肌萎缩侧索硬化患者经皮内镜下胃造瘘术后早期并发症及相关危险因素分析

doi:10.19723/j.issn.1671-167X.2026.01.025

摘要/Abstract

摘要：

目的: 探讨肌萎缩侧索硬化(amyotrophic lateral sclerosis，ALS)患者经皮内镜下胃造瘘术(percutaneous endoscopic gastrostomy，PEG)后发生早期并发症(≤14 d)的临床特征及危险因素。方法: 连续纳入2011年1月至2020年12月在北京大学第三医院首次行PEG的ALS患者，回顾性分析患者的临床资料，明确早期(≤14 d)并发症的发生情况，根据有无并发症以及并发症严重程度进行分组，采用SPSS 27.0统计软件进行数据分析，最终应用多变量Logistic回归模型系统评估早期并发症发生的独立危险因素。结果: 192例PEG均成功完成。97例(51%)男性，ALS发病的平均年龄为(55±11)岁，93例(48%)为延髓起病型。PEG后14 d内40例(21%)发生并发症，均出现发热，16例无明确感染灶，18例呼吸道感染，6例造瘘口感染。13例患者(7%)被判定为严重并发症(11例呼吸道感染，2例造瘘口感染)，其中2例呼吸道感染并发呼吸衰竭死亡，余11例经升级抗生素抗感染后好转。未观察到营养管脱落、良性气腹、出血或包埋综合征等并发症。并发症组的手术时间和术后住院时间显著长于无并发症组[(16±5) min vs. (13±5) min，P＜0.001; 6 (5, 9) d vs. 5 (3, 7) d，P=0.009]。严重并发症亚组与轻度并发症亚组相比，肌酐和甘油三酯显著降低[(46.5±16.2) μmol/L vs.(66.8±16.4) μmol/L，P＜0.001；(1.1±0.5) mmol/L vs.(1.6±0.7) mmol/L，P=0.038]，手术时间显著延长[(20±5) min vs. (15±5) min，P=0.002]。Logistic回归模型分析显示，手术时间延长是并发症发生的独立危险因素(OR=1.132，95%CI: 1.051~1.220，P=0.001)。结论: PEG是ALS患者放置营养管的可靠方法，术后发热是最常见的早期并发症，手术时间延长是早期并发症(≤14 d)发生的独立危险因素。

关键词: 肌萎缩侧索硬化, 胃造瘘术, 统计因素分析, 并发症

Abstract:

Objective: To explore risk factors of early complications (≤14 days) and the clinical characteristics in patients with amyotrophic lateral sclerosis (ALS) after percutaneous endoscopic gastrostomy (PEG). Methods: Patients diagnosed with ALS who underwent first PEG insertion between January 2011 and December 2020 were eligible. Medical records were retrospectively reviewed to determine clinical characteristics and outcomes (≤14 days) of patients who underwent the pull type PEG. Grouping was performed based on the presence and severity of complications, and SPSS 27.0 statistical software was used for data analysis. Finally, Logistic regression model was applied for multivariate factor analysis of risk factors related to complications. Results: In the study, 192 cases of PEG were all successfully completed, with 97 (51%) males, mean age of ALS onset disease (55±11) years and 93 (48%) bulbar onset symptoms included. Complications occurred in 40 (21%) cases after PEG within 14 days, all of which had fever, including 16 cases without clear infection focus, 18 cases of respiratory tract infections, and 6 cases of fistula site infections. In the study, 13 (7%) cases had major complications, including 11 cases of respiratory tract infection and 2 cases of stoma infection. Two cases of respiratory tract infection died due to respiratory failure, and the remaining 11 cases recovered after upgraded antibiotic. No complications, such as tube dislodgement, benign pneumoperitoneum, hemorrhage or buried bumper syndrome occurred. The operation time and postoperative hospital stay were longer in the complication group than in the non-complication group [(16±5) min vs. (13±5) min, P < 0.001; 6 (5, 9) d vs. 5 (3, 7) d, P=0.009]. Compared with the mild complication group, the creatinine and triglyceride in the major complication group were significantly lower [(46.5±16.2) μmol/L vs.(66.8±16.4) μmol/L, P＜0.001; (1.1±0.5) mmol/L vs.(1.6±0.7) mmol/L, P=0.038], and the operation time was significantly longer [(20±5) min vs. (15±5) min, P=0.002]. Further, Logistic regression model analysis revealed that the operation time was also independent associated with complications (OR=1.132, 95%CI: 1.051-1.220, P=0.001). Conclusion: PEG was a reliable method for ALS patients to put nutrition tube. Postoperative fever was the most common complications. Long surgical duration was an independent risk factor for the occurrence of complications (≤14 d).

