胃幽門側切除後の患者に対する経皮内視鏡的胃ろう造設術の工夫

• 篠田 政幸

  芳賀赤十字病院外科

• 五味 玲

  芳賀赤十字病院外科 自治医科大学脳神経外科

• 木下 貴之

  芳賀赤十字病院外科 慶應義塾大学外科学教室

• 深瀬 達

  芳賀赤十字病院外科

• 小島 正夫

  芳賀赤十字病院内科

• 荻原 智信

  芳賀赤十字病院内科

• 種ヶ島 和洋

  芳賀赤十字病院内科

• 井端 由紀郎

  芳賀赤十字病院脳外科

書誌事項

タイトル別名

• Percutaneous Endoscopic Gastrostomy in Patients with Previous Distal Gastrectomy. Combined Baloon and Guide Wire Techniques Using a Modified Coaxial Trocar Introducer.

抄録

Percutaneous endoscopic gastrostomy (PEG) was performed on four patients with previous distal gastrectomy. Previous diseases were gastric cancer in two patients, gastric ulcer in one and duodenal ulcer in one. Three patients had Billroth I reconstruction and one had Billroth II. In the first two patients, visualization of the transverse colon with contrast material and ultrasound scanning of the major hepatic pedicles in the overlying liver were initially done. Then, avoiding these structures, the gastric remnant was carefully punctured with a 22-gauge needle. A 14 French trocar introducer with a peel-away sheath in a commercially available PEG kit (Create Medic Co.) was inserted just beside the initial puncture needle. Finally a 12 Fr. balloon catheter was indwelled. In the remaining two patients, we made some modifications. We inserted a long intestinal tube to the duodenal or jejunal loop and inflated a balloon to occlude the gastric outlet in order to obtain good endoscopic insufflation. An 18G needle was inserted into the gastric remnant with radiographic and sonographic aid. To hold the safe tract made by the pilot puncture, we used a guide wire and a coaxial trocar introducer that we had modified because the original trocar in the PEG kit was not coaxial. One patient in the first series developed a high fever, pleural effusion and disseminated intravascular coagulation : however, recovery occurred in two weeks. The other patients had no complications. Feeding from PEG was possible in all four cases. PEG is allegedly better than nasal intubation for long-term tube feeding. This is true not only for patients with an intact stomach but also for those with a gastric remnant. We believe our methods provide a safer way of applying PEG to a gastric remnant.

収録刊行物

• 日本消化器内視鏡学会雑誌

  日本消化器内視鏡学会雑誌 34 (11), 2655-2660, 1992

  一般社団法人 日本消化器内視鏡学会

詳細情報

• CRID: 1390001204214565888
• NII論文ID: 130004089526
• DOI: 10.11280/gee1973b.34.2655
• ISSN: 18845738
• ISSN: 03871207
• 本文言語コード: ja
• データソース種別:
  • JaLC
  • CiNii Articles
• 抄録ライセンスフラグ: 使用不可