Department of Radiology, Division of Vascular and Interventional Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA.
J Vasc Interv Radiol. 2010 Jul;21(7):1031-7. doi: 10.1016/j.jvir.2010.04.003. Epub 2010 Jun 11.
To determine the outcome of gastrostomy tube-to-gastrojejunostomy tube conversion on the basis of the method of original gastrostomy tube placement.
One hundred twenty-four patients (age range, 13-87 years; 72 male and 52 female patients) underwent conversion of a primarily placed gastrostomy tube to a gastrojejunostomy tube at the authors' institution between January 2000 and December 2008. The method of original gastrostomy tube placement was radiologic (n = 27), endoscopic (n = 75), laparoscopic (n = 2), or open surgery (n = 20). The method of placement was correlated with the success rates of gastrostomy-to-gastrojejunostomy tube conversion. Medical records and radiologic images were reviewed to determine the frequency of proximal migration of the jejunostomy tube into the stomach. Follow-up data were available for an average of 136 days after gastrostomy-to-gastrojejunostomy tube conversion (median, 63 days; range, 1-1,300 days).
Of 124 gastrostomy tube-to-gastrojejunostomy tube conversions, 109 (87.9%) were successfully performed. Procedural conversion failure occurred in one of the 27 radiologically inserted gastrostomy tubes (3.7%) compared to 14 of the 97 (14%) nonradiologically inserted gastrostomy tubes (P = .19), of which 12 were inserted endoscopically and two were inserted surgically. Of the 109 patients with successful tube conversion, jejunal tip malposition occurred at follow-up in 18 (16.5%). Of these, four patients developed aspiration pneumonia (22%), which contributed to patient death in two. The frequency of jejunal tip malposition was 3.8% (one of 26 patients) for radiologically placed gastrostomy tubes and 20% (17 of 83 patients) for nonradiologically placed gastrostomy tubes (P = .07). Combined, 32% of gastrostomy tubes placed nonradiologically resulted in either procedural failure or eventual jejunal tip malposition, compared to 7.4% of radiologically placed gastrostomy tubes (P = .01).
The frequency of procedural failure or eventual jejunal tip malposition with conversion of radiologically placed gastrostomy tubes to gastrojejunostomy tubes is significantly lower with radiologically placed gastrostomy tubes than with nonradiologically inserted gastrostomy tubes.
根据最初胃造口管放置方法，确定胃造口管至空肠造口管转换的结果。
作者所在机构于 2000 年 1 月至 2008 年 12 月期间对 124 例患者（年龄 13-87 岁；男 72 例，女 52 例）进行了经皮胃造口管至空肠造口管的转换。最初胃造口管放置的方法为放射学（n=27）、内镜（n=75）、腹腔镜（n=2）或开放性手术（n=20）。将放置方法与胃造口管至空肠造口管转换的成功率相关联。回顾病历和影像学图像以确定空肠造口管近端向胃内迁移的频率。胃造口管至空肠造口管转换后平均随访 136 天（中位数 63 天；范围 1-1300 天）。
124 例胃造口管至空肠造口管转换中，109 例（87.9%）成功完成。27 例放射学插入的胃造口管中 1 例（3.7%）出现操作转换失败，而 97 例非放射学插入的胃造口管中 14 例（14%）出现操作转换失败（P=0.19），其中 12 例经内镜插入，2 例经手术插入。在 109 例成功转换的患者中，18 例（16.5%）在随访时出现空肠尖端位置不当。其中 4 例发生吸入性肺炎（22%），导致 2 例患者死亡。放射学放置的胃造口管空肠尖端位置不当的发生率为 3.8%（26 例患者中 1 例），而非放射学放置的胃造口管空肠尖端位置不当的发生率为 20%（83 例患者中 17 例）（P=0.07）。总的来说，非放射学放置的胃造口管中，32%的胃造口管出现操作失败或最终空肠尖端位置不当，而放射学放置的胃造口管中，7.4%的胃造口管出现操作失败或最终空肠尖端位置不当（P=0.01）。
与非放射学插入的胃造口管相比，放射学放置的胃造口管转换为空肠造口管的操作失败或最终空肠尖端位置不当的发生率显著降低。
