全球精选文摘 - X线下与内镜下经皮胃造瘘术用于肌萎缩侧索硬化症患者的治疗：耐受性、疗效及生存期多因素分析

Radiologic versus Endoscopic Placement of Percutaneous Gastrostomy in Amyotrophic Lateral Sclerosis: Multivariate Analysis of Tolerance, Efficacy, and Survival

Blondet A, Lebigot J, Nicolas G 2010/7/9 14:05:06

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J Vasc Interv Radiol, 2010,

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Purpose:
To compare percutaneous radiologic gastrostomy (PRG) and percutaneous endoscopic gastrostomy (PEG) in terms of tolerance, efficacy, and survival in patients with amyotrophic lateral sclerosis (ALS).

Materials and Methods:
Forty patients with ALS (17 men; mean age, 66.1 years; range, 39–83y) underwent 21 PEG and 22 PRG attempts (including three unsuccessful PEG attempts) from 1999 to 2005. To assess tolerance and efficacy, a successful and well tolerated placement was defined as any successful placement with no major or minor local complications or pain requiring opioid analgesic agents. Univariate analysis was performed for all recorded parameters, followed by multivariate analysis for successful and well tolerated placement, 6-month mortality rate, and survival.

Results:
General success rates were 85.7% for PEG and 100% for PRG. Pain was more frequent in PRGs (81.8% vs 52.4%; P=.05). Successful and well tolerated placement was seen in 81.8% of PRGs and 57.1% of PEGs (P=0.1). Advanced age (P=.02) and PRG (P=.07) were predictive of successful and well tolerated placement. The interval from diagnosis to placement (P=.001) and ability to perform spirometry (P=.002) were predictive of survival. Oximetry measurements (P=.007) and interval from diagnosis to placement (P=.02) were predictive of mortality at 6 months.

Conclusions:
PRG is more efficacious and better tolerated than PEG, essentially because it avoids the respiratory decompensation that may occur in PEG. Therefore, PRG should be preferred in cases of ALS. Survival is linked to ALS evolution and not to the choice of PRG or PEG placement.

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高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
卒中	肺癌
冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭	心律失常

病例分析 [栏目介绍]

甲状腺功能亢进合并黄疸

王燕燕王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。

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