经皮内镜胃联合空肠造瘘在普通外科疾病中的应用(附12例报告)

目的:探讨经皮内镜胃造瘘(percutaneous endoscopic gastrostomy,PEG)联合经皮内镜空肠造瘘(percutaneous endoscopic jejunostomy,PEJ)用于治疗普通外科多种疾病的价值。方法:2003年10月至2008年6月我院为12例普通外科疾病患者行PEG联合PEJ治疗,其中术后胃瘫2例,胆汁回输4例,胰头癌致胃十二指肠不全梗阻6例。结果:12例PEG及PEJ均一次性完成,手术成功率100%。2例造瘘管周围感染,患者PEG/J管发挥作用后逐步停用原有鼻胃(肠)管,改静脉营养补液为肠内营养补液,患者病情明显好转,9例带管出院,3例病情恢复后拔除PEG/J管,瘘口愈合,起到了替代原有鼻胃(肠)管的治疗作用;患者带管期间原有的咽喉部不适等症状消失,满意度高于传统的经鼻胃(肠)管。结论:PEG/J管是建立胃(肠)腔与外界通道的一种非常微创、有效和安全的方法,PEG置管可替代普通外科中大部分较长期的经鼻置胃(肠)管和手术胃(肠)造瘘置管,值得推广。

The application of percutaneous endoscopic gastrostomy combined with percutaneous endoscopic jejunostomy in the treatment of general surgical diseases:with a report of 12 cases

Objective:To investigate the value of percutaneous endoscopic gastrostomy(PEG) combined with percutaneous endoscopic jejunostomy(PEJ) in the treatment of general surgical diseases.Methods:Twelve patients with general surgical diseases underwent PEG and PEJ from Oct.2003 to Jun.2008.Two of them got postoperative gastroplegia,4 cases were biliary recycle,and 6 cases were gastroduodenal partial obstruction caused by carcinoma of head of pancreas.Results:Twelve cases underwent PEG and PEJ successfully.Infection around fistula occurred in 2 cases.When the PEG/J tubes began to produce an effect,original nasogastric tube or nasointestinal tube was pulled out.After intravenous nutrition was changed into enteral nutrition,patient's condition markedly improved.9 patients discharged with tubes.PEG/J tubes were extracted in 3 patients who recovered well,and the orificium fistulae healed.PEG/J tube replaced original nasogastric tube or nasointestinal tube.The symptoms such as laryngopharyngeal complaint disappeared.The satisfaction rate of PEG/J tube was higher than traditional nasogastric or nasointestinal tube.Conclusions:PEG/J tube is a mini-invasive,effective and safe method to bridge gastric(intestinal) cavity and external space.PEG can replace most of long-term nasogastric(nasointestinal) tube and gastrointestinal fistula tube put by surgery,and is worthy to be popularized.