经皮透视下胃造瘘术后出血危险因素分析

目的：探讨X线透视下经皮胃造瘘（percutaneous fluoroscopical gastrostomy，PFG）术后出血的发生率，并分析术后出血相关危险因素。方法：回顾性分析2015年10月至2019年12月221例住院行PFG患者的临床资料，记录患者的性别、年龄、病因、营养状态、术前CT显示的胃与肠道及肝脏的相对位置、穿刺外口与内口部位、术后是否用明胶海绵加压包扎，分析PFG术后出血相关危险因素。结果：221例患者中有31例发生术后瘘口出血，发生率为14.03%。患者营养状态、穿刺外口位置、穿刺内口位置、术后是否使用明胶海绵包扎及术者经验是影响PFG术后出血的因素（P<0.05）。结论：舟状腹、穿刺外口位于腹直肌中部、穿刺内口位于胃体中部，术后未用明胶海绵加压包扎、术者行PFG少于50例为PFG术后出血的危险因素，提示术前谨慎评估出血风险并制定相应的手术预案，术后使用明胶海绵包扎可减少PFG术后出血的发生。

Analysis of the risk factors for bleeding after percutaneous fluoroscopic gastrostomy

Objective: To investigate the incidence of bleeding after X-ray-guided percutaneous fluoroscopic gastrostomy (PFG) and and analyze the risk factors associated with postoperative bleeding. Methods: The clinical data of 221 hospitalized patients who underwent PFG from October 2015 to December 2019 were retrospectively analyzed. The gender, age, etiology, nutritional status, the relative position of stomach, intestine and liver relative location shown by CT before the operation, the location of puncture external and internal orifice, and whether gelatin sponge pressure bandage after operation were reviewed, and the relationships between them and postoperative bleeding were analyzed. Results: There were 31 cases of postoperative fistula bleeding in 221 patients, the incidence was 14.03%. The nutritional status of the patients, the location of the external and internal puncture sites, whether to use gelatin sponge dressing after the operation, and the experience of the operator were the factors influencing the postoperative bleeding of PFG (P<0.05). Conclusions: The risk factors of postoperative bleeding include scaphoid abdomen, the external puncture site is in the middle of rectus abdominis, the internal puncture site is in the middle of the gastric body, pressure bandage without gelatin sponge after the operation, and operator proceeded less than 50 cases of PFG, indicating that postoperative bleeding risk should be carefully assessed and corresponding operation plan should be made before the operation and gelatin sponge dressing could reduce the incidence of postoperative bleeding.