全程CT引導(dǎo)下經(jīng)皮穿刺胃造瘺的臨床應(yīng)用-論文.pdf

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1、l47生箜鲞箜翅ChineseJournalofClinicalNutrition，June2015，Vo1．23．N0．3·論著·全程CT引導(dǎo)下經(jīng)皮穿刺胃造瘺的臨床應(yīng)用胡鴻濤姚全軍黎海亮郭晨陽(yáng)程洪濤肖金成耿翔馬俊麗【摘要】目的探討全程CT引導(dǎo)下經(jīng)皮穿刺胃造瘺的臨床應(yīng)用價(jià)值。方法2012年12月至2014年12月，共15例因食管完全性梗阻、復(fù)雜食管縱隔氣管瘺患者及嚴(yán)重心臟疾病的患者無(wú)法經(jīng)口插管至胃內(nèi)充氣，采用全程cT引導(dǎo)下使用21G穿刺針穿刺至胃內(nèi)進(jìn)行充氣，然后將胃壁固定至腹壁，使用T型針穿刺胃壁建立胃造瘺通道，經(jīng)可撕脫鞘置人帶球囊的胃造瘺管，充盈球囊，移除可撕脫鞘，完成胃造

2、瘺。結(jié)果所有患者均在全程cT引導(dǎo)下完成胃造瘺治療，治療成功率達(dá)到100％，醫(yī)生操作時(shí)間平均31min。隨訪期間無(wú)嚴(yán)重并發(fā)癥如腹膜炎、胃結(jié)腸瘺及大出血發(fā)生，輕微并發(fā)癥出現(xiàn)6例。3例造瘺口局部感染伴嚴(yán)重肉芽組織增生，經(jīng)局部清創(chuàng)及消毒換藥后痊愈；2例造瘺口食物外滲，更換更粗的胃造瘺管(17G)并重新固定后外滲停止；1例患者在2個(gè)月時(shí)出現(xiàn)造瘺管脫落，當(dāng)即返回醫(yī)院后更換胃造瘺管成功。結(jié)論全程CT引導(dǎo)下胃造瘺技術(shù)成功率高，并發(fā)癥輕微，可作為一種有效的治療手段應(yīng)用于臨床患者?！娟P(guān)鍵詞】CT引導(dǎo)；經(jīng)皮穿刺；胃造瘺【中圖分類(lèi)號(hào)】R459．3【文獻(xiàn)標(biāo)志碼】A【文章編號(hào)】1674—635X(201

3、5)03—0147。04ClinicalapplicationofwholeCTguidedpercutanousgastrostomyHuHongtao，YaoQua~jun，LiHailiang，GuoChenyang，ChengHongtao，XiaoJincheng，GengXiang，MaJunli．DepartmentofInterventionRa—diology，TheAffiliatedCancerHospitalofZhengzhouUniversity，HenanCancerHospital，Zhengzhou45()(】o3．ChinaCorrespo

4、ndingauthor：LiHailiang，E—mail：．1ihailiang@p．163．corn【Abstract】ObjectiveToexploretheclinicalvalueofwholeCT—guidedpercutaneousgastrostomy．MethodsFromDecember2012toDecember2014，weselectedaconsecutiveseriesof15patientswhocouldnotreceiveoralintubationduetoesophaguscompleteobstruction，complicated

5、esophagotrachealfistulaorsevereheartdisease．AllofthesepatientsunderwentCT—guidedgastrostomy，duringwhichthestomachwasfirstpunc—turedusinga21GChibaneedleandinjectedwithair．Thegastricwallwasthenfixedtotheabdominalwal1．Aftersuccessfulgastropexy，achannelforgastrostomywasestablishedwithaTtrocarne

6、edle．Aballoontubewasadvancedviathetroearneedlewithapeel—awaysheathintothegastriclumenandinflated，thepeel—awaysheathwasthenremoved．ResultsTheCT—guidedgastrostomywasfinishedsuccessfullyinallofthe15pa—tients(successrate100％)．Theaveragetimeofprocedurewas31minutes．Duringthefollow—upperiod，therew

7、erenoseverecomplicationssuchasperitonitis，gastrocolicfistula，andmassivebleeding．Minorcomplicationsoccurredinsixpatients．Threepatientshadlocalinfectionwithseverehyperplasiaofgranulationtissuearoundthegastrostomysite，whichwerecuredbylocaldebridementandster