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...     

5例经皮内镜下胃造瘘术的护理——詹红

采用经皮内镜下胃造瘘术行胃造瘘5例,效果满意。其护理要点为：术前加强心理护理;术中严密监测生命体征：术后细致的护理。保持造瘘管通畅,预防感染。减少并发症的发生。     

胃镜下经皮胃造瘘的临床应用

1980 年非手术经皮内镜下胃造瘘术(percutaneous endoscopic gastrostomy, PEG)被介绍应用于临床, 其优点是操作简便、并发症少. 近30年来, PEG临床应用的范围不断扩展,越来越受到重视. 该项技术已在欧美、日本等国家替代外科胃造瘘. 目前PEG已经成为需要长期肠内营养支持患者的首选方法. 本文介绍了PEG技术, PEG的适应证、禁忌证、并发症以及处理方法.     

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...     

经皮内镜下胃造瘘术应用进展

经皮内镜下胃造瘘术(PEG)是20世纪80年代开始应用于临床的一种新的内镜介入技术,主要用于胃肠减压和肠内营养,在国外已广泛应用。此文就其方法、适应症、并发症及禁忌症等作一综述。     

内镜下经皮胃造瘘术的并发症及防治进展

自从1980年第一次报告经内镜下经皮胃造瘘术(percutaneous endoscopic gastrostomy,PEG)以来[1],现已日益较广泛地应用于临床.方法有Pull (Ponsky)、Push(Sachs-Vine)、Introducer(Russell)及Versa(t-fastener)等.目前最常用的是Pull (Ponsky)即提拉式,被认为是比较安全和有效的方法.PEG是一种有创操作,在操作中及操作后都会有并发症出现,而且使用的镇静药物本身就可能加重患者的病情,有1％ ～2％的患者的死亡与操作相关[2].关于并发症的报道显示,因为所选病人以及医疗技术的差异,并发症的发生率有很大差异.总体样本研究显示,PEG的主要轻微并发症率为13％,严重并发症率为8％[3].     

老年人经皮内镜下胃造瘘和小肠造瘘术后长期肠内营养支持的应用

目的评价经皮内镜下胃造瘘术(PEG)和经皮内镜下胃空肠造瘘术(PEGJ)后长期肠内营养支持在老年患者的临床应用。方法对72例行PEG／PEGJ的老年患者进行随访,观察患者的死亡率、造瘘管拔管情况、血清生化指标、营养指标及细胞免疫指标的变化。结果72例中,术后1个月死亡11例(15．3％);4年总死亡率44例(61．1%),主要死亡原因是肺炎;PEG相关的死亡1例,死亡率1．4%。患者术前及术后各点的血清生化指标和营养状况差异无统计学意义,但细胞免疫指标术后各点均高于术前(P<0．01),术前CD4+／CD8+为1．86±1．19,术后1、2、3、4年分别为1．89±1．0、2．21±1．05、2．18±0．93、1．97±0．58,差异有统计学意义(P<0．01)。结论对有吞咽障碍的老年患者长期应用PEG/PEGJ,在维持营养、提高免疫方面是有益的。     

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。     

Bleeding risk with clopidogrel and percutaneous endoscopic gastrostomy

AIM To compare bleeding within 48 h in patients undergoing percutaneous endoscopic gastrostomy(PEG) with or without clopidogrel.METHODS After institutional review board approval, a retrospective study involving a single center was conducted on adult patients having PEG(1/08-1/14). Patients were divided into two groups: Clopidogrel group consisting of those patients taking clopidogrel within 5 d of PEG and the non-clopidogrel group including those patients not taking clopidogrel within 5 d of the PEG.RESULTS Three hundred and nineteen PEG patients were found. One hundred and sixty-eight males and 151 females with mean body mass index 28.47 ± 9.75 kg/m2 and mean age 65.03 ± 16.11 years were identified. Thirtythree patients were on clopidogrel prior to PEG with 286 patients not on clopidogrel. No patients in either group developed hematochezia, melena, or hematemesiswithin 48 h of percutaneous endoscopic gastrostomy(PEG). No statistical differences were observed between the two groups with 48 h for hemoglobin decrease of 2 g/dL(2 vs 5 patients; P = 0.16), blood transfusions(2 vs 7 patients; P = 0.24), and repeat endoscopy for possible gastrointestinal bleeding(no patients in either group). CONCLUSION Based on the results, no significant post-procedure bleeding was observed in patients undergoing PEG with recent use of clopidogrel.     

