经皮胃镜下胃和小肠造瘘术建立肠内营养途经

目的：探讨经皮胃镜下胃和小肠造瘘术建立肠内营养途经的方法。方法：对24例患者采用Pull法经皮胃镜行胃造瘘术（PEG），另3例小肠造瘘术（PEJ）在胃造瘘基础上用异物钳钳夹胃腔内小肠造瘘管，推送胃镜将其送至Trize韧带阶下。结果：PEG成功率为100％。通过改良胃镜下直接置管方法，3例PEJ全部一次放置成功；3例局部有活动性出血，局部稍拉紧外固定片后，出血停止；4例局部有分泌物及红肿，经碘伏消毒、应用抗生素而治愈，未出现严重并发症。结论：PEG简单、安全、可行，PEJ的改良方法可一次使小肠造瘘管到达空肠，有一定应用价值。

Percutaneous endoscopic gastrostomy and percutaneous endoscopic jejunostomy to set up the way of enteral nutrition

Objective To explore the establishment of enteral nutrition through percutaneous endoscopic gastrostomy and percutaneous endoscopic jejunostomy.Methods PEG tubes were placed in twenty four patients with Pull's.On the basis of PEG,PEJ tubes,clipped by the object clip in gastral cavity,were placed under Trize ligament in 3 patients by pushing endoscopy.Results All PEG insertion can be performed successfully.PEJ tubes in 3 patients were placed successfully using the new method.Three patients had very few hemorrhage and four patients had slight infection around tube,which were cured by sterilization with iodophors and antibiotics.There was no severe complication.Conclusion PEG is simple,safe and efficient.The new method of PEJ allows the tube to reach the jejunum only in one attempt,which should should be widely applied.