de Bucourt Maximilian, Collettini Federico, Althoff Christian, Streitparth Florian, Greupner Johannes, Hamm Bernd, Teichgräber U K
Department of Radiology, Charité - University Medicine, Berlin, Germany.
Acta Radiol. 2012 Apr 1;53(3):285-91. doi: 10.1258/ar.2011.110662. Epub 2012 Feb 27.
In amyotrophic lateral sclerosis (ALS) patients with respiratory impairment and/or advanced disease, performing even mild sedation - as is usually necessary for percutaneous endoscopic gastrostomy (PEG) placements - is fraught with risk. These patients are often referred to Interventional Radiology for alternative percutaneous gastrostomy tube placement options.
To report our experience with CT fluoroscopy-guided percutaneous gastrostomy with a novel loop gastropexy and peel-away sheath trocar technique in ALS patients as an alternative to endoscopic techniques.
A consecutive series of 31 amyotrophic lateral sclerosis patients in whom endoscopic gastrostomy was considered too dangerous or impossible to perform underwent CT-guided percutaneous gastropexy and gastrostomy and prospective follow-up. All procedures were performed with a 15 FR Freka® Pexact gastrostomy kit, a 16-row CT scanner (Aquilion 16) and single shot CT fluoroscopy mode.
The procedure was performed successfully in 30 of 31 patients (20 men, 11 women; median age 60 years, range 38-80 years). In the remaining case the stomach was punctured under CT fluoroscopy and CO2 insufflation was initiated thereafter, leading to successful gastrostomy without prior gastropexy and without further adverse events during follow-up. Two patients reported unproblematic exchange of a balloon tube due to skin irritations with no further adverse events. One patient reported accidental displacement of an exchanged new balloon tube in domestic environment due to balloon leakage: A new balloon tube was easily re-inserted in a hospital the same day. No serious adverse events such as peritonitis, persistent local bleeding, systemic blood loss, or any local infection requiring surgical intervention were observed. Until August 11, 2011 follow-up resulted in 7473 cumulative gastrostomy-days from the date of first placement.
Initial results suggest that the described technique under CT guidance is feasible and safe and may especially be advantageous in cases where endoscopic gastrostomy and sedation are contraindicated.
在患有呼吸功能障碍和/或晚期疾病的肌萎缩侧索硬化症（ALS）患者中，即使进行轻度镇静——这是经皮内镜下胃造口术（PEG）置管通常所需的——也充满风险。这些患者常被转介至介入放射科，以寻求替代的经皮胃造口管置管方案。
报告我们在ALS患者中使用新型环形胃固定术和可剥离鞘套管针技术进行CT透视引导下经皮胃造口术的经验，作为内镜技术的替代方法。
连续31例肌萎缩侧索硬化症患者，他们被认为进行内镜下胃造口术过于危险或无法实施，接受了CT引导下经皮胃固定术和胃造口术，并进行了前瞻性随访。所有手术均使用15FR Freka® Pexact胃造口套件、16排CT扫描仪（Aquilion 16）和单次CT透视模式。
31例患者中有30例手术成功（20例男性，11例女性；中位年龄60岁，范围38 - 80岁）。在其余1例中，在CT透视下穿刺胃，随后开始注入二氧化碳，成功进行了胃造口术，无需预先进行胃固定术，且随访期间无进一步不良事件。2例患者因皮肤刺激报告球囊管更换顺利，无进一步不良事件。1例患者报告在家中因球囊漏气，更换的新球囊管意外移位：同一天在医院轻松重新插入了新的球囊管。未观察到严重不良事件，如腹膜炎、持续性局部出血、全身性失血或任何需要手术干预的局部感染。截至2011年8月11日的随访结果显示，自首次置管之日起累积胃造口天数达7473天。
初步结果表明，所述的CT引导下技术可行且安全，尤其在禁忌内镜下胃造口术和镇静的情况下可能具有优势。