Survival of geriatric patients after percutaneous endoscopic gastrostomy in Japan

AIM: To examine the long term survival of geriatric patients treated with percutaneous endoscopic gastrostomy (PEG) in Japan. METHODS: We retrospectively included 46 Japanese community and tertiary hospitals to investigate 931 consecutive geriatric patients (≥ 65 years old) with swallowing difficulty and newly performed PEG between Jan 1st 2005 and Dec 31st 2008. We set death as an outcome and explored the associations among patient’s characteristics at PEG using log-rank tests and Cox proportional hazard m...     

Endoscopic ultrasound-guided percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy (PEG) is the method of choice for feeding and nutritional support in patients with a normal gastrointestinal function who require long-term enteral nutrition. We report our experience regarding an alternative endoscopic ultrasound (EUS)-guided PEG technique. A retrospective clinical experience case series study was conducted from January 2019 to November 2019 at a tertiary center. Adult patients deemed unfit for conventional PEG due to absence of transillumination or previous gastric surgery were enrolled. An EUS target was created by filling a glove with saline and placing it in the abdomen. EUS was performed and the target identified from the stomach. The abdominal wall was punctured from the stomach and a guidewire was advanced. The guidewire was knotted to a string, which was passed into the stomach and drawn back through the mouth. The procedure was continued following the traditional technique. Four patients underwent EUS-PEG in our center during the study period. Mean age was 65 years and 50% were male. Two patients (50%) had a body mass index over 30. PEG indications were tongue malignancies (50%), cerebrovascular disease (25%) and dementia (25%). One patient had a Roux-en-Y gastric bypass and percutaneous endoscopic jejunostomy was performed. Technical success rate was 100% and no complications occurred. This case series shows that the EUS-guided PEG technique is a safe alternative in patients deemed unfit for conventional PEG.     

Complications of percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy (PEG) has become the method of choice for mid-to long-term enteral feeding. The majority of complications that occur are minor, but the rare major complications may be life threatening. Some complications occur soon after tube placement, others develop later, when the gastrostomy tract has matured. Older patients with comorbidities and infections appear to be at a greater risk of developing complications. Apart from being aware of indications and contraindications, proper technique of PEG placement, including correct positioning of the external fixation device, and daily tube care are important preventive measures. Adequate management of anticoagulation and antithrombotic agents is important to prevent bleeding, and administration of broad spectrum antibiotics prior to the procedure helps prevent infectious complications. Early recognition of complications enables prompt diagnosis and effective therapy.     

Long-term outcome following placement of percutaneous endoscopic gastrostomy in younger and older patients

Objective. Percutaneous endoscopic gastrostomy (PEG) is the method of choice in maintaining enteral nutrition in patients with swallowing and nutritional disorders of different etiology. The aim of this study was to assess the long-term outcome of patients following placement of a PEG. Material and methods. All patients who received a PEG between October 1999 and September 2000 were included in this prospective study. Long-term function, replacement or removal of the PEG, complications and survival of the patients were analyzed in group A (younger than 75 years) and group B (75 years or older). Results. The indications for PEG placement in group A (54 patients, mean age 54.5 years) were neurological (66.7%) and malignant (31.5%) disorders, whereas in group B (40 patients, mean age 81 years) the indications were predominantly neurological diseases (87.5%). The majority of patients (91 of 94 patients; 96.8%) could be followed long term or until death. In group A, 46 patients (85.2%) had uncomplicated long-term function of their PEG and interventions were necessary in only 8 patients. Removal of the PEG was possible during the course in 17 patients (31.5%). In group B, uncomplicated long-term function was observed in 34 patients (85%) and interventions were required in only 6 patients. Removal of the PEG was not possible in group B. Survival rates for 1-, 2- and 5 years in group A were 73.9%, 61.8% and 43.9%, respectively, and in group B 41.4%, 31.9% and 15.9%, respectively; the difference was statistically significant (p=0.002). Conclusions. Excellent long-term function of PEG was seen in this study of 94 consecutive patients, and interventions were necessary only in a minority of patients. The prognosis for older patients was worse; however, the 2-year survival rate of 32% justified the PEG insertion.     

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.     

经皮内镜胃造瘘患者的循证治疗

目的:探讨经皮内镜胃造瘘临床上常见问题,并为患者制定合理的治疗方案,以控制患者症状,降低死亡率.方法:在充分评估患者的情况后,提出临床问题,从Cochrane图书馆(1995-2010)、MEDLINE(1990-12/2010)、EMBase (1990-12/2010)、SCIE(1990-12/2010)、中国知...     

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.