摘要
背景对于无法经口进食的患者,胃造瘘的最佳应用技术一直存在争议,目前外科胃造瘘术在临床上已较少应用,而经皮内镜胃造瘘术(percutaneous endoscopic gastrostomy,PEG)和X线或CT引导下经皮穿刺胃造瘘术(percutaneous radiologic gastrostomy,PRG)应用较为广泛.目的系统评价经皮内镜胃造瘘术和X线或CT引导下经皮穿刺胃造瘘术的临床疗效.方法截止至2024-12,在PubMed、Embase、Cochrane Library、中国生物医学数据库、中国知网、万方、维普等数据库收集关于PEG和PRG对比的临床研究,对纳入的文献进行资料提取和质量评价后,采用RevMan5.3软件进行Meta分析.结果(1)共纳入16篇研究,总计2770例患者;(2)结果显示:PEG和PRG在置管成功率(95%CI:0.01-0.12,P<0.05)、瘘管堵塞或狭窄(95%CI:0.23-0.50,P<0.05)、30天死亡率(95%CI:0.42-0.95,P<0.05)差异有显著性意义;(3)但2种方法在瘘口感染(95%CI:0.53-1.10,P>0.05)、疼痛(95%CI:0.40-1.32,P>0.05)、腹膜炎(95%CI:0.36-3.94,P>0.05)方面差异无显著性意义.结论提示PRG组在置管成功率方面优于PEG组,PEG组术后瘘管堵塞或狭窄发生率、术后30 d死亡率较PRG组更低,但二者在瘘口感染、疼痛、腹膜炎方面没有统计学差异.
BACKGROUND The optimal technique for gastrostomy in patients with impaired oral intake remains controversial.While surgical gastrostomy has become less common in clinical practice,percutaneous endoscopic gastrostomy(PEG)and percutaneous radiologic gastrostomy(PRG)have emerged as the predominant techniques.AIM To systematically evaluate the clinical efficacy of PEG vs PRG.METHODS A comprehensive literature search was conducted in PubMed,Embase,Cochrane Library,CBM,CNKI,Wanfang,and VIP databases up to December 2024.Comparative clinical studies on PEG and PRG were included.Data extraction and quality assessment were performed,followed by Meta-analysis using RevMan 5.3 software.RESULTS Sixteen studies involving 2770 patients were included.Significant differences were observed in tube placement success rate(95%confidence interval[CI]:0.01-0.12,P<0.05),tube obstruction/stricture(95%CI:0.23-0.50,P<0.05),and 30-day mortality(95%CI:0.42-0.95,P<0.05),favoring PRG for procedural success and PEG for reduced tube-related complications and mortality.No statistical differences were found in stoma infection(95%CI:0.53-1.10,P>0.05),pain(95%CI:0.40-1.32,P>0.05),or peritonitis(95%CI:0.36-3.94,P>0.05).CONCLUSION The PRG group demonstrated superior catheterization success rates compared to the PEG group.However,the PEG group exhibited lower incidences of postoperative fistula obstruction/stenosis and lower 30-day postoperative mortality rates.No statistically significant differences were observed between the two groups in terms of stoma infection,pain,or peritonitis.
作者
胡云凯
贺博武
苏玉钢
陈永堂
茹清静
Yun-Kai Hu;Bo-Wu He;Yu-Gang Su;Yong-Tang Chen;Qing-Jing Ru(Department of Gastroenterology,Changxing County Hospital of Traditional Chinese Medicine,Huzhou 313100,Zhejiang Province,China;Liver Disease Center,The Second Affiliated College of Zhejiang Chinese Medical University,Hangzhou 310005,Zhejiang Province,China)
出处
《世界华人消化杂志》
2025年第5期412-422,共11页
World Chinese Journal of Digestology
基金
陈永堂全国基层名老中医药专家传承工作室,No.国中医药人教涵[2024]256号.
