Foutch P G, Talbert G A, Waring J P, Sanowski R A
Department of Gastroenterology, VA Medical Center, Phoenix, Arizona.
Am J Gastroenterol. 1988 Feb;83(2):147-50.
Percutaneous endoscopic gastrostomy (PEG) could be potentially more hazardous in patients with prior abdominal surgery. To minimize risk of complications following PEG, we have modified the conventional method to include selection of a "safe gastrocutaneous fistulous tract," using an aspirating, lidocaine-filled syringe and needle. "Safe tracts" prior to PEG placement were determined by simultaneous air return in the aspirating syringe and endoscopic visualization of the intragastric needle. This technique was used to compare the results of PEG in 27 operated and 80 nonoperated patients. Our results show that morbidity and mortality rates and types of complications following PEG in previously operated and nonoperated patients are comparable, but technical success rates are slightly lower in the surgical group (88 vs 100%). The incidence of failed PEGs was highest in patients with partial gastric resection compared to those with intact stomachs (29 vs 5.0% p less than 0.05). PEG was safely and successfully performed in all cases (surgical and nonsurgical) when safe tracts were confirmed. Selection of a safe tract should be made prior to PEG placement, especially in patients with prior abdominal surgery.
经皮内镜下胃造口术（PEG）对于曾接受腹部手术的患者可能具有更大的风险。为了将PEG术后并发症的风险降至最低，我们改进了传统方法，包括使用一个装有利多卡因的抽吸注射器和针头来选择一条“安全的胃皮瘘道”。在放置PEG之前，通过抽吸注射器中的空气回流以及内镜观察胃内针头来确定“安全通道”。我们使用该技术比较了27例接受过手术的患者和80例未接受过手术的患者的PEG结果。我们的结果表明，接受过手术和未接受过手术的患者在PEG术后的发病率、死亡率以及并发症类型相当，但手术组的技术成功率略低（88%对100%）。与胃完整的患者相比，部分胃切除患者的PEG失败发生率最高（29%对5.0%，p<0.05）。当确认安全通道后，所有病例（手术和非手术）的PEG均安全且成功实施。应在放置PEG之前选择安全通道，尤其是对于曾接受腹部手术的患者。
