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Endoskopie heute 2007; 20(2): 129-134
DOI: 10.1055/s-2007-981181
Originalarbeit

© Georg Thieme Verlag Stuttgart · New York

Postoperative Komplikationen von transoraler Durchzugs-PEG und Direktpunktions-PEG bei Patienten mit Kopf-Hals-Tumoren

Postoperative Complications in Head and Neck Cancer Patients using the Pull-Through or Push-Through Technique of Percutaneous Endoscopic GastrostomyC. Barth1 , B. A. Stuck1 , K. Hörmann1 , A. Blum1
  • 1HNO-Universitätsklinik Mannheim, Ruprecht-Karls-Universität Heidelberg
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Publication History

Publication Date:
03 July 2007 (online)

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Zusammenfassung

Einleitung: Dysphagie und konsekutive Mangelernährung stellen bei Patienten mit Kopf-Hals-Karzinomen im Verlauf der Erkrankung häufig ein therapeutisches Problem dar, wobei insbesondere der Mangelernährung eine für den Ausgang der Erkrankung prognostische Bedeutung zukommt. Ziel dieser retrospektiven Studie war es, die Komplikationsraten des transoralen Durchzugs- (TD) und des Direktpunktionsverfahrens (DP) einer perkutanen endoskopischen Gastrostomie (PEG) zu vergleichen. Materialien und Methoden: Beide Verfahren wurden mit jeweils 30 Patienten gegenübergestellt. Untersucht wurden hierbei v. a. Patienten, die an fortgeschrittenen Karzinomen des Oro- / Hypopharynx, Larynx oder Ösophagus erkrankt waren. Ergebnisse: 48 Patienten erhielten eine PEG aufgrund pharyngealer, laryngealer und ösophagealer Tumoren mit bestehender Dysphagie. Diese Tumoren waren bei den TD-Patienten mit 83 % und in der DP-Gruppe mit 77 % vertreten. Neurogener Störungen und andere mit einer Dysphagie vergesellschafteten Erkrankungen machten in der TD- und DP-Gruppe jeweils 17 und 23 % der PEG-Indikationen aus. Leichte Komplikationen fanden sich in beiden Gruppen in je 23,3 % der Fälle. Schwere Komplikationen wurden in der TD-Gruppe mit 10 % verzeichnet. Ursache waren zwei Peritonitiden und eine Magenwandperforation. In der DP-Gruppe traten bei zwei Patienten Bauchwandabszesse auf (7 %). Ein Patient verstarb in der TD-Gruppe. Diskussion: Zusammenfassend zeigt die vorliegende Studie, dass in der Durchzugs-Gruppe entzündliche Komplikationen häufiger vertreten waren, wohingegen bei der Direktpunktion vermehrt Dislokationen auftraten. Schwerwiegende postoperative Komplikationen scheinen nach PEG-Anlage in der TD-Gruppe häufiger aufzutreten. Da aufgrund der niedrigen Inzidenzen schwerer postoperativer Komplikationen die Interpretation der Daten erschwert ist, sind zur weiteren vergleichenden Überprüfung der postoperativen Komplikationen der beiden vorgestellten PEG-Verfahren weiterführende prospektive Untersuchungen wünschenswert.

Abstract

Objective: Dysphagia and malnutrition are routinely associated with head and neck cancer. Especially malnutrition is of crucial interest in respect to the outcome in head and neck cancer patients. In this study we retrospectively compared the complication rate of two different methods of percutaneous endoscopic gastrostomy (PEG), namely the pull method by Ponsky and Gauderer (TD) and the push method by Russel (DP). Material and Methods: Each method included 30 patients. The majority of the cases (48 patients) suffered from dysphagia due to oro- / hypopharyngeal, laryngeal or esophageal cancer. Results: 83 % of the patients of the TD-group and 77 % of the DP-group presented carcinomas of the oro- / hypopharynx, larynx and esophagus. Further indications for PEG placement were neurological dysphagia and others, found in 17 % of the TD-group and 23 % of the DP-group respectively. In both groups minor complications occurred in 23.3 % of the cases. Major complications were found in 10 % of the TD-group due to 2 cases of peritonitis and one gastric perforation. Abscesses of the abdominal wall occurred in 2 patients (7 %) of the DP-group. One patient died in the TD-group. Conclusion: The pull method was more often associated with infectious complications whereas dislocations occurred more frequently with the push method. Major postoperative complications seem to occur more frequently with the pull method. Due to the low incidence of severe complications, the interpretation of the results is limited. Therefore further prospective studies comparing the complications of both methods are required.

Schlüsselwörter

perkutane endoskopische Gastrostomie - Durchzugs- und Direktpunktionsverfahren - Kopf-Hals-Tumoren

Key words

percutaneous endoscopic gastrostomy - push and pull method - head and neck cancer

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Dr. med. C. Barth

Universitäts-HNO-Klinik Mannheim

Theodor-Kutzer-Ufer 1-3

68167 Mannheim

Email: christine.barth@hno.ma.uni-heidelberg.de

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