經皮內視鏡胃造口術在老年人腸道餵食的角色

The Role of Percutaneous Endoscopic Gastrostomy (PEG) in the Enteral Feeding of the Elderly

劉茂森(Maw-Sen Liu) ； 蒲秀瑾(Shou-Jin Pu)

《台灣老年醫學雜誌》 2卷2期 (2006/11) Pp. 82-91

https://doi.org/10.29462/TGG.200611.0003

摘要

經皮內視鏡胃造口術(percutaneous endoscopic gastrostomy, PEG)在1980年首先在小兒科肇始，被用來作爲取代傳統手術方式而創造一個可餵食的胃造口術，自此以後即被廣泛運用在需要長期腸道餵食的老年病患。其適應症主要是針對那些有中樞神經系統障礙、頭頸部腫瘤及臉部外傷造成持續性無法吞嚥或吞嚥障礙之病患。有大量腹水、食道完全阻塞、凝血機能障礙、菌血症、胃出口以下腸道阻塞的病人不可進行此項術式。此術式的常見併發症包括傷口感染、出血、滲漏、吸入性肺炎和瘻管。施行此項造口術，術前需和病患和照護者詳加討論可能的併發症、餵食的方式、術後傷口的照護、併發症的處理和長期追蹤的必要性。經皮內視鏡胃造口術所造成的併發症及死亡率和手術胃造口術大致一樣，然而其所需的費用較低，病人的接受度也較高。放置性經皮內視鏡胃造口術需慎重地評估和選擇適當的病人。經皮內視鏡胃造口術的術後長期照護是一項很重要的工作，一旦放置性經皮內視鏡胃造口術有良好的結果就可使病患和照護者願意接受此術式。

關鍵字

經皮內視鏡胃造口術 ； 老年人

並列摘要

Percutaneous Endoscopic Gastrostomy (PEG) had been first introduced in 1980 as an alternative to the traditional operative procedure to supply the enteral nutrition in children. Later, this newly procedure had further been adopted as a preferred approach for long-term enteral feeding in the elderly. The indications for PEG are usually the same as those for the traditional gastrostomy, including the inability to swallow secondary to chronic neurological impairment, oropharyngeal neoplasms and facial trauma. PEG is contraindicated in the presence of massive ascites, total esophageal obstruction, coagulation disorders and sepsis. Common complications of PEG include wound infection, leakage, hemorrhage, aspiration pneumonia and fistula. It is imperative to discuss with patients and their families regarding the risks and complications of this procedure and to advise them the importance of wound care and the necessity of long term follow-up. The morbidity and mortality of PEG is virtually equivalent to or better than those reported for the traditional operative techniques. In addition, PEG is considered better in terms of cost-effectiveness and patient acceptance. Guidelines for PEG placement include careful evaluation and selection of the appropriate patients with reasonable goals. Attentive long term care after the PEG replacement is mandatory. The acceptance of PEG placement by patients and their families tends to increase once favorable outcomes are offered.

並列關鍵字

Percutaneous Endoscopic Gastrostomy PEG ； elderly