背景:食管胃静脉曲张出血的球囊填塞是一种挽救生命但具有挑战性的手术。经常出现的一个困难是管在口咽中的盘绕。我们描述了一种新颖的使用bougie作为外部探针,以帮助引导气球的餐垫,以帮助克服这一挑战。
结论:我们描述了四个案例,其中Bougie成功地用作外部探针来放置填塞气球(3个明尼苏达管,1Sengstaken-Blakemore管)无任何明显并发症。将探条的直端插入胃抽吸端口的最近端大约0.5cm。然后使用探条在直接或视频喉镜可视化下将管插入食道中,以帮助将管作为外部探针“推动”到位。一旦胃球囊完全膨胀并撤回到胃食管连接处,轻轻取出bougie。
结论:当放置被证明对传统技术难以治疗时,可以考虑将填塞球囊放置于食管胃静脉曲张破裂出血的辅助方法。我们认为这可能是急诊医生程序库的一个有价值的工具。
Balloon tamponade of esophagogastric variceal hemorrhage is a lifesaving but challenging procedure. One difficulty that often arises is coiling of the tube in the oropharynx. We describe a novel use of the bougie as an external stylet to help guide placement of the balloon to help overcome this challenge.
We describe four cases in which the bougie was successfully utilized as an external stylet to place a tamponade balloon (3 Minnesota tubes, 1 Sengstaken-Blakemore tube) without any apparent complication. The straight end of the bougie is inserted approximately 0.5 cm into the most proximal of the gastric aspiration ports. The tube is then inserted into the esophagus under direct or video laryngoscopic visualization using the bougie to help \"push\" the tube into place as an external stylet. Once the gastric balloon is fully inflated and withdrawn to the gastroesophageal junction, the bougie is gently removed.
The bougie may be considered as an adjunct for placement of tamponade balloons for massive esophagogastric variceal hemorrhage when placement proves refractory to traditional techniques. We think this can be a valuable tool in the emergency physician\'s procedural repertoire.