소아에서 경피 내시경하 위루술의 임상적 고찰
Clinical Review of Percutaneous Endoscopic Gastrostomy (PEG) in Children
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목적: 경피 내시경하 위루술(percutaneous endoscopic gastrostomy, PEG)은 입으로 먹을 수 없는 환자에서 장기간 경장 영양을 하기에 가장 효과적인 방법으로 소아에서 시행한 PEG의 경험을 분석하였다. 대상 및 방법: 1995년 1월부터 2002년 7월까지 영남 지역 4개 병원에서 PEG를 하였던 환자들의 임상 소견에 대해 후향적 조사를 하였다. 결과: 총 23명의 환자에게 25회의 PEG를 시행하였다. 남아가 14명, 여아가 9명이었으며, 평균 연령은 5.7±4.1세였고, 2～6세가 약 절반을 차지하였다. 기저 질환은 근 질환 1예를 제외하고 모두 중추 신경계 질환이었다. 주된 적응증은 연하곤란과 동반된 합병증이었고, 83%에서 시술 전 장기간 비위관 영양을 하였다. PEG 시술 시 또는 유치 기간 중에 경미한 합병증들이 발생하였고, 창상 감염이 24%로 가장 많았다. PEG 유치 후 대부분의 환자에서 적절한 체중 증가가 있었다. 2/3 환자에서 6개월 이상 PEG를 유치하였고, 관을 교체한 경우는 2/3의 환자가 1년 뒤에 복벽에서 관을 견인하여 제거하였고, 나머지는 내시경을 통하여 올가미로 제거하였다. 결론: 소아에서 PEG는 간단하고 안전하며, 적절한 영양 공급을 보장할 수 있는 방법이다.
Abstract
Background/Aims: Percutaneous endoscopic gastrostomy (PEG) is a simple, safe and rapid method for the placement of a feeding gastrostomy tube and it is a well- established mean of providing enteral nutrition. Although it is frequently used in adults, there is limited experience for this procedure in children. Methods: Twenty five procedures of PEG in 23 patients were performed in four institutions located in Youngnam province. We retrospectively reviewed our experiences of PEG. Results: Fourteen males and nine females were included and their mean age was 5.7 4.1 years. The patients aged 1 to 6 years accounted for about a half the subjects. The underlying diseases of the patients were CNS disorders in all except one who was suffering with a neuromuscular disorder. The main reason for PEG was swallowing difficulty and the associated complications of the patients. Nasogastric tube feeding was the most common method of nutritional support before the procedures. The most common complication of PEG placement was wound infection. The patients' nutritional status after PEG placement was satisfactorily improved. The indwelling time of PEG tube was over 6 months in 2 of 3 patients and the tube was switched for a new one after a year. Removal of the tubes by using percutaneous traction was done in 2 of 3 patients. Conclusions: The PEG is a safe, easy to perform, and reliable technique to support enteral nutrition in children.
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