Bernstein Ondina A, Campbell Jennifer, Rajan Dheeraj K, Kachura John R, Simons Martin E, Beecroft J Robert, Jaskolka Jeffrey D, Ringash Jolie, Ho Chia S, Tan Kong Teng
Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, University Health Network, Toronto, Ontario, Canada.
Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, University Health Network, Toronto, Ontario, Canada.
J Vasc Interv Radiol. 2015 Nov;26(11):1680-6; quiz 1686. doi: 10.1016/j.jvir.2015.07.012. Epub 2015 Aug 24.
To prospectively compare radiologically created pigtail gastrostomy (PG), in which the tube is inserted directly through the abdominal wall, versus peroral image-guided gastrostomy (POG), in which the tube is inserted through the mouth. Pain profiles (primary outcome measure), fluoroscopy times, total room times, technical success, complications, and quality of life (QOL) were measured.
Sixty patients were prospectively randomized to receive 14-F PG or 20-F POG tubes. All patients received prophylactically created gastrostomies before radiation therapy for head and neck squamous-cell carcinoma. Patients receiving palliative treatment were excluded, as were those with established pharyngeal obstruction. Pain was measured by numeric rating scale (NRS) scores for 6 weeks after the procedure and by intraprocedural fentanyl and midazolam doses and postprocedural 24-h morphine doses. Fluoroscopy times, total room times, technical success, complications up to 6 months, and gastrostomy-related QOL (using the Functional Assessment of Cancer Therapy-Enteral Feeding questionnaire) were determined.
Fifty-six patients underwent the randomized procedure. The POG group required significantly higher intraprocedural midazolam and fentanyl doses (mean, 1.2 mg and 67 μg, respectively, for PG vs 1.9 mg and 105 μg for POG; P < .001) and had significantly longer fluoroscopy times (mean, 1.3 min for PG vs 4.8 min for POG; P < .0001). NRS scores, morphine doses, total room times, technical success, complication rates, and QOL did not differ significantly between groups. The one major complication, a misplaced PG in the peritoneal cavity, followed a technical failure of POG creation.
Despite the differences in insertion technique and tube caliber, the measured outcomes of POG and PG are comparable.
前瞻性比较经皮穿刺猪尾胃造口术（PG），即导管直接经腹壁插入，与经口影像引导胃造口术（POG），即导管经口腔插入。测量疼痛情况（主要结局指标）、透视时间、总操作时间、技术成功率、并发症及生活质量（QOL）。
60例患者前瞻性随机分为接受14F的PG管或20F的POG管。所有患者在接受头颈部鳞状细胞癌放疗前预防性造胃瘘。接受姑息治疗的患者以及已存在咽部梗阻的患者被排除。术后6周通过数字评分量表（NRS）评分测量疼痛，术中通过芬太尼和咪达唑仑剂量以及术后24小时吗啡剂量测量疼痛。确定透视时间、总操作时间、技术成功率、6个月内的并发症以及胃造口术相关的生活质量（使用癌症治疗功能评估 - 肠内喂养问卷）。
56例患者接受了随机手术。POG组术中所需咪达唑仑和芬太尼剂量显著更高（PG组平均分别为1.2mg和67μg，POG组为1.9mg和105μg；P <.001），且透视时间显著更长（PG组平均为1.3分钟，POG组为4.8分钟；P <.0001）。两组之间的NRS评分、吗啡剂量、总操作时间、技术成功率、并发症发生率和生活质量无显著差异。一项主要并发症，即PG误置于腹腔，是由于POG造口技术失败导致的。结论：尽管插入技术和导管口径存在差异，但POG和PG的测量结果具有可比性。
