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姑息性胃肠造口术在恶性肠梗阻伴腹水患者中的应用。

Palliative venting gastrostomy in patients with malignant bowel obstruction and ascites.

机构信息

Section of Interventional Radiology, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

出版信息

Ann Surg Oncol. 2013 Feb;20(2):497-505. doi: 10.1245/s10434-012-2643-5. Epub 2012 Sep 11.

Abstract

BACKGROUND

Fluoroscopic-guided placement of a percutaneous decompression gastrostomy tube (PDGT) is used to palliate patients with malignant bowel obstruction (MBO). We report our clinical experience in cases of MBO and ascites that were known to be technically difficult and at increased risk for complications after PDGT placement.

METHODS

Between October 2005 and April 2010, a total of 89 consecutive oncology patients with MBO and ascites underwent at least one attempt at PDGT placement. We retrospectively reviewed the electronic medical record to collect demographic details, procedure information, and morbidity and mortality data. Kaplan-Meier curves were used to calculate median survival after PDGT.

RESULTS

Ninety-three new gastrostomy encounters occurred in 89 patients. The primary and secondary technical success rates were 72 % (67 of 93) and 77.4 % (72 of 93), respectively. Inadequate gastric distention was the reason for failure in 84.6 % (22 of 26) of the cases in which the initial PDGT attempt was unsuccessful. For ascites management, 13 patients underwent paracentesis and 78 patients underwent placement of an intraperitoneal catheter. The overall complication rate in successful placements was 13.9 %, with a major complication rate of 9.7 %. After PDGT, the median overall survival rate was 28.5 days (95 % confidence interval 20-42).

CONCLUSIONS

PDGT is feasible in the majority of patients with MBO and ascites, although there is an inherent risk of major complications. An intraperitoneal catheter can be used to manage ascites to facilitate PDGT.

摘要

背景

荧光透视引导下经皮减压胃造口管(PDGT)的放置用于缓解恶性肠梗阻(MBO)患者的症状。我们报告了我们在 MBO 和腹水病例中的临床经验,这些病例已知在 PDGT 放置后具有技术难度和增加并发症的风险。

方法

在 2005 年 10 月至 2010 年 4 月期间,共有 89 例患有 MBO 和腹水的肿瘤患者至少进行了一次 PDGT 放置尝试。我们回顾性地查阅了电子病历,以收集人口统计学细节、程序信息和发病率及死亡率数据。Kaplan-Meier 曲线用于计算 PDGT 后中位生存时间。

结果

89 例患者共发生 93 例新胃造口术。主要和次要技术成功率分别为 72%(67/93)和 77.4%(72/93)。在初始 PDGT 尝试失败的 26 例病例中,84.6%(22/26)的原因是胃扩张不足。为了处理腹水,13 例患者进行了腹腔穿刺,78 例患者放置了腹腔内导管。成功放置的总体并发症发生率为 13.9%,严重并发症发生率为 9.7%。PDGT 后,总体中位生存时间为 28.5 天(95%置信区间 20-42)。

结论

尽管存在严重并发症的固有风险,但 PDGT 对大多数患有 MBO 和腹水的患者来说是可行的。腹腔内导管可用于处理腹水以促进 PDGT。

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