Key words: Amyotrophic lateral sclerosis, Gastrostomy, Factor analysis, statistical, Complications

中图分类号:

R744.8

田雪丽, 宋志强, 黄永辉, 姚炜. 肌萎缩侧索硬化患者经皮内镜下胃造瘘术后早期并发症及相关危险因素分析[J]. 北京大学学报（医学版）, 2026, 58(1): 190-195.

Xueli TIAN, Zhiqiang SONG, Yonghui HUANG, Wei YAO. Analysis of early complications and risk factors in patients with amyotrophic lateral sclerosis after percutaneous endoscopic gastrostomy[J]. Journal of Peking University (Health Sciences), 2026, 58(1): 190-195.

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Complications within 14 days	n
Minor complications
Post-operative fever (prophylactic antibiotics)	27
Without evident infection	16
Respiratory tract infection	7
Peristomal wound infection	4
Tube dislodgement	0
Benign pneumoperitoneum	0
Major complications
Post-operative fever (upgraded antibiotics))	13^a
Respiratory tract infection	11^a
Peristomal wound infection	2
Hemorrhage	0
Injury to internal organs	0
Buried bumper syndrome	0
Respiratory failure	2^a
Death	2^a

Items	Complication (n=46)	Non-complication (n=146)	Statistics (χ²/t/z)	P
Male, n (%)	25 (54)	72 (49)	0.354	0.552
Site of disease onset (bulbar), n (%)	21 (46)	72 (49)	0.188	0.665
Age at disease onset /years, $\bar x \pm s$	54±11	56±12	0.897	0.572
Diagnose delay/months, M (P₂₅, P₇₅)	12 (7, 18)	12 (6, 24)	－0.192	0.848
ALSFRS, $\bar x \pm s$	24±10	24±10	－0.247	0.805
Interval from disease onset to PEG/months, M (P₂₅, P₇₅)	25 (17, 39)	26 (18, 40)	－0.329	0.742
Laboratory data, $\bar x \pm s$
Albumin/(g/L)	41.5±4.1	41.2±3.2	0.512	0.610
Creatinine/(μmol/L)	61.0±18.6	60.0±18.0	0.327	0.744
Sodium/(mmol/L)	140.5±2.4	139.9±8.9	0.388	0.698
Potassium/(mmol/L)	3.8±0.3	3.9±0.3	－1.247	0.214
Triglyceride/(mmol/L)	1.5±0.7	1.3±0.6	1.442	0.223
Transnasal gastroscopy, n (%)	34 (73)	107 (73)	0.007	0.933
Operation time/min, $\bar x \pm s$	16±5	13±5	3.606	0.000
Hospital days, M(P₂₅, P₇₅)	6 (5, 9)	5 (3, 7)	2.692	0.009

Items	Minor complication (n=33)	Major complication (n=13)	Statistics (χ²/t/z)	P
Male, n (%)	20 (61)	5 (39)	1.843	0.175
Site of disease onset (bulbar), n (%)	18 (55)	3 (23)	3.722	0.054
Age at disease onset/years，$\bar x \pm s$	56±12	51±10	1.368	0.178
Diagnose delay (months), M (P₂₅, P₇₅)	12 (9, 20)	11 (5, 18)	-0.880	0.379
ALSFRS，$\bar x \pm s$	25±10	23±11	0.438	0.664
Interval from disease onset to PEG/months, M (P₂₅, P₇₅)	25 (15, 35)	25(19, 65)	－1.000	0.317
Laboratory data, $\bar x \pm s$
Albumin/(g/L)	42.2±3.3	39.6±5.4	1.915	0.062
Creatinine/(μmol/L)	66.8±16.4	46.5±16.2	3.788	0.000
Sodium/(mmol/L)	140.7±2.6	139.9±1.7	1.004	0.321
Potassium/(mmol/L)	3.8±0.3	3.9±0.4	－0.889	0.379
Triglyceride/(mmol/L)	1.6±0.7	1.1±0.5	2.148	0.038
Transnasal gastroscopy, n (%)	24 (73)	10 (77)	N/A	>0.999
Operation time/min, $\bar x \pm s$	15±5	20±5	－3.336	0.002
Hospital days, M(P₂₅, P₇₅)	6 (5, 8)	5 (4, 14)	－0.841	0.400

Predictors	OR	95%CI	P
Site of disease onset	0.889	0.406－1.946	0.769
Albumin	1.020	0.907－1.146	0.743
Creatinine	0.727	0.975－1.018	0.727
Triglyceride	1.453	0.834－2.532	0.187
Operation time	1.132	1.051－1.220	0.001