Cardiovascular and Interventional Radiology, Inova Alexandria Hospital, 4320 Seminary Road, Alexandria, VA, 22304, USA.
Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
Abdom Radiol (NY). 2019 May;44(5):1894-1900. doi: 10.1007/s00261-019-01905-8.
To report the transnasal stent-assisted targeting technique for percutaneous jejunostomy placement in patients with hiatal hernias.
Four patients, including three (75%) females and one (25%) male, with mean age of 77.5 years (range 73-78 years), and with a hiatal hernia and intrathoracic stomach precluding gastrostomy placement and loop snare placement into the mid-jejunum underwent the transnasal stent-assisted targeting technique for percutaneous jejunostomy placement. In all patients, a duodenal stent was inserted into the jejunum in a transnasal fashion. The stent was partially unsheathed in an anterior loop of jejunum and percutaneously targeted using an 18-gauge needle through which a guidewire was advanced, trapped within the stent, and removed through the nose. The tract was serially dilated and a jejunostomy was placed. Technical success, procedure time, fluoroscopy time, radiation exposure, complications, time to enteral feeding, and follow-up were recorded.
Technical success was 100% (4/4) with all four patients requiring only one needle pass before successful jejunal cannulation. Mean procedure time was 108 min. Mean fluoroscopy time was 44 min. Mean dose area product was 3969.3 μGym. No minor or major complications occurred. All four patients received enteral feeding one day after the procedure. Mean follow-up was 366 days.
The transnasal stent-assisted targeting technique is a novel method for primary jejunostomy placement in patients with hiatal hernias.
报告经鼻支架辅助靶向技术在食管裂孔疝患者中行经皮空肠造口术的置管方法。
4 名患者，包括 3 名（75%）女性和 1 名（25%）男性，平均年龄 77.5 岁（73-78 岁），因存在食管裂孔疝和胸腔内胃，无法进行胃造口术和套圈圈套至空肠中段，故采用经鼻支架辅助靶向技术行经皮空肠造口术。所有患者均采用经鼻方式将十二指肠支架置入空肠。支架部分暴露于空肠前环，通过 18 号穿刺针经皮靶向穿刺，将导丝推进，困于支架内，并通过鼻腔取出。通过一系列扩张器扩张建立空肠造口。记录技术成功率、手术时间、透视时间、辐射暴露、并发症、开始肠内喂养的时间和随访情况。
技术成功率为 100%（4/4），所有 4 名患者在成功进行空肠穿刺前仅需进行一次针穿。平均手术时间为 108 分钟。平均透视时间为 44 分钟。平均剂量面积乘积为 3969.3 μGym。无轻微或严重并发症发生。所有 4 名患者在术后第 1 天均接受肠内喂养。平均随访时间为 366 天。
经鼻支架辅助靶向技术是一种治疗食管裂孔疝患者经皮空肠造口术的新方法。
