Bergstrom L R, Larson D e, Zinsmeister A R, Sarr M G, Silverstein M D
Division of Area General Internal Medicine, Mayo Clinic Rochester, MN 55905, USA.
Mayo Clin Proc. 1995 Sep;70(9):829-36.
To determine the indications for use of surgical gastrostomy (SG) and surgical jejunostomy (SJ) as feeding tubes, the complications, and the trends in the use of SG and SJ after the introduction of percutaneous endoscopic gastrostomy (PEG) at our institution in 1981.
We conducted a retrospective, population-based cohort study of residents of Olmsted County, Minnesota, who received surgically placed feeding tubes between 1976 and 1989.
The medical records of all Olmsted County residents with surgical placement of a feeding tube during the designated study period were reviewed, and underlying conditions, complications, and survival were analyzed.
Of 77 adult patients (mean age, 66 years; 48% women), 54 underwent SG and 23 had SJ. General anesthesia was used in 42 patients (55%). The indications for SG or SJ were stroke in 23 patients, cancer in 19, other central nervous system-related conditions in 16, and other conditions in 19. Among the numerous comorbid conditions, pulmonary disease (N = 44) and cardiac disease (N = 32) were most frequent. The median duration of follow-up was 181 days. Complications occurred in 31 of 54 patients (57%) with SG and in 13 of 23 (57%) with SJ. Of the 117 complications, 15% were considered major. Twenty patients (26%) resumed eating. Survival at 1, 6, and 12 months was 79%, 49% and 36%, respectively. Most deaths were due to the disease for which the feeding tube had been placed. In a Cox proportional hazards regression analysis, only age and hypoxemia were found to be significantly associated with survival. Hypoxemia, type of tube, central nervous system disease as indication for procedure, and previous aspiration were associated with failure to resume eating (P < 0.05). Survival was similar to that for our patients with PEG during the same period. The overall incidence of feeding tube placement increased throughout the study period.
Patients who require enteral feeding tubes have multiple comorbid conditions that have a major influence on the outcome. The overall incidence of feeding tube placement increased after the introduction of PEG. In patients who require long-term enteral nutrition and are unable to have a feeding tube placed percutaneously, surgically placed feeding tubes have outcomes similar to those reported for patients with PEG.
确定手术胃造口术（SG）和手术空肠造口术（SJ）作为饲管的使用指征、并发症，以及1981年我院引入经皮内镜胃造口术（PEG）后SG和SJ的使用趋势。
我们对明尼苏达州奥尔姆斯特德县在1976年至1989年间接受手术置入饲管的居民进行了一项基于人群的回顾性队列研究。
回顾了在指定研究期间所有奥尔姆斯特德县接受手术置入饲管居民的病历，并分析了基础疾病、并发症和生存率。
77例成年患者（平均年龄66岁；48%为女性）中，54例行SG，23例行SJ。42例患者（55%）使用了全身麻醉。SG或SJ的指征为中风23例、癌症19例、其他中枢神经系统相关疾病16例、其他疾病19例。在众多合并症中，肺部疾病（N = 44）和心脏疾病（N = 32）最为常见。中位随访时间为181天。54例SG患者中有31例（57%）发生并发症，23例SJ患者中有13例（57%）发生并发症。在117例并发症中，15%被认为是严重的。20例患者（26%）恢复进食。1个月、6个月和12个月时的生存率分别为79%、49%和36%。大多数死亡是由于置入饲管所针对的疾病。在Cox比例风险回归分析中，仅发现年龄和低氧血症与生存率显著相关。低氧血症、饲管类型、作为手术指征的中枢神经系统疾病以及既往误吸与未能恢复进食相关（P < 0.05）。生存率与同期接受PEG的患者相似。在整个研究期间，饲管置入的总体发生率有所增加。
需要肠内饲管的患者有多种合并症，对预后有重大影响。PEG引入后，饲管置入的总体发生率增加。对于需要长期肠内营养且无法经皮置入饲管的患者，手术置入饲管的结局与PEG患者报道的相似。
