超细胃镜辅助Introducer 法胃造瘘术的临床应用*

Clinical application of percutaneous endoscopic gastrostomy with the Introducer method using ultrathin gastroscopy*

摘要:

经皮内镜下胃造瘘术；超细胃镜；吞咽障碍；临床疗效目的 评估Introducer 法经超细胃镜胃造瘘术（PEG）对吞咽障碍患者的临床应用效果及安全性。 方法 回顾性分析该院收治的22 例吞咽障碍患者，6 例患者采用普通胃镜完成胃造瘘术，16 例患者因张口困 难、咽喉部或食管重度狭窄不能通过普通胃镜者则使用超细胃镜经鼻或经口完成PEG，观察临床疗效及并发 症情况。结果 成功实施PEG 22 例，其中2 例鼻咽癌放疗术后张口困难、14 例咽喉部及食管重度狭窄且普 通胃镜不能通过者行经超细胃镜经鼻或经口完成胃造瘘术。普通胃镜PEG 组和超细胃镜PEG 组的操作平均 时间分别为（12.2±2.9）和（11.8±3.2）min，但后者成功率更高、舒适性更好。有1 例患者出现造瘘口感染， 未出现出血、食管和胃肠穿孔、包埋综合征等并发症。预防性PEG 为17 例鼻咽癌和食管癌患者辅助同步放 化疗，完成率达100.0% ；对放疗前后营养指标（血红蛋白、白蛋白、红细胞计数）进行配对t 检验，造瘘后 营养状况改善，差异有统计学意义（P <0.05）。结论 Introducer 法经超细胃镜胃造瘘术是一种更加安全有效 的肠内营养方法，尤其适用于各种原因所致张口困难、咽喉部或食管重度狭窄患者。预防性PEG 有助于晚期 鼻咽癌、食管癌患者完成放化疗周期。

Abstract:

Objective To evaluate the clinical application and security of percutaneous endoscopic gastrostomy (PEG) with the Introducer method using ultrathin gastroseopy in dysphagia patients. Methods Clinical data of 22 cases dysphagia patients implemented with PEG with the Introducer method using ultrathin gastroseopy or conventional gastroseopy were retrospectively analyzed, the clinical effect and the complication were observed. Results 22 patients underwent PEG with the Introducer method using conventional gastroscopy (6 cases) or ultrathin gastroscopy (16 cases). Among the 16 patients underwent PEG using ultrathin gastroseopy by transnasal or peroral approach, 2 cases with trimus by received radiotherapy for nasopharyngeal cancer and 14 cases with pharyngeal or esophagus narrowing, could not completed PEG by conventional gastroscopy. The average procedure time of PEG was (12.2 ± 2.9) min in conventional gastroscopy group and (11.8 ± 3.2) min in control group. No complications were observed in these patients, but the patients in ultrathin gastroseopy group reported less discomfort associated with the procedure. 17 patients with advanced nasopharyngeal carcinoma and esophagus cancer who received PEG could completely finished 6 cycles of concurrent chemoradiotherapy. Paired-sample t test of nutrition indicators (hemoglobin, albumin and RBC) before and after the treatment showed significant difference (P < 0.05). Conclusion PEG with the introducer method using ultrathin gastroseopy is a safe and effective methodof enteral nutrition, Ultrathin gastroscopy reduces the discomfort of the procedure, especially in patients with serious trimus and pharyngeal or esophagus narrowing. For patients with advanced nasopharyngeal carcinoma, preventative PEG improved the tolerance of chemoradiotherapy,reduce the incidence of adverse events.