Reichle R L, Venbrux A C, Heitmiller R F, Osterman F A
Department of Radiology and Radiologic Science/CVDL, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
J Vasc Interv Radiol. 1995 Nov-Dec;6(6):939-42. doi: 10.1016/s1051-0443(95)71217-9.
The authors expand their experience with a technique for the percutaneous replacement of a feeding jejunostomy tube in patients who have undergone esophagectomy, in which markers placed during the initial surgical jejunostomy are used.
During esophagectomy in eight patients, a loop of jejunum was intubated with a surgical jejunostomy tube. This loop was then fixed to the anterior abdominal wall and marked with metal clips. In eight patients who required late nutritional support, the surgically placed metal clips on the fixed jejunal loop were used as fluoroscopic guides to mark the site for percutaneous access into the jejunum. Once access was obtained and verified with use of the Seldinger technique, a feeding jejunostomy tube was placed percutaneously after tract dilation.
Percutaneous replacement of a feeding jejunostomy tube was successful in all eight patients; in one patient, two placement attempts on successive days were required. No immediate complications occurred. Only one replacement jejunostomy tube has required replacement due to leakage around the tube (mean follow-up, 3.1 months).
Percutaneous replacement of a feeding jejunostomy tube with use of surgically placed clips as guides for access is a safe and effective method for providing late nutritional support in the postesophagectomy patient.
作者拓展了一种在接受食管切除术的患者中经皮更换空肠造口喂养管的技术经验，该技术利用初次手术行空肠造口时放置的标记物。
在8例患者行食管切除术期间，用一根手术空肠造口管插入一段空肠。然后将这段空肠固定于前腹壁，并用金属夹标记。在8例需要后期营养支持的患者中，将手术时置于固定空肠襻上的金属夹用作透视引导，以标记经皮进入空肠的部位。一旦采用Seldinger技术获得并确认进入通道，在扩张通道后经皮放置一根空肠造口喂养管。
8例患者经皮更换空肠造口喂养管均成功；1例患者连续两天进行了两次放置尝试。无即刻并发症发生。仅1根更换的空肠造口管因管周渗漏而需要更换（平均随访3.1个月）。
以手术放置的夹子作为进入引导经皮更换空肠造口喂养管，是为食管切除术后患者提供后期营养支持的一种安全有效的方法。
