背景:经皮内镜胃造瘘术(PEG)和腹腔镜插入胃造瘘术已成为成人患者和儿童的金标准,分别,需要长期肠内营养支持。手术相关的死亡是一种罕见的事件,在较小的研究中经常报告为零。文献中缺乏关于胃造口术后30天死亡率和长期生存率的国家数据。
目的:研究1998-2019年瑞典胃造口术的使用情况,并分析手术相关死亡率以及短期(<30d)和长期生存率。
方法:在本回顾性研究中,基于人群的队列研究,纳入了1998-2019年间在瑞典接受过胃造口术的患者.在瑞典国家患者登记册中确定了个人,和生存分析是可能的,通过交叉引用瑞典死亡登记册。该队列分为三个年龄组:儿童(0-18岁);成人(19-64岁);和老年人(≥65岁)。采用Kaplan-Meier对数秩检验和Cox回归进行生存分析。
结果:总共48682个人(52%的男性,平均年龄60.9±25.3岁)。该队列由12.0%的儿童组成,29.5%的成年人,58.5%的老年人。在研究期间观察到胃造口术的使用增加,从13.7/100000到22.3/100000个体(P<0.001)。PEG的使用量增加了一倍以上(约800至1800/年),开放胃造口术相应减少(约700至340/年)。腹腔镜胃造口术增加10倍以上(约20~240例/年)。总的来说,PEG,开放式胃造口术,腹腔镜胃造口术占70.0%(n=34060),23.3%(n=11336),4.9%(n=2404),分别。手术相关死亡率为0.1%(n=44)(PEG:0.05%,开放:0.24%,腹腔镜:0.04%)。总体30天死亡率为10.0%(PEG:9.8%,开放:12.4%,腹腔镜:1.7%),从1998-2009年的11.6%下降到2010-2019年的8.5%(P<0.001)。儿童一年和十年生存率,成年人,老年人占93.7%,67.5%,和42.1%和79.9%,39.2%,和6.8%,分别。最常见的死亡原因是恶性肿瘤以及心血管和呼吸系统疾病。
结论:在研究期间,瑞典每年使用胃造口术的人数有所增加,转向更微创的手术。尽管与手术相关的死亡很少见,总体30d死亡率较高(10%).为了克服这一点,我们认为应该改进病人的选择.
BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) and laparoscopically inserted gastrostomy have become the gold standard for adult patients and children, respectively, requiring long-term enteral nutrition support. Procedure-related mortality is a rare event, often reported to be zero in smaller studies. National data on 30-d mortality and long-term survival rates after gastrostomy placement are scarce in the literature.
OBJECTIVE: To study the use of gastrostomies in Sweden from 1998-2019 and to analyze procedure-related mortality and short-term (< 30 d) and long-term survival.
METHODS: In this retrospective, population-based cohort study, individuals that had received a gastrostomy between 1998-2019 in Sweden were included. Individuals were identified in the Swedish National Patient Register, and survival analysis was possible by cross-referencing the Swedish Death Register. The cohort was divided into three age groups: Children (0-18 years); adults (19-64 years); and elderly (≥ 65 years). Kaplan-Meier with log-rank test and Cox regression were used for survival analysis.
RESULTS: In total 48682 individuals (52% males, average age 60.9 ± 25.3 years) were identified. The cohort consisted of 12.0% children, 29.5% adults, and 58.5% elderly. An increased use of gastrostomies was observed during the study period, from 13.7/100000 to 22.3/100000 individuals (P < 0.001). The use of PEG more than doubled (about 800 to 1800/year), with a corresponding decrease in open gastrostomy (about 700 to 340/year). Laparoscopic gastrostomy increased more than ten-fold (about 20 to 240/year). Overall, PEG, open gastrostomy, and laparoscopic gastrostomy constituted 70.0% (n = 34060), 23.3% (n = 11336), and 4.9% (n = 2404), respectively. Procedure-related mortality was 0.1% (n = 44) overall (PEG: 0.05%, open: 0.24%, laparoscopic: 0.04%). The overall 30-d mortality rate was 10.0% (PEG: 9.8%, open: 12.4%, laparoscopic: 1.7%) and decreased from 11.6% in 1998-2009 vs 8.5% in 2010-2019 (P < 0.001). One-year and ten-year survival rates for children, adults, and elderly were 93.7%, 67.5%, and 42.1% and 79.9%, 39.2%, and 6.8%, respectively. The most common causes of death were malignancies and cardiovascular and respiratory diseases.
CONCLUSIONS: The annual use of gastrostomies in Sweden increased during the study period, with a shift towards more minimally invasive procedures. Although procedure-related death was rare, the overall 30-d mortality rate was high (10%). To overcome this, we believe that patient selection should be improved.