Department of Surgery, George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave. NW, Suite 6B, Washington, DC, 20037, USA.
J Gastrointest Surg. 2017 Sep;21(9):1396-1403. doi: 10.1007/s11605-017-3475-1. Epub 2017 Jun 28.
Percutaneous endoscopic gastrostomy (PEG) and laparoscopic gastrostomy (LG) placements provide enteral access to patients unable to tolerate oral feeds. Limited data comparing PEG and LG outcomes is available in adults. This study compares complications between PEG and LG placements.
A retrospective chart review was completed for patients undergoing PEG or LG placement at a single academic center between 2007 and 2014. Patient demographics, comorbidities, and Charlson Comorbidity Index (CCI) were compared. Logistic regression was utilized to identify independent predictors for complication.
Two hundred and twenty-four patients (164 PEGs and 60 LGs) were evaluated. Patients undergoing LG had a higher incidence of prior surgery (42 vs 20%; P < 0.01) and age-adjusted CCI (5 vs 4; P = 0.01). Return to the OR was more common following PEG than LG (5.5 vs 0%) but did not achieve significance (P = 0.12). There were no differences in 30-day mortality; however, age-adjusted CCI was predictive of 30-day mortality (OR 1.3, 95% CI 1.1-1.6).
Despite increased comorbidities, LG tubes are at least as safe as PEGs. Research should focus on identifying predictive factors associated with post-operative complications to identify which patients would have superior outcomes with LG placement.
经皮内镜胃造口术（PEG）和腹腔镜胃造口术（LG）为无法经口进食的患者提供肠内营养途径。目前仅有少量比较 PEG 和 LG 治疗效果的研究，且多为针对成人患者。本研究旨在比较两种治疗方式的并发症。
对 2007 年至 2014 年期间在一家学术中心接受 PEG 或 LG 置管术的患者进行回顾性图表分析。比较患者的人口统计学、合并症和 Charlson 合并症指数（CCI）。采用逻辑回归分析确定并发症的独立预测因素。
共评估了 224 例患者（164 例行 PEG 术，60 例行 LG 术）。LG 组患者既往手术史（42%比 20%，P < 0.01）和年龄校正 CCI（5 比 4，P = 0.01）发生率更高。PEG 组患者返回手术室的比例高于 LG 组（5.5%比 0%，但无统计学意义，P = 0.12）。两组患者 30 天死亡率无差异，但年龄校正 CCI 是 30 天死亡率的预测因素（OR 1.3，95%CI 1.1-1.6）。
尽管 LG 组患者合并症更多，但与 PEG 相比，LG 管同样安全。研究应集中于确定与术后并发症相关的预测因素，以确定哪些患者接受 LG 置管术的效果更好。
