透视引导下经现有胃造口管放置空肠延长管：391例手术分析

Fluoroscopy-guided jejunal extension tube placement through existing gastrostomy tubes: analysis of 391 procedures.

作者信息

Uflacker Andre, Qiao Yujie, Easley Genevieve, Patrie James, Lambert Drew, de Lange Eduard E

机构信息

Department of Radiology, University of Virginia, Charlottesville, Virginia, USA.

出版信息

Diagn Interv Radiol. 2015 Nov-Dec;21(6):488-93. doi: 10.5152/dir.2015.14524.

DOI:10.5152/dir.2015.14524

PMID:26380895

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4622397/

Abstract

PURPOSE

We aimed to evaluate the safety and efficacy of fluoroscopically placed jejunal extension tubes (J-arm) in patients with existing gastrostomy tubes.

METHODS

We conducted a retrospective review of 391 J-arm placements performed in 174 patients. Indications for jejunal nutrition were aspiration risk (35%), pancreatitis (17%), gastroparesis (13%), gastric outlet obstruction (12%), and other (23%). Technical success, complications, malfunctions, and patency were assessed. Percutaneous gastrostomy (PEG) tube location, J-arm course, and fluoroscopy time were correlated with success/failure. Failure was defined as inability to exit the stomach. Procedure-related complications were defined as adverse events related to tube placement occurring within seven days. Tube malfunctions and aspiration events were recorded and assessed.

RESULTS

Technical success was achieved in 91.9% (95% CI, 86.7%-95.2%) of new tubes versus 94.2% (95% CI, 86.7%-95.2%) of replacements (P = 0.373). Periprocedural complications occurred in three patients (0.8%). Malfunctions occurred in 197 patients (50%). Median tube patency was 103 days (95% CI, 71-134 days). No association was found between successful J-arm placement and gastric PEG tube position (P = 0.677), indication for jejunal nutrition (P = 0.349), J-arm trajectory in the stomach and incidence of malfunction (P = 0.365), risk of tube migration and PEG tube position (P = 0.173), or J-arm length (P = 0.987). A fluoroscopy time of 21.3 min was identified as a threshold for failure. Malfunctions occurred more often in tubes replaced after 90 days than in tubes replaced before 90 days (P < 0.001). A total of 42 aspiration events occurred (OR 6.4, P < 0.001, compared with nonmalfunctioning tubes).

CONCLUSION

Fluoroscopy-guided J-arm placement is safe for patients requiring jejunal nutrition. Tubes indwelling for longer than 90 days have higher rates of malfunction and aspiration.

摘要

目的

我们旨在评估在已有胃造瘘管的患者中，透视引导下放置空肠延长管（J臂）的安全性和有效性。

方法

我们对174例患者进行的391次J臂放置进行了回顾性研究。空肠营养的适应证包括误吸风险（35%）、胰腺炎（17%）、胃轻瘫（13%）、胃出口梗阻（12%）和其他（23%）。评估技术成功率、并发症、故障及通畅情况。经皮胃造瘘（PEG）管位置、J臂走行及透视时间与成功/失败相关。失败定义为无法穿出胃。与操作相关的并发症定义为置管后7天内发生的与置管相关的不良事件。记录并评估管道故障及误吸事件。

结果

新置管的技术成功率为91.9%（95%CI，86.7%-95.2%），置换管的技术成功率为94.2%（95%CI，86.7%-95.2%）（P = 0.373）。围手术期并发症发生在3例患者中（0.8%）。197例患者（50%）出现故障。管道通畅的中位时间为103天（95%CI，71 - 134天）。J臂放置成功与胃PEG管位置（P = 0.677）、空肠营养适应证（P = 0.349）、J臂在胃内的走行与故障发生率（P = 0.365）、管道移位风险与PEG管位置（P = 0.173）或J臂长度（P = 0.987）之间均未发现关联。确定透视时间21.3分钟为失败阈值。90天后置换的管道比90天前置换的管道故障发生率更高（P < 0.001）。共发生42次误吸事件（与无故障管道相比，OR 6.4，P < 0.001）。