Bradford Royal Infirmary, Bradford, UK.
Clin Radiol. 2012 Sep;67(9):843-54. doi: 10.1016/j.crad.2012.01.014. Epub 2012 Jun 8.
To evaluate the variance in current UK clinical practice and clinical outcomes for direct percutaneous radiologically inserted gastrostomy (RIG).
A prospective UK multicentre survey of RIG performed between October 2008 and August 2010 was performed through the British Society of Gastrointestinal and Abdominal Radiology (BSGAR).
Data from 684 patients were provided by 45 radiologists working at 17 UK centres. Two hundred and sixty-three cases (40%) were performed with loop-retained catheters, and 346 (53%) with balloon-retained devices. Sixty percent of all patients experienced pain in the first 24 h, but settled in the majority thereafter. Early complications, defined as occurring in the first 24 h, included minor bleeding (1%), wound infection (3%), peritonism (2%), and tube misplacement (1%). Late complications, defined as occurring between day 2 and day 30 post-procedure, included mild pain (30%), persisting peritonism (2%), and 30 day mortality of 1% (5/665). Pre-procedural antibiotics or anti-methicillin-resistant Staphylococcus aureus (MRSA) prophylaxis did not affect the rate of wound infection, peritonitis, post-procedural pain, or mortality. Ninety-three percent of cases were performed using gastropexy. Gastropexy decreased post-procedural pain (p < 0.001), but gastropexy-related complications occurred in 5% of patients. However, post-procedure pain increased with the number of gastropexy sutures used (p < 0.001). The use of gastropexy did not affect the overall complication rate or mortality. Post-procedure pain increased significantly as tube size increased (p < 0.001). The use of balloon-retention feeding tubes was associated with more pain than the deployment of loop-retention devices (p < 0.001).
RIG is a relatively safe procedure with a mortality of 1%, with or without gastropexy. Pain is the commonest complication. The use of gastropexy, fixation dressing or skin sutures, smaller tube sizes, and loop-retention catheters significantly reduced the incidence of pain. There was a gastropexy-related complication rate in 5% of patients. Neither pre-procedural antibiotics nor anti-MRSA prophylaxis affected the rate of wound infection.
评估当前英国直接经皮放射学引导胃造口术（RIG）的临床实践差异和临床结果。
通过英国胃肠和腹部放射学会（BSGAR），于 2008 年 10 月至 2010 年 8 月进行了一项针对 RIG 的前瞻性英国多中心调查。
45 名放射科医生在 17 个英国中心提供了 684 名患者的数据。263 例（40%）采用环保持导管，346 例（53%）采用球囊保持装置。60%的患者在 24 小时内出现疼痛，但此后多数患者的疼痛得到缓解。早期并发症（定义为在 24 小时内发生）包括轻微出血（1%）、伤口感染（3%）、腹膜炎（2%）和导管错位（1%）。晚期并发症（定义为术后 2 至 30 天发生）包括轻度疼痛（30%）、持续腹膜炎（2%）和 30 天死亡率为 1%（5/665）。术前使用抗生素或抗耐甲氧西林金黄色葡萄球菌（MRSA）预防用药并不影响伤口感染、腹膜炎、术后疼痛或死亡率。93%的病例采用胃固定术。胃固定术降低了术后疼痛（p<0.001），但胃固定术相关并发症发生率为 5%。然而，术后疼痛随胃固定术缝线数量的增加而增加（p<0.001）。胃固定术并不影响总体并发症发生率或死亡率。术后疼痛随管腔大小的增加而显著增加（p<0.001）。与环保持装置相比，球囊保持喂养管的使用与更多的疼痛相关（p<0.001）。
RIG 是一种相对安全的手术，死亡率为 1%，无论是否进行胃固定术。疼痛是最常见的并发症。胃固定术、固定敷料或皮肤缝线、较小的管腔尺寸和环保持导管的使用显著降低了疼痛的发生率。有 5%的患者发生胃固定术相关并发症。术前使用抗生素或抗 MRSA 预防用药并不影响伤口感染的发生率。
