Lech Gustaw, Pawłowski Waldemar, Korcz Wojciech, Guzel Tomasz, Dąbrowski Bohdan, Opuchlik Andrzej, Głąbska Dominika, Słodkowski Maciej
Department of General, Gastroenterological and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland.
Department of Neurology, Medical University of Warsaw, Warsaw, Poland.
Wideochir Inne Tech Maloinwazyjne. 2022 Sep;17(3):475-481. doi: 10.5114/wiitm.2022.116703. Epub 2022 Sep 7.
Percutaneous endoscopic gastrostomy (PEG) has become the primary procedure for long-term enteral nutrition of most, but not all patients with dysphagia. Still in some patients gastrostomy may only be performed with open surgical technique (SG). Finally, in some patients due to relative contraindications to both methods, surgeons have to choose one of them.
To compare PEG with SG in terms of effectiveness and safety.
A retrospective study of 612 patients with dysphagia, who underwent PEG (573) or SG (39) was conducted. Authors analysed effectiveness of PEG and SG procedures as well as the type, frequency and treatment methods of complications classified according to Clavien-Dindo Classification.
The rate of all complications was significantly lower for PEG than for SG and a significant effect of the treatment type on the probability of serious complications was observed - notably lower after PEG (OR = 0.21, 95% CI: 0.05-0.8, p = 0.02). The 30-day mortality rate was 1.74% for PEG and 0% for SG. PEG patients who required laparotomy were over 30 times more likely to die than others. No significant effect of the nutrition status on the probability of serious complications was observed (OR = 0.83, 95% CI: 0.51-1.34, p = 0.46).
A significant effect of the treatment type on the probability of serious complications was confirmed. This result was robust to the preoperative patients' nutrition status which was found to be insignificant. A lower risk of postoperative complications, a relatively easy procedure make PEG a procedure of choice in patients with dysphagia.
经皮内镜下胃造口术（PEG）已成为大多数（但并非所有）吞咽困难患者长期肠内营养的主要方法。仍有一些患者只能通过开放手术技术（SG）进行胃造口术。最后，在一些患者中，由于两种方法都存在相对禁忌证，外科医生必须选择其中一种。
比较PEG和SG在有效性和安全性方面的差异。
对612例吞咽困难患者进行了回顾性研究，这些患者接受了PEG（573例）或SG（39例）。作者分析了PEG和SG手术的有效性以及根据Clavien-Dindo分类法分类的并发症类型、发生率和治疗方法。
PEG的所有并发症发生率显著低于SG，并且观察到治疗类型对严重并发症发生概率有显著影响——PEG术后显著更低（OR = 0.21，95%CI：0.05 - 0.8，p = 0.02）。PEG的30天死亡率为1.74%，SG为0%。需要剖腹手术的PEG患者死亡可能性是其他患者的30倍以上。未观察到营养状况对严重并发症发生概率有显著影响（OR = 0.83，95%CI：0.51 - 1.34，p = 0.46）。
证实了治疗类型对严重并发症发生概率有显著影响。这一结果不受术前患者营养状况的影响，术前营养状况被发现无显著意义。术后并发症风险较低、操作相对简单，使得PEG成为吞咽困难患者的首选手术方法。
