Deitel M, Bendago M, Spratt E H, Burul C J, To T B
Department of Surgery, University of Toronto, Ont.
Can J Surg. 1988 Mar;31(2):102-4.
After 28 patients, studied prospectively, underwent percutaneous endoscopic gastrostomy (PEG) by the Ponsky "pull" technique, another 28 patients underwent PEG by the Russell "introducer" method. These two groups were compared retrospectively with 28 patients who had previously undergone Stamm gastrostomy as an independent operation performed by the same group of surgeons. All procedures were done within a 5-year period. The major indication for gastrostomy was the inability to swallow due to neurologic diseases; a similar number of patients in each group also had pharyngeal blockage, cachexia, respiratory failure and inhalation burns. Percutaneous endoscopic gastrostomy could be done most appropriately under local anesthesia, the "introducer" method requiring less time than the "pull" method, which in turn required less time than the Stamm gastrostomy. Feeding was generally instituted successfully 24 hours after PEG compared with 3 days after Stamm gastrostomy. "Introducer" PEG was not associated with peristomal infection, and the authors postulate that the peristomal infections in the "pull" PEG group were due to oropharyngeal bacteria brought through the abdominal wall by that technique.
28例患者经前瞻性研究后，采用庞斯基“牵拉”技术进行了经皮内镜下胃造口术（PEG），另外28例患者采用拉塞尔“导入器”法进行了PEG。将这两组患者与之前由同一组外科医生独立实施 Stamm 胃造口术的28例患者进行回顾性比较。所有手术均在5年内完成。胃造口术的主要指征是因神经系统疾病导致吞咽困难；每组中患有咽梗阻、恶病质、呼吸衰竭和吸入性烧伤的患者数量相近。经皮内镜下胃造口术在局部麻醉下进行最为合适，“导入器”法所需时间比“牵拉”法少，而“牵拉”法又比 Stamm 胃造口术所需时间少。与 Stamm 胃造口术后3天相比，PEG术后24小时一般就能成功开始喂养。“导入器”PEG未出现造口周围感染，作者推测“牵拉”PEG组的造口周围感染是由该技术经腹壁带入的口咽细菌所致。
