胃镜辅助放置鼻胃管和空肠营养管

目的:探讨胃镜下放置鼻胃管和空肠营养管建立肠内营养途径的方法.方法:11例鼻胃管,其中8例患者在胃镜下用异物钳钳夹鼻胃管推送胃镜将其送至胃腔,3例在胃镜下放入导丝,通过导丝放入鼻胃管.46例空肠营养管,在胃镜下用异物钳钳夹胃腔内空肠营养管,推送胃镜将其送至Treitz韧带以下.结果:胃镜下11例鼻胃管全部放置成功.通过改良胃镜直接置管方法,空肠营养管放置成功率例为100%,其中鼻肠管29例,三腔鼻肠管17例.鼻肠管弯曲,折回,打圈7例,后退鼻肠管头端重新放置成功,退出胃镜后鼻肠管脱出3例,改进方法后,2例2次,1例3次放置成功.1例胰腺炎置管后血淀粉酶增高.结论:对常规放置困难的鼻胃管,胃镜下放置简单可行.改良方法后可一次使空肠营养管头端到达空肠,此方法副作用小,成功率高,操作技术简单安全.

Endoscopically assisted nasogastri tube and nasojejunal tube placement

AIM:To investigate the path of enteral nutrition by endoscopic placement of nasogastric or nasojejunal tubes. METHODS:The nasogastric tubes were placed in the gastric cavity of 8 patients by pushing en- doscope after being clipped by foreign body for- ceps,and 3 patients by guide wire.Clipped by foreign body forceps,the nasojejunal tubes were placed in 46 patients by pushing endoscopy through the Treitz ligament. RESULTS:Nasogastric tubes placement were performed successfully in all the 11 patients. The success rate of nasojejunal tube placement was also 100% after using modified methods. Of the 46 cases,29 received nasointestinal tubes while 17 received triple-lumen tubes.Curvature, snaping-back and looping occurred in 7 cases, but the tubes were re-placed successfully after backing off.When the endoscope was retired,3 nasointestinal tubes dropped off.The placement was performed successfully with a modified method in 2 cases at the 2~(nd) time and 1 case at the 3rd time.There were no severe complications. The level of amylase rose in only 1 case after placement. CONCLUSION:Endoscopic placement of na- sogastric tubes is simple,feasible,and suitable for the patients difficult to be placed by routine method.The modified method can achieve one- time placement of nasointestinal tube under Treitz ligament with less side effect and high success rate.