Chiò A, Galletti R, Finocchiaro C, Righi D, Ruffino M A, Calvo A, Di Vito N, Ghiglione P, Terreni A A, Mutani R
Second Division of Neurology, Department of Neuroscience, University of Turin, via Cherasco 15, 10126 Turin, Italy.
J Neurol Neurosurg Psychiatry. 2004 Apr;75(4):645-7. doi: 10.1136/jnnp.2003.020347.
Enteral nutrition may be required in amyotrophic lateral sclerosis (ALS), and is usually achieved by percutaneous endoscopic gastrostomy (PEG). As PEG is not indicated in patients with severe respiratory impairment, an alternative is percutaneous radiological gastrostomy (PRG), involving air insufflation into the stomach under fluoroscopic guidance for tube insertion.
To evaluate the safety of PRG and its effect on survival and respiratory function in ALS patients with respiratory failure.
25 consecutive ALS patients with severe dysphagia and forced vital capacity (FVC) <50% underwent PRG after October 2000. They were compared with 25 consecutive ALS patients with FVC <50% who underwent PEG before October 2000. Respiratory function was evaluated before and after the procedure.
The two groups were similar for all relevant characteristics. PRG was successful in all cases, PEG in 23/25. One patient in each group died after the procedure. The mean survival time after the procedure was 204 days in the PRG group and 85 days in the PEG group (p<0.004). Respiratory function decreased more in the PEG group than in the PRG group (p<0.02).
PRG appears to be safer than PEG in ALS patients with moderate or severe respiratory impairment, and is followed by a longer survival.
肌萎缩侧索硬化症（ALS）患者可能需要肠内营养，通常通过经皮内镜下胃造口术（PEG）来实现。由于PEG不适用于严重呼吸功能不全的患者，另一种选择是经皮放射学胃造口术（PRG），即在透视引导下向胃内注入空气以插入胃管。
评估PRG在呼吸衰竭的ALS患者中的安全性及其对生存和呼吸功能的影响。
2000年10月以后，连续25例严重吞咽困难且用力肺活量（FVC）<50%的ALS患者接受了PRG。将他们与2000年10月以前连续25例FVC<50%且接受了PEG的ALS患者进行比较。在手术前后评估呼吸功能。
两组在所有相关特征方面相似。PRG手术全部成功，PEG手术23/25成功。每组各有1例患者术后死亡。PRG组术后平均生存时间为204天，PEG组为85天（p<0.004）。PEG组呼吸功能下降比PRG组更明显（p<0.02）。
对于中度或重度呼吸功能不全的ALS患者，PRG似乎比PEG更安全，且术后生存时间更长。
