周雪强

[摘要] 目的 探討胃镜引导下经胃放置鼻胃肠营养管在食管恶性狭窄中的应用的优势，为基层医院采用普通胃镜完成经胃放置鼻胃肠营养管提供经验。 方法 选取2012年1月～2016年12月我院收治的30例食管恶性狭窄患者，采用经胃镜引导下鼻胃肠营养管置入（A组）；选取2007年10月～2011年11月我院30例食管恶性狭窄患者，采用盲插法鼻胃肠营养管置入（B组），采集记录两组一次性置管成功率、平均置管操作时间、置管成功率、置管深度。术后随访1个月，记录有无恶心呕吐、咽部不适、心率增快、反流等近期并发症。 结果 A组30例均一次性置管成功，成功率100%。B组有22例一次性置管成功，成功率73.3%，差异有统计学意义（P<0.05）。A组平均操作时间明显低于B组，差异有统计学意义（P<0.05）。A组平均置管深度，明显高于B组，差异有统计学意义（P<0.05）；A组30例患者术后恶心呕吐、咽部不适、心率增快等发生情况明显低于对照组，且比较差异均有统计学意义（P<0.05）。 结论 胃镜引导下经胃放置鼻胃肠营养管在食管恶性狭窄中效果显著，并发症少，可在基层医院有推广价值。

[关键词] 胃镜；食管恶性狭窄；肠营养管；胃管

[中图分类号] R459.3 [文献标识码] A [文章编号] 2095-0616（2017）11-248-03

Application of gastrointestinal - guided nasal gastrointestinal nutrient tube in esophageal malignant stenosis

ZHOU Xueqiang

Department of Internal Medicine，Pengpai Memorial Hospital of Haifeng，Haifeng 516400，China

[Abstract] Objective To explore the advantages of gastrectomy for nasogastric nutrition tube in esophageal malignant stenosis guided by endoscopy，and to provide experience for the placement of nasogastric nutrition tube through gastric gastrectomy in primary hospital. Methods 30 patients with malignant esophageal stenosis from January 2012 to December 2016 were enrolled in this study.The patients were treated with endoscopic sinus feeding （group A）.30 patients with malignant esophageal stenosis from October 2007 to November 2011 were selected and treated with blind insertion nasogastric enteral tube implantation （group B）.The one-time catheterization success rate，the average catheter operation time，catheter success rate，catheter depth of the two groups were collected.The patients were followed up for 1 month.Recent complications such as nausea，vomiting， pharyngeal discomfort，rapid heart rate，and regurgitation were recorded. Results In group A，30 cases were successfully managed by single catheterization，with a success rate of 100%.In group B，22 cases were successfully treated with disposable catheter， the success rate was 73.3%，the difference was statistically significant （P<0.05）.The average operation time of group A were significantly lower than those of groscomfort and heart rate increase in group A were significantly lower than those in group B （P<0.05），and the difference was statistically significant （P<0.05） Control group，and the difference was statistically significant （P<0.05）. Conclusion Gastrointestinal-guided nasogastric nutrition tube is effective in esophageal malignant stenosis guided by eup B，and the difference was statistically significant （P<0.05）.The incidence of nausea and vomiting，pharyngeal dindoscopy，and there are few complications，which can be used in primary hospital.

[Key words] Endoscopy；Esophageal malignant stenosis；Enteral nutrient tube；Stomach tube

食管癌向腔内生长易造成食管狭窄，导致患者吞咽困难，甚至出现进食后呕吐，严重影响患者的生活质量[1]。鼻饲营养是食管、贲门恶性狭窄患者的主要治疗方法之一，也是临终关怀的重要内容，没有经济能力或不能耐受狭窄扩张、支架放置的患者，鼻饲营养是营养支持的首选途径[2-5]。随着内镜技术的发展，内镜外径逐渐变细，直径已经由普通胃镜的10～13mm缩小到超细胃镜的不足。我院自2012年1月～2016年12月对30例食管、贲门狭窄患者进行了胃镜引导下经胃放置鼻胃肠营养管治疗，现报道如下。

1 资料与方法

1.1 一般资料

选取2012年1月～2016年12月我院收治的30例食管恶性狭窄患者设为A组，其中，男25例、女5例，年龄57～88岁，平均71.7岁，食管上段狭窄3例、中下段狭窄23例、贲门狭窄4例；……