Akkersdijk W L, van Bergeijk J D, van Egmond T, Mulder C J, van Berge Henegouwen G P, van der Werken C, van Erpecum K J
Department of Surgery, Utrecht University Hospital, The Netherlands.
Endoscopy. 1995 May;27(4):313-6. doi: 10.1055/s-2007-1005699.
Infection of the gastrostomy opening after placement of a percutaneous endoscopic gastrostomy (PEG) catheter has been reported to occur quite often, especially when the pull method is used. We therefore compared complications occurring with the pull and push methods, and evaluated the role of antibiotic prophylaxis.
In a prospective study, 100 consecutive patients were randomly assigned to group A (pull plus antibiotic prophylaxis: amoxycillin-clavulanic acid 3 x 1.2 g i.v. over 24 hours; 37 patients), group B (pull without antibiotic prophylaxis; 34 patients) and group C (push without antibiotic prophylaxis; 29 patients). The indications for PEG placement were dysphagia due to oropharyngeal tumors (56%), neurological disease (32%), or other (12%). Patients were evaluated twice weekly for one month after the PEG placement.
PEG catheters were successfully placed in 96% of the patients. The total procedure-related complication rate was significantly lower in group A than in groups B and C (28%, 58%, and 70%, respectively; p < 0.01). Major complications occurred in one patient in group A (seeding metastasis of a hypopharyngeal carcinoma in the gastrostomy tract), and in four patients in group B (three cases of peritonitis and one aspiration, resulting in two deaths), but in none of the group C patients. Group A patients experienced fewer peristomal infections than the other two groups (14%, 30%, and 41%, respectively: p = 0.05). The risk of peristomal pain was similar (11%, 15%, and 11%, respectively; p = n.s.). In three patients in group C, the PEG catheter had to be replaced by the pull method, due to repeated dislocation of the balloon catheter.
The complication rate with PEG placement is high with both the push and pull methods. The complication rate with the pull method is significantly reduced when antibiotic prophylaxis is used.
据报道，经皮内镜下胃造口术（PEG）导管置入后胃造口处感染很常见，尤其是采用牵拉法时。因此，我们比较了牵拉法和推注法出现的并发症，并评估了抗生素预防的作用。
在一项前瞻性研究中，100例连续患者被随机分为A组（牵拉法加抗生素预防：阿莫西林 - 克拉维酸3×1.2 g静脉滴注，24小时内完成；37例患者）、B组（牵拉法不使用抗生素预防；34例患者）和C组（推注法不使用抗生素预防；第29例患者）。PEG置入的适应证为口咽肿瘤导致的吞咽困难（56%）、神经系统疾病（32%）或其他（12%）。PEG置入后1个月内，每周对患者评估两次。
96%的患者成功置入PEG导管。A组与操作相关的总并发症发生率显著低于B组和C组（分别为28%、58%和70%；p<0.01）。A组1例患者出现严重并发症（下咽癌在胃造口处种植转移），B组4例患者出现严重并发症（3例腹膜炎和1例误吸，导致2例死亡），但C组患者均未出现严重并发症。A组患者造口周围感染少于其他两组（分别为14%）、30%和41%：p = 0.05）。造口周围疼痛的风险相似（分别为11%、15%和11%；p = 无统计学意义）。C组有3例患者因球囊导管反复脱位，不得不采用牵拉法更换PEG导管。
PEG置入术采用推注法和牵拉法时并发症发生率都很高。使用抗生素预防时，牵拉法的并发症发生率显著降低。
