96). Functional status was evaluated by a standard rehabilitation medicine scale. Nutritional status was evaluated by serum albumin and cholesterol concentrations and by weight. PEG-related complications requiring hospitalization or emergency room or clinic evaluations were noted. Additionally, changes in resuscitation status were noted. The predominant indication for PEG placement was dementia (52%). At PEG placement, 48% of patients had total functional impairment. Regardless of the severity of impairment, no patient's functional status improved after PEG. Nutritional status did not improve significantly. Mortality approached 50% and 60% at 12 and 18 months, respectively, and was significantly related to age, resuscitation status, and serum albumin concentration. All patients under 40 years of age at PEG survived, in contrast to 41.3% of patients over 40 years of age (P<0.001). Sixty-three percent of patients who were full code at PEG placement survived, in contrast to 10% of no code patients (P<0.001). Albumin 3.5 g/dl at PEG or thereafter was associated with improved survival (P<0.001) as compared to albumin <3.5 g/dl. PEG-related complications occurred in 34.7% of patients, and the first occurred four months after PEG. We conclude that realistic expectations of what PEG can accomplish be a factor in the decision to place a PEG tube in nursing home patients.     

Increased risk of peristomal wound infection after percutaneous endoscopic gastrostomy in patients with diabetes mellitus

Background. Results of prospective studies on the effect of prophylactic antibiotics before percutaneous endoscopic gastrostomy are conflicting. Factors for increased risk of peristomal wound infection have not been clearly identified.

Aim. To evaluate the incidence of complications of percutaneous endoscopic gastrostomy and to determine the predictors of wound infection.

Patients and Methods. Percutaneous endoscopic gastrostomy was performed on 134 patients in different disease groups between January 1996 and June 2000. Medical records were carefully reviewed for demographic data, indications for percutaneous endoscopic gastrostomy, use of prophylactic antibiotics, complications and comorbid conditions predisposing to wound infection.

Results. Of 134 patients, 22 (16.4%) developed complications after percutaneous endoscopic gastrostomy. Wound infection, the most common complication, occurred in 19 patients (14.2%) and Pseudomonas aeruginosa was the most frequently isolated microorganism. In univariate analysis, non-malignant disease and diabetes mellitus were significantly associated with peristomal wound infection after percutaneous endoscopic gastrostomy. In multivariate analysis, only diabetes mellitus was an independent risk factor for the development of peristomal wound infection after percutaneous endoscopic gastrostomy (p=0.035).

Conclusions. Patients with diabetes mellitus have a higher risk of peristomal wound infection after percutaneous endoscopic gastrostomy.     

经皮内镜下胃造瘘在治疗中风后患者中的应用进展

中风后很多患者都会出现吞咽困难,并且在短时间内无法恢复.经皮内镜下胃造瘘术(percutaneous endoscopic gastrostomy,PEG)可以为中风后吞咽功能障碍的患者提供长期的营养支持,与静脉营养以及传统的鼻胃管治疗相比有很多的优势,因此传统的观念认为PEG可以减少并发症,提高患者的生活质量,但是近年来的关于并发症和死亡率的研究有相反的结果.因此如何选择合适的患者,合适的时机,预测可能出现的各种并发症以及生存时间才能使患者从中获益.本文全面地分析了近年来的研究并对比了早期的研究,阐述了PEG在中风患者中的应用应该个体化综合分析的理念,为临床上PEG应用前提供参考依据.     

经皮内镜下胃造口空肠置管术在良性食管瘘患者中的应用

目的研究经皮内镜下胃造口空肠置管术(PEJ)在良性食管瘘患者中应用的可行性、疗效和并发症。方法观察18例良性食管瘘患者接受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(21.75±5.9)min,成功率为94.44%,未发生置管相关性并发症,置管后并发症的发生率为11.11%,平均导管留置时间为(76.88±21.13)d。结论 PEJ是一项安全有效的治疗方法,具有操作简便、快捷、易于护理、患者痛苦少、易于耐受等优点,适合良性食管瘘患者应用。