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目的评价X线下经皮胃造瘘术(PRG)在51例肌萎缩侧索硬化症(ALS)吞咽困难患者中的临床应用,评估PRG对肺功能不全ALS患者的安全性及营养状况的改善作用。方法回顾性分析51例行PRG手术的ALS患者。记录手术成功率,观察术后并发症情况。术后对患者进行定期随访,记录患者长期并发症及术后1、3、6个月病死率,评估术后营养状况的改变。结果为51例ALS患者行PRG手术,手术成功率100%。7例患者(13.7%)出现轻微并发症,出现1例(2.0%)大出血严重并发症,术后未发现患者呼吸功能受损情况。术后1、3个月无患者死亡,术后6个月死亡3例(6.8%,3/44)。术后1个月31例患者体重增加超过1 kg,平均BMI从术前18.60±2.14增加到19.27±1.81(术后1个月)、19.17±1.93(术后3个月)和18.89±2.33(术后6个月)。结论 PRG无需胃镜和麻醉,降低了肺功能差的ALS患者的经皮胃造瘘术的误吸窒息风险,提高了手术成功率和安全性,是保证肺功能不全ALS患者足够的能量摄入、改善患者营养状况的有效手段之一。
Objective To evaluate the clinical application of percutaneous gastrostomy (PRG) in 51 patients with amyotrophic lateral sclerosis (ALS) dysphagia under X-ray and to evaluate the safety and nutritional status of PRG in ALS patients with pulmonary insufficiency effect. Methods Retrospective analysis of 51 patients with ALS undergoing PRG surgery. Record the success rate of surgery and observe the postoperative complications. Patients were followed up regularly to record long-term complications and 1,3,6 months postoperative mortality, to assess the nutritional status of postoperative changes. The results of 51 cases of ALS patients underwent PRG surgery, the success rate of 100%. Seven patients (13.7%) had minor complication and one (2.0%) had severe complications of hemorrhage. No postoperative respiratory dysfunction was found. No patient died at 1 month and 3 months after operation, and 3 patients died at 6 months after operation (6.8%, 3/44). The average BMI increased from 18.60 ± 2.14 to 19.27 ± 1.81 (one month after surgery), 19.17 ± 1.93 (three months after surgery) and 18.89 ± 2.33 (one month after surgery) 6 months after surgery). Conclusions PRG does not require endoscopy and anesthesia and reduces the risk of aspiration and asphyxia of percutaneous gastrostomy in ALS patients with poor lung function and improves the success rate and safety of operation. It is enough energy intake to ensure ALS patients with pulmonary insufficiency, One of the effective ways to improve the nutritional status of patients.