经皮内镜下胃/肠造瘘营养治疗途径
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摘要
PEG近年来在国内发展较快,日益受到临床医师的重视。ESPEN将PEG作为放疗患者肠内营养的首选途径,并在2006年的肿瘤肠内营养指南中加以推荐。临床实践已证明,通过PEG途径可以使晚期头颈部肿瘤的患者得到营养治疗,停止并逆转体重丢失。PEJ基于PEG发展而来,当患者存在胃或食管反流、幽门或十二指肠不全梗阻、胃或残胃有排空障碍时,更适宜采用PEJ途径。目前对于PEG和PEJ的比较尚没有较高等级的RCT能证实。PEJ在临床上的使用与PEG相类似,PEJ的选择应考虑患者是否存在PEG的禁忌证而适合使用PEJ。
PEG was developed rapidly in recent years, attracted the attention of the clinicians. ESPEN regarded PEG as the preferred way of radiotherapy in patients with enteral nutrition, and it was recommend in the 2006 tumor enteral nutrition guidelines. Clinical practice had proved that advanced head and neck cancer patients could get nutritional treatment through PEG, stoping and reversing weight loss. PEJ was developed based on the PEG, PEJ was more suitable for patients with gastric/esophageal reflux, incomplete pyloric/duodenal obstruction and delayed gastric emptying. There was not high level of RCT comparing PEG with PEJ until now. The usage of PEJ was similar as PEG, the choice of PEJ should considered whether the patients was contraindicated for PEG.
PEG was developed rapidly in recent years, attracted the attention of the clinicians. ESPEN regarded PEG as the preferred way of radiotherapy in patients with enteral nutrition, and it was recommend in the 2006 tumor enteral nutrition guidelines. Clinical practice had proved that advanced head and neck cancer patients could get nutritional treatment through PEG, stoping and reversing weight loss. PEJ was developed based on the PEG, PEJ was more suitable for patients with gastric/esophageal reflux, incomplete pyloric/duodenal obstruction and delayed gastric emptying. There was not high level of RCT comparing PEG with PEJ until now. The usage of PEJ was similar as PEG, the choice of PEJ should considered whether the patients was contraindicated for PEG.
引文
1.Gauderer MW,Ponsky JL,Izant RJ Jr.Gastrostomy without laparotomy:a percutaneous endoscopic technique.J Pediatr Surg.1980;15(6):872-875.
2 .蒋朱明.临床诊疗指南:肠外肠内营养学分册(2008版).北京:人民卫生出版社,2009.Jiang ZM.Clinical practice guidelines:enteral nutrition and parenteral nutrition(2008).Beijing:People's Medical Publishing House,2009.
3 蒋朱明,吴蔚然.肠内营养.2版.北京:人民卫生出版社,2002.Jiang ZM,Wu WR.Enteral nutrition(second).Beijing:People's Medical Publishing House,2002.
4 Arends J,Bodoky G,Bozzetti F,et al.ESPEN guidelines on enteral nutrition:non-surgical oncology.Clin Nutr.2006;25(2):245-259.
5 Campos AC,Butters M,Meguid MM.Home enteral nutrition via gastrostomy in advanced head and neck cancer patients.Head Neck.1990;12(2):137-142.
6 Ohrn KE,Wahlin YB,Sj?dén PO.Oral status during radiotherapy and chemotherapy:a descriptive study of patient experiences and the occurrence of oral complications.Support Care Cancer.2001;9(4):247-257.
7 Mekhail TM,Adelstein DJ,Rybicki LA,et al.Enteral nutrition during the treatment of head and neck carcinoma:is a percutaneous endoscopic gastrostomy tube preferable to a nasogastric tube?Cancer.2001;91(9):1785-1790.
8 Lees J.Nasogastric and percutaneous endoscopic gastrostomy feeding in head and neck cancer patients receiving radiotherapy treatment at a regional oncology unit:a two year study.Eur J Cancer Care.1997;6(1):45-49.
9 柏屏,彭南海.经皮内镜下胃造口在晚期癌性肠梗阻患者中的应用及护理.实用临床医药杂志.2005;9(6):11-12.Bo P,Peng NH.Application and nursing of percutaneous endoscopic gastrostomy of patients with adanced cancer ileus.J Clin Med Prac.2005;9(6):11-12.
10 江志伟,汪志明,李国立,等.经皮内镜下空肠造口术在恶性肿瘤治疗中的应用.中华外科杂志.2004;42(20):1273-1274.Jiang ZW,Wang ZM,Li GL,et al.Application of percutaneous endoscopic jejunostomy in treatment of malignant.Chin J Surg.2004;42(20):1273-1274.
2 .蒋朱明.临床诊疗指南:肠外肠内营养学分册(2008版).北京:人民卫生出版社,2009.Jiang ZM.Clinical practice guidelines:enteral nutrition and parenteral nutrition(2008).Beijing:People's Medical Publishing House,2009.
3 蒋朱明,吴蔚然.肠内营养.2版.北京:人民卫生出版社,2002.Jiang ZM,Wu WR.Enteral nutrition(second).Beijing:People's Medical Publishing House,2002.
4 Arends J,Bodoky G,Bozzetti F,et al.ESPEN guidelines on enteral nutrition:non-surgical oncology.Clin Nutr.2006;25(2):245-259.
5 Campos AC,Butters M,Meguid MM.Home enteral nutrition via gastrostomy in advanced head and neck cancer patients.Head Neck.1990;12(2):137-142.
6 Ohrn KE,Wahlin YB,Sj?dén PO.Oral status during radiotherapy and chemotherapy:a descriptive study of patient experiences and the occurrence of oral complications.Support Care Cancer.2001;9(4):247-257.
7 Mekhail TM,Adelstein DJ,Rybicki LA,et al.Enteral nutrition during the treatment of head and neck carcinoma:is a percutaneous endoscopic gastrostomy tube preferable to a nasogastric tube?Cancer.2001;91(9):1785-1790.
8 Lees J.Nasogastric and percutaneous endoscopic gastrostomy feeding in head and neck cancer patients receiving radiotherapy treatment at a regional oncology unit:a two year study.Eur J Cancer Care.1997;6(1):45-49.
9 柏屏,彭南海.经皮内镜下胃造口在晚期癌性肠梗阻患者中的应用及护理.实用临床医药杂志.2005;9(6):11-12.Bo P,Peng NH.Application and nursing of percutaneous endoscopic gastrostomy of patients with adanced cancer ileus.J Clin Med Prac.2005;9(6):11-12.
10 江志伟,汪志明,李国立,等.经皮内镜下空肠造口术在恶性肿瘤治疗中的应用.中华外科杂志.2004;42(20):1273-1274.Jiang ZW,Wang ZM,Li GL,et al.Application of percutaneous endoscopic jejunostomy in treatment of malignant.Chin J Surg.2004;42(20):1273-1274.