MacFadyen B V, Ghobrial R, Catalano M, Raijman I
Department of Surgery, University of Texas Medical School, Houston 77030.
Surg Endosc. 1992 Nov-Dec;6(6):289-93. doi: 10.1007/BF02498862.
Percutaneous endoscopic gastrostomies have gained wide use for long-term enteral nutrition. However, gastroesophageal reflux and aspiration pneumonia have occurred following this procedure. Initial enthusiasm concerning the ability of intrajejunal feeding to negate the risk of aspiration has been challenged by some reports. In this report, a new method is described for concomitant placement of endoscopic gastrostomy and feeding jejunostomy wherein the tip of the feeding jejunostomy is placed at least 40 cm distal to the pylorus while the gastrostomy tube is used for drainage. Twenty critically ill patients underwent the procedure utilizing general or local anesthesia. Sixty-day follow-up showed one uneventful episode of pulmonary aspiration (5%) after retrograde migration of the jejunal tube into the duodenum. All but two patients (90%) tolerated their tube feedings well. This technique can be easily performed with accurate placement of the PEJ tube distal to the pylorus and is associated with minimal risk of aspiration.
经皮内镜胃造口术已广泛用于长期肠内营养。然而，该手术后出现了胃食管反流和吸入性肺炎。一些报告对空肠内喂养消除误吸风险的能力的最初热情提出了挑战。在本报告中，描述了一种同时放置内镜胃造口术和喂养空肠造口术的新方法，其中喂养空肠造口术的尖端放置在幽门远端至少40厘米处，而胃造口管用于引流。20名重症患者接受了全身或局部麻醉下的该手术。60天随访显示，空肠管逆行移入十二指肠后发生了1次无并发症的肺误吸事件（5%）。除两名患者外，所有患者（90%）对管饲耐受良好。该技术可以轻松完成，PEJ管准确放置在幽门远端，且误吸风险极小。
