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目的:探讨经皮内镜下胃造口空肠置管术(PEJ)和鼻肠管置管在晚期上消化道恶性肿瘤病人家庭肠内营养(HEN)的应用效果。方法:回顾分析2009年1月至2013年1月,我科收治的未接受剖腹手术的105例病人,其中48例接受PEJ,57例鼻肠管置管晚期上消化道恶性肿瘤病人开展HEN情况,病人每2个月到我科或电话随访1次,直至出院后6个月或病人死亡。比较两种置管方式在HEN中的应用、并发症发生率和病死率等情况。结果:病人出院后6个月内,PEJ组EN支持率明显高于鼻肠管组(95.8%vs 78.9%,P<0.05)。PEJ组的EN相关并发症发生率明显低于鼻肠管组(22.9%vs 45.6%,P<0.05)。PEJ组的管道相关并发症发生率明显低于鼻肠管组(6.3%vs 21.1%,P<0.01)。而出院后2、4和6个月时两组病人的功能状态评分和病死率均无显著性差异(P>0.05)。结论:PEJ是晚期上消化道恶性肿瘤病人开展HEN的有效途径。
Objective: To investigate the effect of percutaneous endoscopic gastrointestinal jejunostomy (PEJ) and nasal tube placement on home enteral nutrition (HEN) in patients with advanced upper gastrointestinal malignancies. Methods: From January 2009 to January 2013, 105 patients who underwent laparotomy in our department were retrospectively analyzed. Among them, 48 patients underwent PEJ and 57 patients with advanced upper gastrointestinal cancer who underwent nasogastric tube implantation for HEN. The patients were followed up every 2 months in our department or on the telephone until 6 months after discharge or the patient died. Compare the application of two kinds of catheterization in HEN, the incidence of complications and mortality and so on. Results: Within 6 months after discharge, EN support rate in PEJ group was significantly higher than that in nasal tube group (95.8% vs 78.9%, P <0.05). The incidence of EN related complication in PEJ group was significantly lower than that in nasal tube group (22.9% vs 45.6%, P <0.05). The incidence of pipeline-related complications in the PEJ group was significantly lower than that in the nasal tube group (6.3% vs 21.1%, P <0.01). There were no significant differences in functional status score and case fatality rate between the two groups at 2, 4 and 6 months after discharge (P> 0.05). Conclusion: PEJ is an effective way to carry out HEN in patients with advanced upper gastrointestinal cancer.