Hunter J G, Lauretano L, Shellito P C
Department of Surgery, University of Utah Medical Center, Salt Lake City 84132.
Ann Surg. 1989 Jul;210(1):42-6. doi: 10.1097/00000658-198907000-00006.
Unique problems accompany percutaneous endoscopic gastrostomy (PEG) in head and neck cancer patients. This study analyzed the experience of one surgeon (P.S.) performing PEG in 50 patients with advanced oropharyngeal cancer. The records of 54 such patients consecutively referred for PEG at the Massachusetts General Hospital were reviewed. A pull-through PEG technique was used. The procedure was successful in 50 patients (success rate, 93%). Failures were caused by esophageal stricture, respiratory distress, and hiatus hernia. The two patients with insurmountable esophageal stricture had piriform sinus tumors. Cancer in this location and pharyngoesophageal strictures were predictive of PEG failure. A single death, 21 days after endoscopy, was caused by pneumonia. The only major complications were two transient respiratory arrests. Neither patient had a tracheostomy in place, and both had unresected cancer present. Minor complications were transient gastroparesis, pneumonia, unexplained fever, and a broken traction suture. There were no wound or intraabdominal infections and no episodes of bleeding. While PEG was successful in 93% of these difficult patients, with few complications, results could be improved by tracheostomy or resection performed before PEG in patients with tumors near the airway and dilatation of troublesome esophageal strictures under endoscopic view before PEG.
头颈部癌症患者进行经皮内镜下胃造口术（PEG）会伴随一些独特的问题。本研究分析了一位外科医生（P.S.）为50例晚期口咽癌患者实施PEG的经验。回顾了在马萨诸塞州总医院连续接受PEG治疗的54例此类患者的记录。采用了拉出式PEG技术。该手术在50例患者中成功（成功率93%）。失败原因包括食管狭窄、呼吸窘迫和食管裂孔疝。两名患有无法克服的食管狭窄的患者患有梨状窦肿瘤。该部位的癌症和咽食管狭窄是PEG失败的预测因素。1例患者在内镜检查后21天因肺炎死亡。仅有的主要并发症是2次短暂的呼吸骤停。两名患者均未行气管造口术，且均有未切除的癌症。轻微并发症包括短暂性胃轻瘫、肺炎、不明原因发热和牵引缝线断裂。未发生伤口或腹腔内感染，也无出血事件。虽然PEG在93%的这些困难患者中取得成功，且并发症较少，但对于气道附近有肿瘤的患者，在PEG之前进行气管造口术或切除术，以及在PEG之前在内镜直视下扩张棘手的食管狭窄，可能会改善结果。
