全程CT引导下经皮穿刺胃造瘘的临床应用-论文.pdf

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1、l47生箜鲞箜翅ChineseJournalofClinicalNutrition，June2015，Vo1．23．N0．3·论著·全程CT引导下经皮穿刺胃造瘘的临床应用胡鸿涛姚全军黎海亮郭晨阳程洪涛肖金成耿翔马俊丽【摘要】目的探讨全程CT引导下经皮穿刺胃造瘘的临床应用价值。方法2012年12月至2014年12月，共15例因食管完全性梗阻、复杂食管纵隔气管瘘患者及严重心脏疾病的患者无法经口插管至胃内充气，采用全程cT引导下使用21G穿刺针穿刺至胃内进行充气，然后将胃壁固定至腹壁，使用T型针穿刺胃壁建立胃造瘘通道，经可撕脱鞘置人带球囊的胃造瘘管，充盈球囊，移除可撕脱鞘，完成胃造

2、瘘。结果所有患者均在全程cT引导下完成胃造瘘治疗，治疗成功率达到100％，医生操作时间平均31min。随访期间无严重并发症如腹膜炎、胃结肠瘘及大出血发生，轻微并发症出现6例。3例造瘘口局部感染伴严重肉芽组织增生，经局部清创及消毒换药后痊愈；2例造瘘口食物外渗，更换更粗的胃造瘘管(17G)并重新固定后外渗停止；1例患者在2个月时出现造瘘管脱落，当即返回医院后更换胃造瘘管成功。结论全程CT引导下胃造瘘技术成功率高，并发症轻微，可作为一种有效的治疗手段应用于临床患者。【关键词】CT引导；经皮穿刺；胃造瘘【中图分类号】R459．3【文献标志码】A【文章编号】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