Bochicchio Grant V, Guzzo James L, Scalea Thomas M
Division of Clinical and Outcomes Research, The R. Adams Cowley Shock Trauma Center and University of Maryland School of Medicine, Department of Surgery, Baltimore, Maryland, USA.
JSLS. 2006 Oct-Dec;10(4):409-13.
Obesity is reaching epidemic proportions in the United States, and as patients at the extremes of morbid obesity come under the care of surgeons, routine procedures may become increasingly complex in the face of greater body mass. We prospectively evaluated the success rate of percutaneous endoscopic gastrostomy (PEG) placement in a group of morbidly obese patients outside the current classification systems used to stratify obesity.
Patients with a body mass index (BMI) greater than 60 kg/m2 who presented for PEG over a one year period were prospectively enrolled. Each patient underwent attempted PEG placement using the pull method by a single surgeon. Outcome variables included: successful PEG, wound infection, tube dislodgement, or bleeding.
Six patients with BMI > 60 kg/m2 presented for PEG. All patients were in a surgical critical care unit maintained on mechanical ventilation. All underwent successful PEG placement with standard techniques and sustained no post-procedural complications.
In the hands of an experienced surgical endoscopist, percutaneous endoscopic gastrostomy can be safely performed in patients at the extremes of morbid obesity. Future studies are warranted to validate the results of our small series.
肥胖在美国正呈流行趋势，随着极度病态肥胖患者接受外科医生的治疗，面对更大的体重，常规手术可能会变得越来越复杂。我们前瞻性地评估了在一组超出当前用于肥胖分层的分类系统的病态肥胖患者中经皮内镜下胃造口术（PEG）置入的成功率。
前瞻性纳入在一年时间内前来接受PEG治疗的体重指数（BMI）大于60 kg/m²的患者。每位患者由一名外科医生采用牵拉法尝试进行PEG置入。结果变量包括：PEG置入成功、伤口感染、导管移位或出血。
6例BMI>60 kg/m²的患者前来接受PEG治疗。所有患者均在接受机械通气的外科重症监护病房。所有患者均采用标准技术成功置入PEG，且术后无并发症。
在经验丰富的外科内镜医师手中，经皮内镜下胃造口术可在极度病态肥胖患者中安全实施。有必要开展进一步研究以验证我们这一小组病例的结果。
