介入微课堂│经皮透视下胃造瘘术在渐冻人中的应用

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介入微课堂│经皮透视下胃造瘘术在渐冻人中的应用

作者：曹军

                                                                                                   

什么是渐冻人？

肌萎缩侧索硬化症即通常所说“渐冻人”，简称ALS。人体的所有活动包括运动、说话、吞咽及呼吸肌活动都是由运动神经细胞支配。“渐冻人”患者由于脑和脊髓中运动神经细胞发生进行性退化，肌肉逐渐萎缩和无力，以至瘫痪，身体如同被逐渐冻住一样。

渐冻人进食特点

出现进行性吞咽困难，吃饭非常慢，很易发生呛咳和窒息，卡路里的摄入逐渐落后于消耗，身体消瘦。常常呼吸功能不好，需要呼吸机支持治疗。口水较多，无法吞咽易导致窒息。

怎么样解决渐冻人进食问题

1876年，Vemeui在法国成功实施第1例外科手术胃造瘘术。外科手术胃造瘘术广泛地运用于因各种原因需要长期进行肠内营养输注或进行胃肠减压治疗的患者。

经皮透视下胃造瘘术(PRG)首次于1981年由Preshaw应用于临床。大部分PRG在透视引导下进行，也有部分通过CT引导下完成。经皮透视下胃造瘘术(PRG)为X线引导,无需胃镜，简单方便，能够准确判断胃结肠的关系，避免胃结肠瘘，而所用器材为导管5F，可在导丝引导下进入，比胃镜耐受好，也无需静脉镇静，减少吸入性肺炎，降低了肺功能差的ALS患者的经皮胃造瘘术的误吸风险，提高了手术成功率和安全性，是保证肺功能不全的ALS患者足够的能量摄入、改善患者营养状况的有效手段之一。

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猴哥

谢谢曹主任百忙之中发帖科普

不忘初_Q1lZs

如果再发个手术过程图解就更直观了，还是非常感谢能让家属多一些知识。