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首页> 外文期刊>Acta Radiologica >CT fluoroscopy-guided percutaneous gastrostomy with loop gastropexy and peel-away sheath trocar technique in 31 amyotrophic lateral sclerosis patients
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CT fluoroscopy-guided percutaneous gastrostomy with loop gastropexy and peel-away sheath trocar technique in 31 amyotrophic lateral sclerosis patients

机译：CT荧光透视引导下经皮胃造口术配合loop行胃切除术和可剥皮套管针技术治疗31例肌萎缩性侧索硬化症患者

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Background: In amyotrophic lateral sclerosis (ALS) patients with respiratory impairment and/or advanced disease, performing even mild sedation - as is usually necessary for percutaneous endoscopic gastrostomy (PEG) placements - is fraught with risk. These patients are often referred to Interventional Radiology for alternative percutaneous gastrostomy tube placement options. Purpose: To report our experience with CT fluoroscopy-guided percutaneous gastrostomy with a novel loop gastropexy and peel-away sheath trocar technique in ALS patients as an alternative to endoscopic techniques. Material and Methods: A consecutive series of 31 amyotrophic lateral sclerosis patients in whom endoscopic gastrostomy was considered too dangerous or impossible to perform underwent CT-guided percutaneous gastropexy and gastrostomy and prospective follow-up. All procedures were performed with a 15 FR Frekaw Pexact gastrostomy kit, a 16-row CT scanner (Aquilion 16) and single shot CT fluoroscopy mode. Results: The procedure was performed successfully in 30 of 31 patients (20 men, 11 women; median age 60 years, range 38-80 years). In the remaining case the stomach was punctured under CT fluoroscopy and CO 2 insufflation was initiated thereafter, leading to successful gastrostomy without prior gastropexy and without further adverse events during follow-up. Two patients reported unproblematic exchange of a balloon tube due to skin irritations with no further adverse events. One patient reported accidental displacement of an exchanged new balloon tube in domestic environment due to balloon leakage: A new balloon tube was easily re-inserted in a hospital the same day. No serious adverse events such as peritonitis, persistent local bleeding, systemic blood loss, or any local infection requiring surgical intervention were observed. Until August 11, 2011 follow-up resulted in 7473 cumulative gastrostomy-days from the date of first placement. Conclusion: Initial results suggest that the described technique under CT guidance is feasible and safe and may especially be advantageous in cases where endoscopic gastrostomy and sedation are contraindicated.
机译：背景：在患有呼吸功能减退和/或晚期疾病的肌萎缩性侧索硬化症（ALS）患者中，即使经皮内镜下胃造口术（PEG）放置通常也需要进行轻度镇静，这充满了风险。这些患者通常因介入性胃造口术管放置选择而被转介介入放射学。目的：报道我们在CT透视引导下经皮胃造口术的经验，该技术在ALS患者中作为一种新型内窥镜胃切除术和可剥离护套套管针技术，替代了内窥镜技术。材料和方法：连续31例肌萎缩性侧索硬化患者，其内镜下胃造口术被认为太危险或无法进行，因此接受了CT引导的经皮胃造瘘术和胃造口术以及前瞻性随访。所有程序均使用15 FR Frekaw Pexact胃造口术套件，16行CT扫描仪（Aquilion 16）和单次CT荧光检查模式进行。结果：该手术在31例患者中的30例中成功完成（20例男性，11例女性;中位年龄60岁，范围38-80岁）。在剩下的情况下，在CT透视下将胃穿刺，然后开始进行CO 2吹气，从而成功进行了胃造口术，而无需事先进行胃食管扩张术，并且在随访期间没有进一步的不良事件发生。两名患者报告由于皮肤刺激而无问题地更换了球囊管，没有其他不良事件。一名患者报告由于气球泄漏而在家庭环境中意外更换了新的气球管：在同一天，很容易将新的气球管重新插入了医院。没有观察到严重的不良事件，如腹膜炎，持续的局部出血，全身性失血或任何需要手术干预的局部感染。截至2011年8月11日，自首次植入日期起，累计胃造口术累计达7473天。结论：初步结果表明，在CT引导下描述的技术是可行和安全的，在禁忌内镜胃造口术和镇静的情况下尤其有利。

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