Stuart S P, Tiley E H, Boland J P
Department of Surgery, WVU Health Sciences Center/Charleston Division.
South Med J. 1993 Feb;86(2):169-72.
Gastrostomy can be a valuable adjunct to patient care, and percutaneous endoscopic gastrostomy is often considered the method of choice for gastrostomy placement. As with all surgical procedures, however, patient selection is important no matter how the gastrostomy is placed. In a retrospective review of 125 randomly selected patients having gastrostomy tube placement, there were certain groups of patients who received virtually no benefit from gastrostomy and may even have died sooner due to gastrostomy placement. The leading indication for gastrostomy placement was neurologic debilitation; the procedural mortality rate for these patients was 28%. However, patients with pulmonary cachexia or metastatic cachexia had much higher mortality rates: 90% and 37%, respectively. We believe patient selection has been imperfect and that certain patients should not have a gastrostomy tube. These patients suffer the moral indignation of persistent intervention and often die without receiving any real benefit.
胃造口术可以成为患者护理的一项重要辅助手段，经皮内镜下胃造口术通常被认为是胃造口术置管的首选方法。然而，与所有外科手术一样，无论胃造口术如何实施，患者的选择都很重要。在一项对125例随机选择的接受胃造口管置管患者的回顾性研究中，有某些患者群体实际上并未从胃造口术中获益，甚至可能因胃造口术置管而死亡更早。胃造口术置管的主要指征是神经功能衰弱；这些患者的手术死亡率为28%。然而，患有肺恶病质或转移性恶病质的患者死亡率要高得多，分别为90%和37%。我们认为患者的选择并不完美，某些患者不应进行胃造口管置管。这些患者遭受持续干预带来的道德愤慨，而且往往在没有获得任何实际益处的情况下死亡。
