Maetani Iruru, Yasuda Masatoshi, Seike Masahiro, Ikeda Masaki, Tada Tomoko, Ukita Takeo, Sakai Yoshihiro
Division of Gastroenterology, Department of Internal Medicine, Toho University Ohashi Hospital, Tokyo, Japan.
Gastrointest Endosc. 2005 Apr;61(4):522-7. doi: 10.1016/s0016-5107(05)00012-x.
With the conventional pull method of PEG placement, there is a significant risk of wound infection from contamination of the gastrostomy catheter as it passes through the oral cavity. This study compared the occurrence of peristomal wound infection associated with PEG placement with and without use of an overtube.
Consecutive patients with dysphagia were randomized to undergo PEG placement with (Group I) or without (Group II) an overtube. For each patient, the peristomal area was evaluated daily for 1 week after PEG placement. The presence of erythema and of exudate were scored on a scale of 0 to 4; induration was scored on a scale of 0 to 3. Criteria for infection were a maximum combined score of 8 or higher, or the presence of microscopic and microbiologic evidence of suppurating exudate. In each group, cefazolin was administered prophylactically (2 g/d intravenously) for 3 days. For patients who had received an antibiotic(s) before PEG placement, the same antibiotic(s) was used. All procedures in both groups were performed by one of two investigators who used the pull method.
A total of 76 patients were randomized; 3 were excluded from analysis, because death occurred within 1 week after the procedure. Two of 3 deaths were procedure-related (aspiration pneumonia in Group I, peritonitis in Group II). Data for 37 patients in Group I and 36 in Group II were analyzed. There was no significant difference between the groups with respect to baseline characteristics. The occurrence of peristomal infection within 1 week of PEG was significantly lower in Group I compared with Group II (2 vs. 12; p = 0.0029). The mean daily combined scores in Group I also were significantly lower than those in Group II ( p < 0.0001), and the median maximum parameter scores in Group I were significantly lower than those in Group II (erythema, p = 0.0062; induration, p = 0.0390; exudate, p < 0.0001), although the nominal significance for induration was removed by correction for the multiple testing of data. One patient excluded from Group II died from sepsis because of procedure-induced peritonitis. Among the 73 enrolled patients, there was no procedure-related mortality or clinically important wound infections that required surgical intervention in either group.
Use of an overtube during PEG placement reduces the risk of peristomal wound infection.
采用传统的经皮内镜下胃造口术（PEG）置管牵拉法时，胃造口导管经口腔穿出过程中存在伤口感染的重大风险。本研究比较了使用和不使用外套管进行PEG置管时，造口周围伤口感染的发生率。
将连续的吞咽困难患者随机分为两组，一组在PEG置管时使用外套管（I组），另一组不使用外套管（II组）。对每位患者在PEG置管后1周内每天评估造口周围区域。红斑和渗出液的存在情况按0至4分进行评分；硬结按0至3分进行评分。感染标准为综合评分最高达到8分或更高，或存在脓性渗出液的显微镜和微生物学证据。每组患者均预防性静脉注射头孢唑林（2 g/天），共3天。对于PEG置管前已接受抗生素治疗的患者，使用相同的抗生素。两组的所有操作均由两名采用牵拉法的研究人员之一进行。
共有76例患者被随机分组；3例被排除在分析之外，因为在手术后1周内死亡。3例死亡中有2例与手术相关（I组为吸入性肺炎，II组为腹膜炎）。对I组的37例患者和II组的36例患者的数据进行了分析。两组患者的基线特征无显著差异。与II组相比，I组在PEG置管后1周内造口周围感染的发生率显著更低（2例 vs. 12例；p = 0.0029）。I组的每日平均综合评分也显著低于II组（p < 0.0001），I组的最大参数中位数评分显著低于II组（红斑，p = 0.0062；硬结，p = 0.0390；渗出液，p < 0.0001），不过硬结评分的名义显著性经数据多重检验校正后消失。II组中有1例被排除的患者因手术引起的腹膜炎死于败血症。在73例入组患者中，两组均未发生与手术相关的死亡或需要手术干预的具有临床重要意义的伤口感染。
PEG置管时使用外套管可降低造口周围伤口感染的风险。
