Wolfsen H C, Kozarek R A, Ball T J, Patterson D J, Botoman V A
Section of Therapeutic Endoscopy, Virginia Mason Clinic, Seattle, Washington 98101.
Gastrointest Endosc. 1990 May-Jun;36(3):261-3. doi: 10.1016/s0016-5107(90)71019-x.
Percutaneous endoscopic gastrostomy (PEG) and jejunostomy (PEJ) have supplanted their surgical counterparts in many institutions. Previous reports have claimed advantages in placing PEJ tubes because of reduced gastroesophageal reflux, prevention of aspiration, and improved tube anchoring distally. We reviewed the records of 191 patients who underwent placement of PEG/J tubes. Data collected included incidence of tube dysfunction, need for tube replacement or removal, and aspiration after PEG or PEJ tube placement. Tube dysfunction, defined as peritube leakage, plugging, fracture, or migration, occurred in 36% of patients over a mean follow-up period of 275 days and was significantly more common and likely to necessitate tube replacement in PEJ patients. Tube trade-out or removal and aspiration within a 30-day period after tube placement occurred in 28% and 10% of patients, respectively. These complications were significantly more common in PEJ patients than in PEG patients. Because of the increased incidence of tube dysfunction and the failure to prevent aspiration in predisposed patients, PEJ tube placement is not routinely indicated in patients requiring tube feedings.
在许多机构中，经皮内镜下胃造口术（PEG）和空肠造口术（PEJ）已取代了传统的外科手术造口术。既往报告称，放置PEJ管具有诸多优势，如可减少胃食管反流、预防误吸以及改善导管在远端的固定。我们回顾了191例行PEG/J管置入术患者的记录。收集的数据包括导管功能障碍的发生率、更换或移除导管的必要性以及PEG或PEJ管置入术后的误吸情况。导管功能障碍定义为导管周围渗漏、堵塞、断裂或移位，在平均275天的随访期内，36%的患者出现了该情况，且在PEJ患者中更为常见，也更有可能需要更换导管。置管后30天内，分别有28%和10%的患者出现导管更换或移除以及误吸情况。这些并发症在PEJ患者中比PEG患者更为常见。由于导管功能障碍的发生率增加，且未能预防易感患者发生误吸，因此对于需要管饲的患者，不常规推荐放置PEJ管。
