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目的:探讨胃癌伴梗阻病人三种经内镜肠内营养(EN)通路建立的方法和效果,为胃癌伴梗阻的病人提供营养支持。方法:将71例胃癌伴梗阻的病人按EN通路建立方法分为A组(经内镜异物钳夹持放置鼻饲管,n=39)、B组(经内镜导丝交换法放置鼻饲管,n=18)和C组[经皮经内镜下胃造口/空肠置管术(PEJ),(n=14)]。比较三种置管方法的操作时间、成功率、相关并发症和置管后并发症的发生率。结果:本组有67例病人成功经内镜建立EN通路,操作过程中无一例出现置管相关并发症。A组置管时间为(10.68±3.15)min,置管成功率为94.9%(37/39);B组置管时间为(15.88±3.74)min,置管成功率为94.4%(17/18);C组置管时间为(16.07±3.4)min,置管成功率为92.8%(13/14)。结论:三种经内镜EN通路建立的方法均安全、可行,成功率高。前两种方法适合于围手术期需要接受EN治疗的病人,而PEJ更适用于晚期胃癌病人的EN支持治疗。
Objective: To investigate the methods and effects of three endoscopic enteral nutrition (EN) pathways in patients with gastric cancer and obstruction, and to provide nutritional support for gastric cancer with obstruction. Methods: 71 patients with gastric cancer with obstruction were enrolled into group A (n = 39 with endoscopic clamp, n = 39), group B (nasogastric tube placed by endoscopic wire exchange method, n = 18) and Group C [percutaneous endoscopic gastrostomy / jejunal catheterization (PEJ), (n = 14)]. The operation time, success rate, related complications and incidence of complications after catheterization were compared between the three methods. Results: 67 patients in this group were successfully established endoscopic EN pathway by endoscopy. No catheter-related complications occurred during operation. The duration of catheterization in group A was (10.68 ± 3.15) min, the success rate of catheterization was 94.9% (37/39), that of group B was (15.88 ± 3.74) min, and the success rate of catheterization was 94.4% (17/18) ). The catheterization time in group C was (16.07 ± 3.4) min, and the success rate of catheterization was 92.8% (13/14). Conclusion: The three methods of endoscopic EN pathway are safe, feasible and high success rate. The first two methods are suitable for perioperative patients who require EN treatment, while PEJ is more suitable for EN supportive treatment of patients with advanced gastric cancer.