急性护理手术中“拖出式”与“推入式”经皮内镜下胃造口术的结局比较：拖出式经皮内镜下胃造口术胃管移位发生率报告不足
Comparing Outcomes Between "Pull" Versus "Push" Percutaneous Endoscopic Gastrostomy in Acute Care Surgery: Under-Reported Pull Percutaneous Endoscopic Gastrostomy Incidence of Tube Dislodgement.
作者信息
Kulvatunyou Narong, Zimmerman Steven A, Sadoun Moutamn, Joseph Bellal A, Friese Randall S, Gries Lynn M, O'Keeffe Terence, Tang Andrew L
机构信息
Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona.
Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona.
出版信息
J Surg Res. 2018 Dec;232:56-62. doi: 10.1016/j.jss.2018.06.011. Epub 2018 Jul 3.
BACKGROUND
Percutaneous endoscopic gastrostomy (PEG) complications are often under-reported in the literature, especially regarding the incidence of tube dislodgement (TD). TD can cause significant morbidity depending on its timing. We compared outcomes between "push" and "pull" PEGs. We hypothesized that push PEGs, because of its T-fasteners and balloon tip, would have a lower incidence of TD and complications compared with pull PEGs.
METHODS
We performed a chart review of our prospectively maintained acute care surgery database for patients who underwent PEG tube placement from July 1, 2009 through June 30, 2013. Data regarding age, gender, body mass index, indications (trauma versus nontrauma), and complications (including TD) were extracted. Procedure-related complications were classified as either major if patients required an operative intervention or minor if they did not. We compared outcomes between pull PEG and push PEG. Multiple regression analysis was performed to identify risk factors associated with major complications.
RESULTS
During the 4-y study period, 264 patients underwent pull PEGs and 59 underwent push PEGs. Age, gender, body mass index, and indications were similar between the two groups. The overall complications (major and minor) were similar (20% pull versus 22% push, P = 0.61). The incidence of TD was also similar (12% pull versus 9% push, P = 0.49). However, TD associated with major complications was higher in pull PEGs but was not statistically significant (6% pull versus 2% push, P = 0.21). Multiple regression analysis showed that dislodged pull PEG was associated with major complications (odds ratio 29.5; 95% confidence interval, 11.3-76.9; P < 0.001).
CONCLUSIONS
The incidence of pull PEG TD associated with major complications is under-recognized. Specific measures should be undertaken to help prevent pull PEG TD.
LEVEL OF EVIDENCE
IV, therapeutic.
背景
经皮内镜下胃造口术（PEG）并发症在文献中常常报道不足，尤其是关于导管移位（TD）的发生率。TD根据其发生时间可导致显著的发病率。我们比较了“推式”和“拉式”PEG的结局。我们假设，由于其T形固定器和球囊尖端，推式PEG与拉式PEG相比，TD和并发症的发生率会更低。
方法
我们对前瞻性维护的急性护理手术数据库进行了图表回顾，纳入了2009年7月1日至2013年6月30日期间接受PEG管置入的患者。提取了有关年龄、性别、体重指数、适应证（创伤与非创伤）和并发症（包括TD）的数据。与手术相关的并发症如果患者需要手术干预则分类为严重并发症，如果不需要则分类为轻微并发症。我们比较了拉式PEG和推式PEG的结局。进行多因素回归分析以确定与严重并发症相关的危险因素。
结果
在4年的研究期间，264例患者接受了拉式PEG，59例患者接受了推式PEG。两组之间的年龄、性别、体重指数和适应证相似。总体并发症（严重和轻微）相似（拉式20%对推式22%，P = 0.61）。TD的发生率也相似（拉式12%对推式9%，P = 0.49）。然而，与严重并发症相关的TD在拉式PEG中更高，但无统计学意义（拉式6%对推式2%，P = 0.21）。多因素回归分析显示，移位的拉式PEG与严重并发症相关（比值比29.5；95%置信区间，11.3 - 76.9；P < 0.001）。
结论
与严重并发症相关的拉式PEG TD的发生率未得到充分认识。应采取具体措施以帮助预防拉式PEG TD。
证据级别
IV，治疗性。
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