Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand.
Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand.
Surg Endosc. 2023 Jul;37(7):5109-5113. doi: 10.1007/s00464-023-09984-x. Epub 2023 Mar 16.
Esophageal squamous cell cancer (ESCC) is mostly diagnosed in its later stages, when patients present with dysphagia and weight loss. Esophageal dilation with percutaneous endoscopic gastrostomy (PEG) is a common surgical procedure in patients with locally advanced ESCC because of tumor obstruction and enteral nutrition support during neoadjuvant or definitive concurrent chemoradiotherapy (CCRT). Esophageal dilation with PEG is widely performed under general anesthesia (GA) with endotracheal intubation.
To determine the overall success rate of completing this procedure using intravenous (IV) sedation with dexmedetomidine (DEX) relative to GA and to compare its perioperative conditions, including procedure times, pain scores (visual analog scale), adverse events, and costs.
Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Thailand.
Prospective randomized controlled trial (RCT) of locally advanced ESCC patients who had dysphagia and needed esophageal dilation with PEG between January 2020 and December 2021. Esophageal dilation (using a Savary-Gilliard dilator) and PEG were performed using the pull technique.
Seventy patients were randomly assigned to either the DEX group (n = 34) or the GA group (n = 36). All patients in both groups underwent successful surgery. The DEX group had a significantly shorter procedure time, lower procedure cost, and lower total hospital cost than the GA group. However, there were no significant between-group differences in pain scores or length of hospital stay. There were no serious adverse events in either group; however, the GA group had some incidences of sore throat, transient hoarseness, and atelectasis.
This study found that IV sedation with DEX during esophageal dilation with PEG was as effective and safe as using GA.
食管鳞状细胞癌（ESCC）大多在晚期诊断，此时患者出现吞咽困难和体重减轻。由于肿瘤阻塞和新辅助或根治性同期放化疗期间的肠内营养支持，经皮内镜胃造口术（PEG）在局部晚期 ESCC 患者中是一种常见的手术。PEG 食管扩张术广泛应用于全身麻醉（GA）下经气管插管。
确定使用静脉（IV）镇静剂右美托咪定（DEX）完成该手术的总体成功率，与 GA 相比，并比较其围手术期情况，包括手术时间、疼痛评分（视觉模拟评分）、不良事件和成本。
泰国宋卡王子大学诗里叻医学院宋卡拉林格医院。
这是一项前瞻性随机对照试验（RCT），纳入 2020 年 1 月至 2021 年 12 月间患有吞咽困难且需要进行 PEG 食管扩张术的局部晚期 ESCC 患者。采用拉式技术进行食管扩张（使用 Savary-Gilliard 扩张器）和 PEG。
70 名患者被随机分为 DEX 组（n=34）或 GA 组（n=36）。两组患者均成功完成手术。DEX 组的手术时间、手术费用和总住院费用明显低于 GA 组。然而，两组间疼痛评分或住院时间无显著差异。两组均无严重不良事件；然而，GA 组出现一些咽痛、短暂性声音嘶哑和肺不张。
本研究发现，PEG 食管扩张术时使用 DEX 静脉镇静与 GA 一样有效且安全。
