The Discussion Of The Efficacy And Safety Of Two Types Of Gastrostomy In Advanced Tumor With Feeding Disorder

Objective:In order to meet the long-term nutritional needs of patients with various types of advanced tumor and feeding disorder,the efficacy and safety of introducer technical percutaneous endoscopic gastrostomy(Introducer-PEG)combined with esophageal dilation and gastrostomy surgery were discussed in these patients.Method:A retrospective analysis was performed on 18 patients,with various advanced tumor and feeding disorder,undergoing gastrostomy in the first affiliated hospital of suzhou university from May 2015 to March 2019.They were divided into Introducer-PEG group and gastrostomy surgery group.Introducer-PEG group has 9 patients,including 1 case of laryngeal cancer,1 case of cervical esophageal cancer,4 cases of thoracic esophageal cancer,2 cases of lung cancer with metastasis and 1 case of colorectal cancer with metastasis.Gastrostomy surgery group also has 9 patients,including 2 cases of nasopharyngeal cancer,2 cases of hypopharyngeal cancer,1 case of laryngeal cancer,2 cases of thoracic esophageal cancer and 2 cases of cardiac cancer.Blood routine,blood coagulation routine,chest X-ray,electrocardiogram and other examinations were completed in all patients to eliminate contraindications.Six patients of Introducer-PEG group with severe esophageal stenosis,the stenosis of esophagus were dilated carefully till ultrafine gastroscope could go through at first.Then they underwent introducer technical percutaneous endoscopic gastrostomy.The other three patients,with the stenosis barely passed through by the ultrafine gastroscope,underwent introducer technical percutaneous endoscopic gastrostomy directly.Eight Patients in gastrostomy surgery group underwent open gastrostomy surgery.The other one patient in gastrostomy surgery group underwent laparoscopic gastrostomy.All patients were monitored by ECG after the operation,and were treated by fasting,oxygen intake,acid inhibition and anti-infection.Attention was paid to the vital signs,fistula the presence of abdominal pain,hematemesis,abdominal tenderness or rebound pain and other symptoms or signs.Patients in Introducer-PEG group were given tube feeding after observed for 24 hours with stable vital signs.Patients in gastrostomy surgery group were given tube feeding after the recovery of exhaust and defecation with stable vital signs.The operation time,hospitalization time and postoperative open tube feeding time of the two groups were recorded,and intraoperative and postoperative complications were observed.All data were statistically tested.Results:The success rate of Introducer-PEG group and gastrostomy surgery group were all 100%.The operation time of Introducer-PEG group was(24.93 ± 5.83)min.The operation time of gastrostomy surgery group was(67.33±40.07)min.During and after the surgery,patients in Introducer-PEG group did not happeen the abdominal cavity viscera damage,the stoma complications such as infection,acute peritonitis and Introducer-PEG group had a 0%chance of complications.There were 4 patients in gastrostomy group having complications during and after surgery,including 1 case of intraoperative pharyngeal hemorrhage,1 case of postoperative tracheostomy tube prolapse,1 case of postoperative pulmonary infection,and 1 case of postoperative airway obstruction.Gastrostomy surgery group had a 44.44%chance of complications.The postoperative open tube feeding time in Introducer-PEG group was 1 day and it was(2.78±2.17)days in gastrostomy surgery group.Conclusions:Introducer-PEG is a safe and effective treatment.Compared with gastrostomy surgery,Introducer-PEG has shorter operation time,less complications and faster postoperative open tube feeding.At the same time,combined with esophageal dilation,the applicable population was further expanded and it still has the same safety and efficacy of Introducer-PEG,which is worthy of further clinical promotion.