外科理论与实践

外科理论与实践 ›› 2020, Vol. 25 ›› Issue (02): 120-123.doi: 10.16139/j.1007-9610.2020.02.007

• 论著 • 上一篇    下一篇

经皮胃造瘘术在食管梗阻病人中的应用研究

贾震易a, 陈尼维b, 朱悦琦c, 樊友本a, 高琦a, 王志刚a()   

  1. a.上海交通大学附属第六人民医院 普外科,上海 200233
    b.上海交通大学附属第六人民医院 消化内镜中心,上海 200233
    c.上海交通大学附属第六人民医院 介入放射科,上海 200233
  • 收稿日期:2020-01-08 出版日期:2020-03-25 发布日期:2020-04-25
  • 通讯作者: 王志刚,E-mail: surlab@hotmail.com

Application study of percutaneous gastrostomy in patients with esophageal obstruction

JIA Zhenyia, CHEN Niweib, ZHU Yueqic, FAN Youbena, GAO Qia, WANG Zhiganga()   

  1. a. Department of General Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
    b. Department of Digestive Endoscopy Center, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
    c. Department of Interventional Radiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
  • Received:2020-01-08 Online:2020-03-25 Published:2020-04-25

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摘要：

目的: 分析经皮胃造瘘术（percutaneous gastrostomy, PG）在食管梗阻病人中的应用。方法: 收集2016年9月至2019年9月,在我院因食管梗阻行胃造瘘术病人的临床资料。比较PG与开腹胃造瘘（open gastrostomy, OG）的手术时间、术中出血量、术后疼痛评分（第2、60天）、术后营养启动时间、术后住院时间、60 d并发症发生率、术后第60天体重及血清白蛋白。结果: 共纳入39例,其中12例PG,27例OG,两组病例的基线数据差异无统计学意义（P>0.05）。PG手术时间和出血量分别为（24.6±9.9） min和（8.8±3.0） mL,明显低于OG（61.9±9.1） min（P<0.001）和（26.0±7.8） mL（P<0.001）。PG术后第2天和术后第60天疼痛评分分别为1.60±0.50和0.75±0.50,明显低于OG术后的2.3±0.8（P=0.008）和2.0±0.5（P<0.001）。PG的术后营养启动时间和住院时间分别为（18.8±4.6） h和（2.8±1.0） d;明显少于OG组的（64.3±15.7） h（P<0.001）和（4.4±1.2） d（P<0.001）。OG组有2例失访,PG组和OG组并发症发生率分别为8.3%（1/12）和24.0%（6/25）,两组间差异无统计学意义（P=0.389）。PG组术后第60天的体重和血清白蛋白与术前相比增加值分别为（0.6±0.8） kg和（1.3±0.9） g/L,OG组分别为（0.3±0.7） kg和（-0.1±1.3） g/L,两组血清白蛋白增加值差异有显著统计学意义（P<0.001）。结论: PG是一项安全、有效的微创技术,围术期多项指标均优于OG,可在食管梗阻病人中推广应用。

关键词: 经皮胃造瘘, 开腹胃造瘘, 食管梗阻

Abstract:

Objective: To analyze the application of percutaneous gastrostomy(PG) in patients with esophageal obstruction. Methods: The clinical data of patients undergoing gastrostomy for esophageal obstruction in our hospital from September 2016 to September 2019 were collected. Operative time, intraoperative blood loss, 2-day and 60-day postoperative pain test scores, beginning time of postoperative nutrition support, postoperative length of stay, 60-day morbidity, 60-day postoperative both body weight and serum albumin were compared between PG group and open gastrostomy (OG) group. Results: A total of 39 patients were studied including 12 cases with PG and 27 cases with OG. There was no signi-ficant difference in baseline data between two groups (P>0.05). The operative time and blood loss were (24.6±9.9) min and (8.8±3.0) mL in PG group respectively, which were significantly lower than those [(61.9±9.1) min and (26.0 ±7.8) mL] in OG group (P<0.001, P<0.001). The 2-day and 60-day postoperative pain scores were 1.60±0.50 and 0.75 ±0.50 in PG group respectively, lower significantly than those [(2.3±0.8) and (2.0 ±0.5)] in OG group (P=0.008, P<0.001). Beginning time of postoperative nutrition support [(18.8±4.6) h] and length of stay [(2.8±1.0) d] in PG group were significantly less than those [(64.3±15.7) h and (4.4±1.2) d] in OG group (P<0.001, P<0.001). Two cases lost follow-up in OG group. There was morbidity 8.3% (1/12) in PG group and 24.0% (6/25) in OG group respectively with no significant difference (P=0.389). The increase in 60-day postoperative body weight was (0.6±0.8) kg in PG group and (0.3 ±0.7) kg in OS group. There was significant difference of increase in 60-day postoperative serum albumin between PG group [(1.3±0.9) g/L] and OG group [(-0.1±1.3) g/L] (P<0.001). Conclusions: PG is minimally invasive and safe and effective with perioperative advantage when compared with OG and could be widely applied in patients with esophageal obstruction.

Key words: Percutaneous gastrostomy, Open gastrostomy, Esophageal obstruction

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